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Published Online: February 2013

Decisions to Initiate Involuntary Commitment: The Role of Intensive Community Services and Other Factors

Abstract

For individuals in crisis, involuntary psychiatric hospitalization can be lifesaving—but also life disrupting. In Virginia, decisions to initiate involuntary commitment are made by emergency evaluators employed by 40 community service boards. Data from more than 2,600 evaluations showed that a lack of intensive community-based alternatives to hospitalization, such as temporary housing and voluntary residential or short-term crisis stabilization, was a significant predictor of evaluators’ decisions to initiate commitment. The findings provide “a sound empirical basis” for investing in a continuum of crisis stabilization services, the authors note.

Abstract

Objective

This study examined the predictors of actions to initiate involuntary commitment of individuals experiencing a mental health crisis.

Methods

Emergency services clinicians throughout Virginia completed a questionnaire following each face-to-face evaluation of individuals experiencing a mental health crisis. Over a one-month period in 2007, a total of 2,624 adults were evaluated. Logistic hierarchical multiple regression was used to analyze the relationship between demographic, clinical, and service-related variables and outcomes of the emergency evaluations.

Results

Several factors predicted 84% of the actions taken to initiate involuntary commitment. These included unavailability of alternatives to hospitalization, such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment; and clinical factors related to the commitment criteria, including risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence.

Conclusions

A lack of intensive community-based treatment and support in lieu of hospitalization accounted for a significant portion of variance in actions to initiate involuntary commitment. Comprehensive community services and supports for individuals experiencing mental health crises may reduce the rate of involuntary hospitalization. There is a need to enrich intensive community mental health services and supports and to evaluate the impact of these enhancements on the frequency of involuntary mental health interventions.

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Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Cover: Tommy, by Mitchell Siporin, 1943. Gouache, 9 × 7 inches. Courtesy of the estate of the artist and the Susan Teller Gallery, New York City.
Psychiatric Services
Pages: 120 - 126
PubMed: 23475404

History

Published in print: February 2013
Published online: 15 October 2014

Authors

Details

Elizabeth Lloyd McGarvey, Ed.D.
Dr. McGarvey, Ms. Leon-Verdin, and Dr. Wanchek are affiliated with the Department of Public Health Sciences and Dr. Bonnie is with the School of Law, all at the University of Virginia, P.O. Box 800717, Charlottesville, VA 22903 (e-mail: [email protected]).
MaGuadalupe Leon-Verdin, M.S.
Dr. McGarvey, Ms. Leon-Verdin, and Dr. Wanchek are affiliated with the Department of Public Health Sciences and Dr. Bonnie is with the School of Law, all at the University of Virginia, P.O. Box 800717, Charlottesville, VA 22903 (e-mail: [email protected]).
Tanya Nicole Wanchek, Ph.D., J.D.
Dr. McGarvey, Ms. Leon-Verdin, and Dr. Wanchek are affiliated with the Department of Public Health Sciences and Dr. Bonnie is with the School of Law, all at the University of Virginia, P.O. Box 800717, Charlottesville, VA 22903 (e-mail: [email protected]).
Richard J. Bonnie, LL.B.
Dr. McGarvey, Ms. Leon-Verdin, and Dr. Wanchek are affiliated with the Department of Public Health Sciences and Dr. Bonnie is with the School of Law, all at the University of Virginia, P.O. Box 800717, Charlottesville, VA 22903 (e-mail: [email protected]).

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