I read with interest the article in the August 17 issue on short, temporary detentions making commitments more likely. New Hampshire has had a similar experience.
In New Hampshire, people hospitalized involuntarily due to being a danger to themselves or to others as a result of mental illness have two court hearings that may lead to longer-term hospitalization to treat their mental illness symptoms. The first hearing determines if there is probable cause for the initial involuntary admission and needs to be held within three business days, excluding Sundays and holidays. If the judge or hearings officer finds probable cause for the hospitalization, the patient could, under an older law, be hospitalized involuntarily for a maximum of 10 days. The second hearing is held (if necessary) to establish if a longer-term involuntary hospitalization is warranted.
New Hampshire legislation passed in 2010 extended the initial duration of involuntary emergency admissions from a maximum of 10 days to a potential maximum of 14 days.
All involuntary emergency admissions sent to two adult units over a one-year period from the start date of the implementation of the new law were assessed. Psychiatrists caring for these patients were queried on day 10 if, still subject to the old law, they would have filed a petition for a longer-term commitment. It was then determined whether these same individuals had such a petition filed on day 14 of their hospitalization.
In the year following the implementation of the new law, 1,098 patients were admitted on an involuntary emergency admission to two adult units. Psychiatrists said they would have filed 214 longer-term commitments on day 10. The total number of individuals for whom petitions were filed on day 14 was 117. While the study was open and nonblinded, a significant decrease in actual petitions filed was found. The probate court, which holds the longer-term involuntary commitment hearings, noted that there was an overall 8 percent decrease in long-term commitment hearings held the first year the new law came into effect. Finally, the average length of hospital stay of individuals admitted one year prior to and one year after the implementation of the new law did not change—it stayed at seven days.
The New Hampshire experience shows that, similar to Virginia’s, lengthening the initial involuntary admission time leads to a decrease in the rate of longer-term commitments. It also does not lead to a change in the average length of hospital stay. Decreasing the number of longer-term commitments may also decrease the number of petitions for emergency involuntary treatment as well as applications for guardianship.
ALEXANDER DE NESNERA, M.D. Concord, N.H.
