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Clinicians' decision making about involuntary commitment

N B Engleman1, D A Jobes, A L Berman

  • 1Department of Psychology, Catholic University of America, Washington, DC, USA.

Psychiatric Services (Washington, D.C.)
|July 14, 1998
PubMed
Summary
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Clinician decisions on involuntary commitment depend on their past detention rates and where evaluations occur, not patient factors. Bed availability also influences detention decisions.

Area of Science:

  • Psychiatry and Mental Health Services Research
  • Clinical Decision-Making in Emergency Settings

Background:

  • Involuntary commitment is a critical intervention in mental healthcare.
  • Understanding factors influencing clinicians' decisions to detain patients is essential for equitable care.

Purpose of the Study:

  • To examine clinicians' decision-making processes regarding involuntary commitment.
  • To investigate the impact of patient characteristics, clinician factors, and resource availability (detention bed capacity) on detention decisions.

Main Methods:

  • Eighteen mental health clinicians (psychologists, social workers) assessed 169 at-risk patients using the Risk Assessment Questionnaire.
  • Data collected included clinician characteristics (detention ratio), evaluation setting (in-house vs. mobile crisis unit), and community detention bed availability.
Keywords:
Empirical ApproachMental Health Therapies

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  • Forty-two patients were ultimately detained.

    • Main Results:

    • Clinician detention ratio and evaluation setting significantly predicted detention decisions.
    • Availability of community detention beds was a significant predictor of patient detention.
    • No patient characteristics (diagnosis, sex, age, insurance) were significantly associated with the detention decision.

    Conclusions:

    • The decision to detain patients for involuntary commitment is influenced by systemic and clinician-specific factors.
    • Factors such as the clinician's past detention practices and the availability of resources play a crucial role.
    • Patient-specific clinical factors did not significantly influence the decision to detain in this study.