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Psychiatrists Describe Involvement With Civil-Commitment Proceedings

American psychiatrists appear to favor relatively limited grounds for involuntarily committing patients—"danger to self," "danger to others," or "grave disability" head the list.

Although psychiatrists are probably the most influential voice in the involuntary civil commitment of seriously mentally ill people in the United States, little is known about their experience with such commitment, their knowledge of commitment laws, or their opinions on how commitment laws should be formulated. In fact, the last comprehensive national survey on the topic was conducted over a quarter century ago.

So Robert Brooks, J.D., Ph.D., an assistant professor of criminal justice at Worcester State College in Massachusetts, decided to conduct a new national survey on the subject. He obtained copies of all states' and the District of Columbia's involuntary civil-commitment statutes.

He sent a questionnaire to 1,500 members of APA, with 739 (49 percent) returning them. His results were published in the June Journal of the American Academy of Psychiatry and the Law.

Nearly 62 percent of respondents were found to have had direct experience with involuntary civil commitment in the preceding two years. Of those who had had such experience, 77 percent had been involved in the commitment of a current patient, and 23 percent had been involved in the commitment of a former patient. Moreover, 41 percent had provided expert testimony regarding involuntary civil commitment, and more than a quarter had been involved in involuntary civil commitment in some other way.

All respondents were found to be correct in believing that danger to self and danger to others were grounds for involuntary civil commitment in their states. But replies regarding other possible grounds for involuntary civil commitment in their states were less accurate. For example, 84 percent of respondents were correct regarding whether alcohol addiction was grounds for commitment in their state, and only 57 percent regarding sexual-predator status.

Thus, "the respondents' knowledge of the law may. . .be of some concern," Brooks commented in his report, "and thus more education about the contents of the law may be in order. However, it is also true that respondents showed the greatest familiarity with the grounds that they were most likely to encounter in practice (dangerousness to self or others) and were least likely to be correct about the criterion of sexual-predator status, which is used infrequently and almost always in connection with impending release of a sex offender from incarceration."

When respondents were asked what they personally believed should be the grounds for involuntary civil commitment, nearly all said "a danger to self" or "a danger to others," and nearly 90 percent favored the "grave-disability" standard. In a previous national survey, support for the grave-disability standard was more limited. "If the current results could be read as increased support," Brooks wrote, "this may be due to the widespread adoption of the grave-disability standard into most states' laws.... Greater support for grave disability may also be due to its increased use, estimated by some to be the most-used ground for commitment."

In contrast, there was only tepid support (52 percent) among respondents for the "illness-relapse" standard, that is, civil commitment based on relapse of a severe and chronic mental illness. Also, respondents largely opposed involuntary civil commitment on the basis of alcohol addiction or drug addiction—in contrast to the findings from the national survey 25 years ago in which more respondents viewed those criteria as acceptable for civil commitment.

Overall, respondents tended to support relatively limited criteria for involuntary civil commitment, Brooks concluded, and such a position, he speculated, might have been linked with their ambivalence about the use of involuntary civil commitment in the first place. For example, some might have believed that commitment against a patient's will damages the psychiatrist-patient relationship, or that it compromises a patient's right to be free.

In any event, he concluded, "Discovering the views of psychiatrists about involuntary commitment is important because psychiatrists provide information and opinions to legislators and others in crafting legislation, and survey research lets us know where psychiatrists stand on these matters."

"Psychiatrists' Opinions About Involuntary Civil Commitment: Results of a National Survey" is posted at <www.jaapl.org/cgi/reprint/35/2/219>.

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