Civil commitment: An economic perspective

The rules governing the civil commitment of mentally ill persons result from complex legislative and judicial processes. In this article an economic approach to the evaluation of commitment laws is presented. A related economic model is applied to the process by which commitment rules are selected and changed. In the economic approach the benefits and costs of civil commitment are specified and analyzed to determine an optimal number of commitments. A graphical model is used to reinforce the conclusions. The distinction between private and social benefits and costs is used to derive the conclusion that some civil commitment is consistent with the economic principle of optimality. Failures in the political process are shown to generate a need for judicial intervention to correct for possible biases toward overcommitment and an inadequate quality of care. An alternative to the economic evaluation of commitment rules, based on the work of Rawls, is also presented.     

Civil commitment: A review of empirical research

This article presents a comprehensive review of empirical micro-level research which has attempted to evaluate changes in civil commitment law in the United States. It groups studies by category of the general question they address: Who are being processed through civil commitment and who are being committed? How dangerous are civil commitment candidates on admission, in the hospital, and after release? To what extent are court officers adhering to procedural protections in form and in intent? To what extent have restrictive criteria influenced the behavior of medical professionals in processing individuals through civil commitment? and What happens to individuals after their civil commitment experience and their involuntary hospitalization? The article points to needed research and concludes by summarizing existing research from the perspective of finding a balance between civil liverty and benevolence.     

Sexual predator commitment laws: lessons for law and the behavioral sciences

Sex offender commitment laws use a mental health commitment model to lock up the "most dangerous" sex offenders after their prison sentences expire. In Kansas v. Hendricks, the United States Supreme Court rejected the major constitutional challenges to these laws. The Hendricks case clarifies important ambiguities about the use of civil commitment to enforce "police power" interests, as opposed to "parens patriae" interests. Hendricks also clarifies the role of "treatment" in justifying civil commitment. While there remain some important legal issues to be resolved, the future direction of sex offender commitment schemes will turn most significantly on policy decisions. The behavioral sciences can play an important role in shaping these decisions. The most significant questions concern whether expensive commitment programs are the most effective use of scarce treatment and supervision dollars. Additional research should be directed to improving dynamic predictors of recidivism, operationalizing "inability to control" standards, judging the "social meaning" of commitment laws, and assessing the potential treatment disincentives of these laws.     

Self-esteem: Its mediating effects on the relationship between discrimination at work and employee organisation commitment and turn-over intention

This study examined self-esteem as a mediator of the relationship between perceived discrimination, employee intentions to quit, and affective organisation commitment. A convenience sample of 414 South African employees were participants (female?=?44.9%; black?=?42.3%; 38.2% between the age of 26 and 35). Of the participants, 72.7% were from the private sector. The employees completed measures of self-esteem, perceived discrimination, and affective organisation commitment. We utilised Structural Equation Modelling to determine the direct and indirect effects of self-esteem on employee attitudes, affective organisation commitment, and intentions to quit. Findings indicate that high self-esteem scores predict affective organisation commitment by ameliorating a sense of work-place discrimination. This is influenced by race, ethnicity, and gender. By contrast, low self-esteem scores predicted high intensions to quit due to perceived work-place discrimination. As such, high self-esteem is important for the reduction of the perceived work-place discrimination effects on affective organisation commitment and for job retention among workers of a society with a history of race-based civil strife.     

The application of civil commitment law and practices to a case of delusional disorder: a cross-national comparison of legal approaches in the United States and the United Kingdom

Legal approaches to civil commitment in the United States and the United Kingdom are compared. A concise overview of the historical evolution of civil commitment in both countries precedes a discussion of the present scheme of commitment standards in each system. These current standards in U.S. and U.K. jurisdictions are then applied to a hypothetical case of delusional disorder. A discussion of the constructive use of civil commitment in patients with delusional disorder who may be dangerous focuses on its value as a preventive measure against potential harm to self or others, as well as the pros and cons of coercive assessment and treatment. Despite the many differences in approach to commitment, the authors concur that in both countries the patient with delusional disorder was committable before the commission of a serious criminal offense.     

