Clinical judgments in the decision to commit. Psychiatric discretion and the law

Judicial decisions and statutory reforms point to a return to psychiatric discretion when clinical needs and patients' rights must be balanced. In seeking to commit patients, psychiatrists have been accused of contravening the legal rights of their patients by applying criteria other than those prescribed by law. This study examined the factors involved in the psychiatrists' decisions to seek commitment or to release 90 voluntarily hospitalized patients; we found psychiatrists' decisions to be appropriately correlated to legal criteria and legally relevant clinical and psychosocial factors. Interpersonal variables did not play a material role in the decision. Independent assessment of the patients' clinical status were consistent with clinicians' judgments of dangerousness. These findings indicate that this group of psychiatrists, faced with the decision to seek commitment, based their judgments on clinically relevant data rather than interpersonal factors and conformed to the dangerousness requirements of the commitment law.