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Published Online: 1 July 2012

Use of Longer Periods of Temporary Detention to Reduce Mental Health Civil Commitments

Tanya Nicole Wanchek, Ph.D., J.D., and Richard J. Bonnie, LL.B.Authors Info & Affiliations

Publication: Psychiatric Services

Volume 63, Number 7

https://doi.org/10.1176/appi.ps.201100359

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Abstract

Individuals experiencing a mental health crisis can be held on a temporary detention order (TDO) before a civil commitment hearing is required. TDO periods, which permit stabilization and evaluation of patients, vary across the U.S. from 48 hours to 30 days. Because involuntary hospitalization may result in stigma and trauma for patients and families, researchers in Virginia examined whether longer TDO periods would mean fewer subsequent commitments. They took advantage of natural variation in the state's 48-hour TDO period over holiday weekends to collect their data.

Abstract

Objective:

This study examined whether lengthening the holding period for an individual experiencing a mental health crisis under a temporary detention order (TDO) can reduce the number and length of post-TDO involuntary hospital commitments.

Methods:

Data from the Virginia Court System were matched to the Commonwealth of Virginia Medicaid claims database for July 1, 2008, through March 30, 2009. The final data set included 500 Medicaid recipients who had a mental health diagnosis and at least one TDO during the study period. Covariates included sex, race, age, primary diagnosis, and Community Service Board serving the individual. Logistic and multivariate regression models were used.

Results:

Longer TDO periods were correlated with an increased probability of a dismissal of the commitment petition rather than hospitalization after a TDO. Among individuals who were hospitalized, longer TDO periods were correlated with an increased likelihood of voluntary hospitalization, rather than involuntary commitment, and shorter hospitalizations, although the net care time (TDO period plus post-TDO hospitalization) increased for individuals whose TDO length was greater than 24 hours.

Conclusions:

Longer TDO periods were correlated with shorter hospital stays and fewer involuntary commitments. These findings support previous work showing that short TDO periods provide insufficient time to stabilize and evaluate individuals. More research is needed to establish a causal link between TDO length and health outcomes. (Psychiatric Services 63:643–648, 2012; doi: 10.1176/appi.ps.201100359)

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Figures and Tables

Figure 1 Length of temporary detention order (TDO) and subsequent outcomes

Table 1 Characteristics of 500 Medicaid recipients with a mental health diagnosis and at least one temporary detention order

Table 2 Predictors of outcome of temporary detention order (TDO) hearings among Medicaid recipients

Table 3 Predicted probability of hospitalization after a temporary detention order (TDO) among Medicaid recipients

Table 4 Multivariate regression model of predictors of length of hospital stay among 398 Medicaid recipients hospitalized after a temporary detention order (TDO)

Information & Authors

Information

Published In

Cover: Flag on Orange Field, by Jasper Johns, 1967. Museum Ludwig, Cologne, Germany. © VAGA, New York. Photo © Erich Lessing/Art Resource, New York.

Psychiatric Services

Volume 63 • Number 7 • July 2012

Pages: 643 - 648

PubMed: 22588149

History

Published online: 1 July 2012

Published in print: July 2012

Authors

Details

Tanya Nicole Wanchek, Ph.D., J.D.

Dr. Wanchek is affiliated with the Weldon Cooper Center for Public Service and Dr. Bonnie is with the School of Law, both at the University of Virginia, Charlottesville, VA 22908 (e-mail: [email protected]).

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Richard J. Bonnie, LL.B.

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Use of Longer Periods of Temporary Detention to Reduce Mental Health Civil Commitments

Abstract