The future of involuntary civil commitment in the U.S.A. after Kansas v. Hendricks

This article examines new sexual predator commitment laws enacted recently in the United States to civilly commit dangerous sex offenders after they have served their prison sentences. It then examines Kansas v. Hendricks, a Supreme Court case that upheld these laws as constitutionally permitted. The article next describes the broad parameters that demarcate the government's civil commitment authority identified by the Supreme Court in that case. The author concludes that Hendricks establishes that the state has expansive civil commitment power much greater than our previous understanding. The government may use civil commitment solely to protect the public from dangerous individuals without proving a medically recognized mental disorder, recent evidence of dangerousness, or a treatment purpose or possibility. Moreover, this quarantine system may be justified by proving the same unlawful behavior for which the individual has already been criminally punished.     

Uncivil Disobedience: Political Commitment and Violence

Standard accounts of civil disobedience include nonviolence as a necessary condition. Here I argue that such accounts are mistaken and that civil disobedience can include violence in many aspects, primarily excepting violence directed at other persons. I base this argument on a novel understanding of civil disobedience: the special character of the practice comes from its combination of condemnation of a political practice with an expressed commitment to the political. The commitment to the political is a commitment to engaging with others as co-members in the on-going political project of living together. I show how such an understanding of civil disobedience is superior to the Rawlsian strain of thought, which focuses on fidelity to law. Rawls was concerned with civil disobedience solely in the context of overriding political obligation. The project of characterizing a contestatory political practice that can be distinguished and used in a wider variety of contexts than Rawls is concerned with, including under illegitimate regimes, beyond the nation-state, or on behalf of anarchism, requires a different understanding of civil disobedience.     

STAYING IN THE CLOSET VERSUS COMING OUT: RELATIONSHIPS BETWEEN COMMUNICATION ABOUT SEXUAL ORIENTATION AND WORK ATTITUDES

The threat of job discrimination causes many gay men and lesbians to keep their sexual orientation secret at work. This study investigates the relationships between extent of communication about sexual orientation and critical work attitudes. We hypothesize that "closeted" gay workers will experience more negative work attitudes than will either "openly" gay or heterosexual workers. The sample consisted of 900 lesbian, gay, and heterosexual workers identified from the mailing list of a civil rights group focused on homosexual rights. The hypothesis is supported for affective organizational commitment, job satisfaction, belief in support of top management, role ambiguity, role conflict, and conflict between work and home issues, but not for continuance commitment. Although causal relationships are not specified, we conclude that work attitude levels of gay and lesbian workers are predicted in part by the amount of communication about their sexual orientation in which these workers engage.     

Identity as a moderator of gender differences in the emotional closeness of emerging adults' same- and cross-sex friendships

Closeness is an integral aspect of friendships, and males and females differ in their closeness experiences within these relationships. However, identity development and friendship type (e.g., same-sex versus cross-sex friendships) may moderate these gender differences. In an attempt to clarify the relationships among gender, identity, and friendship closeness, the current study examined gender and identity associations with reported emotional closeness in emerging adults' same- and cross-sex friendships. Responses from 181 college undergraduates (89 males and 92 females) indicated similar levels of emotional closeness reported for same- and cross-sex friendships. Results also indicated overall identity commitment and friendship identity commitment associations with same-sex friendship closeness. Examination of closeness reports for cross-sex friends revealed a significant association with overall identity commitment for emerging adult males. A significant association was not indicated for emerging adult females. The associations between identity and emotional closeness in same-sex friendships and male cross-sex friendships support previous studies that report differences in the role of these relationships for emerging adult males and females. Findings are discussed in terms of understanding the gender and identity differences in emerging adults' reports of friendship closeness.     

Competence to proceed in SVP commitment hearings: Irrelevant or fundamental due process right?

