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.     

How psychiatrists and judges assess the dangerousness of persons with mental illness: an 'expertise bias"

When assessing dangerousness of mentally ill persons with the objective of making a decision on civil commitment, medical and legal experts use information typically belonging to their professional frame of reference. This is investigated in two studies of the commitment decision. It is hypothesized that an 'expertise bias' may explain differences between the medical and the legal expert in defining the dangerousness concept (study 1), and in assessing the seriousness of the danger (study 2). Judges define dangerousness more often as harming others, whereas psychiatrists more often include harm to self in the definition. In assessing the seriousness of the danger, experts tend to be more tolerant with regard to false negatives, as the type of behavior is more familiar to them. The theoretical and practical implications of the results are discussed.     

Langzeituntergebrachte in der Sicherungsverwahrung

Due to the decision of the European Court for Human Rights, up to mid-2010 the courts of execution had to decide about the release of offenders who had been imprisoned for more than 10 years in preventive detention. This in fact was problematic because preventive detention was limited to a maximum of 10 years at the time of conviction. In all of these cases preventive detention persisted due the assumed high dangerousness of those affected. Regarding the 11 cases that had to be decided by the provincial High Court of Hamm, Germany in 2010, the completion of the detention has been concluded in all cases. The majority of these cases will be described briefly in order to illustrate the different case constellations which led to long-term detention. Moreover these cases serve to demonstrate the difficulties which can arise when trying to evaluate or predict future dangerousness.     

Imminent suicide: the illusion of short-term prediction

The concept of imminent suicide is examined. A search of National Electronic Library for Mental Health, the Cochrane Library, PubMed, OVID and MD Consult databases was conducted using the terms "suicide, imminent." The term imminent frequently appears in the mental health literature, finding common usage among clinicians. It is also a legal term of art embedded in civil commitment statutes; duty to warn and protect statutes and case law, usually under the rubric of dangerousness; and in seclusion and restraint policies. Managed care admission protocols may contain imminence criteria for patients at risk for suicide before approving insurance benefits, yet no suicide risk factors exist for the short-term prediction of suicide.     

From Mental Health to Juvenile Justice: What Factors Predict This Transition?

We identify youth who are at risk for a critical transition from mental health to juvenile justice. A statewide longitudinal sample of Medicaid-eligible youth (aged 10–17) in the public mental health system (n = 5,455), during approximately one fiscal year (July 1, 1994–August 30, 1995), was used to determine the risk factors for, and timing of, a subsequent juvenile justice detention or commitment during the three subsequent fiscal years (1994–1997). Logistic regression and Cox Proportional Hazards modeling were used. Risk factors for juvenile justice detention or commitment included being: male, black or Hispanic, in junior high school, involuntarily admitted to mental health, having a DSM-IV diagnosis of conduct disorder, alcohol problems, a constellation of risk behavior, and receiving prior mental health services. Factors that accelerate the timing of detention or commitment in the juvenile justice system after a mental health visit included most of the general risk factors except risk behavior and involuntary admission were no longer significant and having a DSM-IV nonalcohol drug use diagnosis, antisocial behavior, and school problems became significant. Our study helps to identify youth who are at risk for multiple system use so that they may be provided appropriate services to prevent multiple system use.     

The effect of decision risk and project stage on escalation of commitment

We investigate the joint effects of decision risk and the stage of project completion on escalation of commitment. In two experiments, we demonstrate that the effect of decision risk is moderated by project stage such that the decision risk has the strongest effect on escalation of commitment at the intermediate stage of project completion. This is due to the dynamic influences underlying escalation of commitment. Whereas the need for project information influences resource commitment at the initial stage of a project, the need for project completion affects resource allocation at the terminal stage. In contrast, motivation to commit resources is disproportionately low at the intermediate stage since both the need for project information and the need for project completion are relatively weak. As such, the decision to commit resources is most sensitive to the moderating effect of decision risk when the project is about half complete.     

