North Carolina Resident Psychiatrists Knowledge of the Commitment Statutes: Do They Stray from the Legal Standard in the Hypothetical Application of Involuntary Commitment Criteria?

Abstract

Objectives are to examine North Carolina (NC) resident psychiatrists knowledge of commitment statutes and their willingness to involuntarily admit hypothetical patients who do not meet statutory criteria. It is hypothesized that the need for transportation may be a salient factor. In one vignette the patient had schizophrenia and the other alcohol dependence. The respondents were asked to make a decision about commitment and to rate how 9 specified factors affected their decision. Sixty-one residents responded. Thirty percent answered incorrectly about statutory provisions for 'mental illness' and 'dangerousness', 10% answered incorrectly that grave disability does not meet the dangerousness criterion, and 41% answered incorrectly about the NC statutory language of the 'least restrictive alternative' principle. While neither hypothetical patient met the commitment standard, 74% of respondents would involuntarily admit the patient with psychotic illness and 87% would involuntarily admit the patient with alcohol dependence. Training in commitment standards with clinical vignettes should be conducted with residents to protect patient rights.

Understanding U.S. debates surrounding standards in involuntary inpatient psychiatric commitment through the Maryland experience

“…Our findings corroborate literature that indicates wide variation in understanding and implementation of standards for involuntary psychiatric commitment (Kaufman & Way, 2010). Survey respondents and testifiers alike described a lack of uniformity in their interpretation and application of the existing criteria for involuntary commitment.…”

“…Opponents believe that such a solution brings with it all of the harm that the current regime was created to remedy, with no efforts or incentives to make the fundamental improvements necessary. Such concerns are exacerbated by the findings that lack of alternatives influence decision making around involuntary commitment (Kaufman & Way, 2010;Lorant et al, 2007;McGarvey et al, 2013). Our findings also suggest that we may resort to paternalism because we do not have sufficient supports to make a focus on autonomy feasible.…”

“…Fisher and Grisso (2010) assert that clinicians often make decisions on a case by case basis as standards lack adequate clarity. A study of North Carolina psychiatric residents found that only a third of surveyed residents fully understood the state's civil commitment standards (Kaufman & Way, 2010). Additionally, assessment of risk related to severe mental illness among members of different professions displayed considerable variation in determining risk of danger, and that professionals are easily swayed by small contextual changes in psychiatric situations.…”

“…McGarvey, Leon-Verdin, Wanchek, and Bonnie (2013) found that the availability of voluntary residential services was associated with the likelihood of involuntary civil commitment. Similarly, Kaufman and Way (2010) reported that psychiatric residents often considered the availability of community resources, particularly transportation, when determining commitment. One study conducted in Belgium found that "the lack of a less restrictive alternative form of care was the criterion most crucial in decisions in favour of commitment" (Lorant, Depuydt, Gillain, Guillet, & Dubois, 2007, p. 362).…”

Impact of Psychiatrists’ Qualifications on the Rate of Compulsory Admissions

“…The procedure aimed to decrease the proportion of involuntary hospitalizations and this is indeed what was observed. The results is possibly explained by a limited knowledge of the residents in psychiatry on commitment statues as suggested by a previous survey conducted in a sample of residents in psychiatry in the US [19].…”