Indexing Civil Commitment in Psychiatric Emergency Rooms

Segal, Sp; Ma, Watson; Ls, Nelson

doi:10.1177/0002716286484001005

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…The results replicate the TRIAD reliability assessments of Segal et al 19 reported above. Though there was a significant reduction in interrater reliability of the danger-to-others scores (P<.05), no significant reductions were observed in the TRIAD total, danger-to-self, and grave-disability scores, and all reliability figures remain in a respectable range.…”

Section: Triad Interrater Reliabilitysupporting

confidence: 88%

“…In operationalizing the concept of dangerousness, Segal et al 19 developed an index entitled Three Ratings of Involuntary Admissibility (TRIAD) to reflect the way clinicians in psychiatric emergency rooms interpret and apply the criteria "danger to self," "danger to others," and "grave disability" due to mental disorder (see Appendix: The TRIAD Assessment). In 1981, they observed 89 cases at two urban county hospital psychiatric emergency rooms in the San Francisco Bay Area, leading them to the following conclusions.…”

Section: Measures: Defining and Measuring Concepts Of Dangerousnessmentioning

confidence: 99%

“…TRIAD was developed in settings in which demand for inpatient beds is high and the vacancy rate is low (less than 10%). 19 Although bedspace did not account for disagreement between TRIAD and clinician ratings or TRIAD and disposition, we expected that clinicians might be less rigorous in their thinking about the criteria in settings in which bed space was not a problem. However, in the study reported herein, TRIAD held up equally well in settings with higher vacancy rates (up to 21%).…”

Section: Generalizability Of Triadmentioning

confidence: 99%

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Civil Commitment in the Psychiatric Emergency Room

Segal¹

1988

Arch Gen Psychiatry

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Critics of the dangerousness standard for civil commitment contend that there is no professional standard for the evaluation of dangerousness. We used Three Ratings of Involuntary Admissibility, a reliable Index of behavioral indicators of danger to self, danger to others, and grave disability, and found that when combined into weighted patterns these indicators predicted disposition decisions of 70 clinicians in five psychiatric emergency rooms over 251 cases. A concurrent measure of perceived dangerousness, Clinician's Global Ratings of patients on these criteria, yielded similar results. We conclude that clinicians in California psychiatric emergency rooms apply a shared concept of dangerousness that can be described in behavioral terms.In the past three decades, involuntary confinement of the mentally ill has been dramatically curtailed. Several factors, including concern for the civil rights of patients, converged to bring about a decrease in reliance on institutional care and a narrowing of the grounds for civil commitment. Most state commitment statutes today specify that patients may be involuntarily admitted to a hospital only on grounds of danger to self, danger to others, or (in many states) grave disability, and then only if the condition results from mental disorder. Judicial interpretations of these statutes indicate that the common denominator, ie, the only legitimate basis for civil commitment, is danger due to mental disorder. [1][2][3][4] In the view of many commentators, 4,5 the adoption of the dangerousness standard constituted the most fundamental change brought about by commitment reform laws of the 1970s, laws modeled after California's Lanterman-Petris-Short (LPS) Act. 6 This standard

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Section: Triad Interrater Reliabilitysupporting

confidence: 88%

Section: Measures: Defining and Measuring Concepts Of Dangerousnessmentioning

confidence: 99%

Section: Generalizability Of Triadmentioning

confidence: 99%

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Civil Commitment in the Psychiatric Emergency Room

Segal¹

1988

Arch Gen Psychiatry

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“…To measure perceived dangerousness, we used Three Ratings of Involuntary Admissibility (TRIAD), a reliable index of indicators used to assess danger to self, danger to others, and grave disability (14)(15)(16)(17)(18). These criteria represent the legal "dangerousness standard" for civil commitment (19) and are the grounds for emergency retention specified in California statutes (20).…”

Section: Methodsmentioning

confidence: 99%

“…In 1981 Segal and associates (17) developed and tested TRIAD at psychiatric emergency rooms in two urban county hospitals in the San Francisco Bay Area. They obtained interrater reliability coefficients (Pearson r) equal to .89 for danger-to-self score, .94 for danger-toothers score, .77 for grave-disability score, and .89 for the total TRIAD score.…”

Section: Methodsmentioning

confidence: 99%

Police Referral to Psychiatric Emergency Services and Its Effect on Disposition Decisions

Watson¹,

Segal²,

Newhill³

1993

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Objective: Some clinicians and researchers have questioned the appropriateness of police referrals to psychiatric emergency services and have suggested that police exercise undue influence on hospital admission decisions. The purpose of this study was to test these assertions. Methods:Research clinicians in nine emergency services in California observed staff evaluations of 112 cases and rated patients' symptom severity, danger to self or others, and grave disability. They also reviewed the criminal justice records of these patients both before and for 18 months after the index evaluation. A total of 186 patients referred by police were compared with 577 patients not referred by police.Results: Patients brought by police were more likely to be subsequently hospitalized, but they were also more psychiatrically disturbed. They were more dangerous to others and more gravely disabled. They were no more likely to have a criminal record than patients not referred by police. Conclusions:Police did not exercise undue influence on dispositions nor were the patients they brought in more "criminal" than others.Police officers have been called the primary referral source for psychiatric assistance in the community (1,2) and are among the most important providers of front-line crisis intervention, particularly for poor and underprivileged persons (3,4). To understand how emergency room personnel make decisions to hospitalize persons with psychiatric disorders, several authors have investigated referrals by police officers and have reported that a large proportion of such admissions are police referrals (5,6). Some authors have even suggested that police exercise undue influence over admission decisions (7). Psychiatric emergency service staff often view patients referred by police as "their most undesirable cases: hostile, aggressive young males" (8). Some authors have assumed that police referrals to emergency rooms represent an effort to hospitalize people who are really criminals (9,10). Steadman and associates (8,11

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Civil commitment: A review of empirical research

Hiday

1988

Behavioral Sci & The Law

100

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Indexing Civil Commitment in Psychiatric Emergency Rooms

Cited by 8 publications

References 11 publications

Civil Commitment in the Psychiatric Emergency Room

Civil Commitment in the Psychiatric Emergency Room

Police Referral to Psychiatric Emergency Services and Its Effect on Disposition Decisions

Civil commitment: A review of empirical research

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