Sexually Violent Predator (SVP) civil commitment, intended to incapacitate offenders and protect the public, has been implemented in 21 jurisdictions. While respondents in traditional civil commitment proceedings need not be competent to proceed, SVP commitment may present a greater deprivation of liberty and therefore greater procedural protections may be merited. Statutes and case law regarding competence in this context address two issues: competence to challenge unproven sexual offense allegations and competence to participate in the SVP commitment process. Of the 14 states that have addressed the issue, one concluded that respondents must be competent to challenge unproven allegations and one concluded that all SVP respondents must be competent to participate in the commitment process. Differences between SVP and traditional civil commitment, the rationale underlying the competence requirement, and decisions regarding competence in SVP commitment are reviewed to inform debate regarding whether SVP respondents must be competent to proceed with the commitment process. Copyright © 2010 John Wiley & Sons, Ltd.     

The function of punishment in the "civil" commitment of sexually violent predators

Two experiments find that support for civil commitment procedures for sexually violent predators is based primarily upon the retributive rather than incapacitative goals of respondents. Two discrete samples composed of students (N = 175) and jury-eligible citizens (N = 200) completed experimental surveys assessing their support or opposition to scenarios in which a sexual predator was to be released after completing his criminal sentence. Respondents were sensitive to likelihood of recidivism only when the initial sentence was sufficiently punitive. When initial sentence was lenient, respondents strongly supported civil commitment without regard to future risk. Results are discussed in light of the U.S. Supreme Court's ruling in Kansas v. Hendricks (1997) on the constitutionality of civil commitment laws for sexually violent predators.     

Juror decision-making in a mock sexually violent predator trial: gender differences in the impact of divergent types of expert testimony

Despite widespread use of mental health testimony in cases where violence risk is at issue, relatively little is known about the impact of such information on juror decision-making. This study addressed the effects of testimony based on three types of risk assessment instrument or method (clinical opinion, actuarial assessment, and ratings of psychopathy) to examine whether they would have differential impact on jurors' perceptions of the defendant. In a mock sexually violent predator civil commitment trial, 172 undergraduates were presented a case summary that included prosecution and defense expert testimony related to violence risk based on one of the three methods noted above. Consistent with earlier research, the hypothesis that a defendant described as a "high risk psychopath" by the prosecution would be judged more severely than a defendant judged as "high risk" based on other evaluation procedures was supported, but only among female jurors. Unlike prior studies, little support was found for the hypothesis that clinical opinion testimony would be more influential than actuarially based testimony for either gender. Mechanisms that may underlie the observed gender differences are discussed, as are the potential implications of these findings for civil commitment proceedings.     

Patient's choice to suicide v. treater's duty to prevent suicide: Some changing clinical dilemmas

The evolution of civil commitment procedures is seen as reflecting changing social and ethical values regarding individual liberty versus protection of self and others. The dilemma of dealing with the modern suicidal patient places the psychiatrist at the interface of conflicting societal expectations. The legal aspects of civil commitment are seen as not necessarily compatible with the best clinical course for the suicidal patient. The relationship of the process of the civil commitment to the process of treatment is briefly explored.     

Short-term involuntary examination of older adults in Florida

The elder population continues to grow rapidly in many countries. Florida's elder population is growing faster than most states', with over one-quarter of the Florida population projected to be aged 65 and over by 2025. Involuntary examination (i.e. emergency commitment) under a state's civil commitment law is one means by which older adults experience assessment for acute mental health care. In Florida, the civil commitment law permits the involuntary examination of an individual for up to 72 hours to determine whether the person meets standards for involuntary treatment. From calendar year 2001 through 2005, there were 531,091 involuntary examinations in Florida for 301,886 people of all ages. Thirteen percent were 60 years and older at the time of their examination. The purpose of this paper is to describe the characteristics of older adults subject to involuntary examination and the nature of their examinations. While these data permit a number of inferences, there is an expansive area of research and policy analysis that remains untapped and would permit better understanding of how older adults experience such examinations. These research and policy issues will also be discussed.     

