Patients Requesting Psychiatric Hospitalization

To the Editor: The study by William Gardner, Ph.D., et al. of changes in patients’ beliefs regarding their need for psychiatric hospitalization (1) provided interesting data on an understudied subject. The authors studied voluntary and involuntary psychiatric admissions in Virginia and Pennsylvania. The authors noted that for a patient to be committed, both states require individuals to be mentally ill and either dangerous to themselves or to others or unable to care for themselves. I am puzzled, however, by the authors’ statement that “Virginia permits commitment of individuals who are mentally ill if they are at risk of substantial deterioration” (p. 1386). I cannot find any such language in the statutes governing involuntary psychiatric hospitalization of adults in Virginia, nor could our hospital’s general counsel (Jean Reed, personal communication, Oct. 19, 1999). The closest language I could find is in the law pertaining to psychiatric admission by a parent of an objecting minor over the age of 14. Here the law allows admission either for danger to self or others or if the minor “is experiencing a serious deterioration of his ability to care for himself in a developmentally age-appropriate manner, as evidenced by delusionary thinking or by a significant impairment of functioning in hydration, nutrition, self-protection, or self-control” (Virginia Code §161.339). This only applies to minors over age 14 and does not seem substantially different from the adult criterion of “unable to care for themselves.” Can Dr. Gardner and colleagues clarify this point and provide a citation for their statement?