Consistency in the application of civil commitment standards in psychiatric emergency rooms

In the controversy over civil commitment procedures, reliability as well as validity of clinicians' assessments have been challenged. In this study, the generalizability of TRIAD, an observational assessment device, was tested. Patient load strongly influenced the degree to which TRIAD predicted case disposition and clinician global ratings of dangerousness and grave disability. Given comparable patient-clinician ratios, TRIAD predicted 81% to 86% of case dispositions. Agreement between clinician global assessments and TRIAD ratings was high to moderate. Clinicians apparently agree on sets of indicators which can be consistently weighted, but the application of the standard described by TRIAD may be jeopardized by increasing patient loads.