The effectiveness and ethical justification of psychiatric outpatient commitment

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.     

An experimental analysis of the civil commitment recommendations of psychologists and psychiatrists

Legal and nonlegal factors influencing the civil commitment recommendations of psychologists and psychiatrists separately and as a whole were investigated using an experimental design. One hundred and seventy-six psychologists and psychiatrists made recommendations for or against commitment for a series of clinical vignettes wherein the five facets of commitment criterion, legal committability, clinical treatability, alternative resources and presence of psychosis were systematically varied. Results revealed that all facets contributed independently and in combination to the commitment decisions of participants as a whole. It was concluded that mental health professionals may utilize a variety of types of information, beyond the relevant legal criteria, in making actual decisions to initiate civil commitments.     

The Relationship of Hardiness, Gender, and Stress to Health Outcomes in Adolescents

The present study examined the relationship between the hardiness components of commitment, control, and challenge, and the experience of physical and psychological symptoms in a sample of 150 (75 male, 75 female) adolescents. A measure of psychosocial stress was included to permit an examination of whether the hardiness components interact with stress in predicting health outcomes. Analyses revealed main effects of stress, gender, and the hardiness components of commitment and control for several of the health measures. More important was the finding of a consistent interaction of stress, gender, and hardiness for several of the health measures. Whereas low-stress males experienced few physical and psychological symptoms regardless of their levels of commitment and control, high-stress males experienced more problems when they were low rather than high in either commitment or control. The hardiness components did not interact with stress in the prediction of health outcomes among females.     

Justification and legitimacy in global civil society

As some thinkers have sought in the concept of global civil society an ethically driven site of deliberation and even resistance, so others have criticized global civil society for its lack of legitimacy and representativeness. This article attempts to answer these criticisms – at least in part – by invoking a moral commitment to the value of justification. I argue that the idea of justification, when examined, offers us a particular understanding of legitimacy which would be attainable for global civil society actors. The article begins by setting out the case for concern about the legitimacy of global civil society. I then outline a certain understanding of justification, showing how a commitment to this conception provides both a response to critics of global civil society and an ethical baseline for humane actors within global civil society. I move on to trace the significance of the moral relevance of justification for actors' strategies. Lastly, however, I highlight the difficulty of justification in a diverse world. This is to say that the issues of legitimacy and strategy facing global civil society are only made more tractable, not dissolved, by an appeal to the importance of justification.     

Why the gap? Practice and policy in civil commitment hearings.

The failure of civil commitment procedures to meet statutory requirements is one of the more reliable findings in the applied social sciences. Most states now require specific legal procedures and behavioral standards for involuntary hospitalization. Nonetheless, empirical studies have demonstrated that commitment hearings are rarely adversarial and clinical concerns continue to take precedence over legal issues. These findings are analyzed in the context of three related issues: the grounds for commitment that are used in civil commitment hearings, the particular difficulties of recommitment hearings, and the shortcomings of the national policy of deinstitutionalization. The authors conclude that a primary cause of the gap between legal standards and actual practice is the absence of viable, less restrictive alternatives to inpatient treatment.     

Adolescents' self-efficacy to communicate about sex: its role in condom attitudes, commitment, and use

This study examined whether and how self-efficacy to communicate with parents and peers about sex relate to sexually experienced adolescent males' and females' (N= 144, 112) condom attitudes, intentions, and use. Results showed that males who reported greater self-efficacy to communicate with parents used condoms more frequently; and both males and females who can communicate with peers used condoms more frequently. Self-efficacy to communicate with peers was related to more positive condom attitudes, which in turn were associated with greater condom commitment and use. Greater ability to communicate with parents was also related to greater condom commitment and use among males. These results suggest the importance of designing interventions that give adolescents the skills they need to feel efficacious in their ability to communicate about sex and contraception.