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.     

Legal schizophrenia and the mental health lawyer: Recent trends in civil commitment litigation

Mental disability law is among the most conflicted fields in American jurisprudence, whose essential adversarial structure has accentuated a natural degree of tension between the interests of the disabled and those of society at large, and created a largely needless division between legal rights and human needs. Practitioners in this field, whether lawyers or mental health services providers, exhibit the deleterious symptoms of this conflicted state of things which range from an indiscriminate hyperactivity to nearcatatonia. This overview of recent developments in commitment-related litigation traces the persisting conflicts over admission criteria, outpatient treatment alternatives, conditional release, transfer procedures, remedies for inappropriate commitment, and the scope of confidentiality rights. It draws a picture of practitioners who continue to be at the mercy of the law's contradictory pushes and pulls. While a degree of conflict in mental disability law is inevitable, the article suggests that by focusing on the best particular interests of the disabled client, practitioners can do social good and avoid the damage that results when other interests are allowed to dominate.     

男性犯罪者人格对人身危险性的影响:有中介的调节模型

以463名男性犯罪者为调查对象,在控制人口学变量后,探讨人格、成熟应付方式、社会支持与人身危险性的关系。结果表明:(1)年龄、文化程度、婚姻和犯罪次数是人身危险性的重要预测变量。(2)人格可以显著预测人身危险性。(3)社会支持调节人格与人身危险性之间的关系。(4)这种调节作用以成熟应付方式为中介变量,其中通过中介变量起作用的调节效应占总调节效应的29.4%。因此,人格对男性犯罪者人身危险性的影响是有中介的调节效应。     

Satisfaction with Initial Work Assignment and Organizational Commitment1

The present study examined the moderating effects of role stressors on the relationship between initial work assignment satisfaction and organizational commitment. Moderated multiple regression analyses on data collected from 76 employees of an American military Research and Development (R&D) laboratory indicated that initial work assignment satisfaction accounted for little variance in commitment among workers low in role conflict but considerable variance among workers high in role conflict. However, role ambiguity had no moderating effect on the initial work assignment satisfaction-commitment relationship.     

Relation of socioeconomic status to logical and sociomoral judgment of middle-aged men

Empirical links between socioeconomic status and logical and sociomoral judgment were studied. Logical judgment was measured with adaptations of the pendulum and correlations tasks devised by Inhelder and Piaget (1958); sociomoral judgment was scored with the standard Kohlberg interview. Measures of socioeconomic status (SES) were status of family of origin and subject's educational attainment and occupational prestige. In a sample of 83 middle-aged men, the 3 measures of SES accounted for 25% and 12% of the variance in logical and sociomoral judgment, respectively. Adult occupational prestige accounted for 6% of the variance in logical judgment beyond that explained by family status and education, suggesting that adult cognitive functioning may be related to occupational placement, occupational experience, or both.     

Image Theory: Testing the Role of Image Compatibility in Progress Decisions

Image compatibility, one of Image Theory′s (Beach & Mitchell, 1987; 1990) most instrumental components, was tested in two lab studies. Consistent with theory propositions, results show that when perceptions of a project′s current and target images were more compatible, decision makers were more inclined to continue a project and more willing to commit additional resources. This pattern was found when project performance feedback was positive or negative (Experiment 1), or merely framed in a positive or negative manner (Experiment 2). Moreover, data from both studies indicated that image compatibility accounted for significant variance over and above that predicted by feedback sign and dissatisfaction with project performance alone. Results are discussed in terms of their contribution to the current status of the Image Theory paradigm and as a basis from which future research might build.     

Risk and Resistance Factors Associated with Paternal Adjustment to Obstetrical Brachial Plexus Injuries

This study aimed to identify risk and resistance factors associated with the psychological adjustment of fathers of children with obstetrical brachial plexus injuries (OBPI). Participants were 34 fathers of children with OBPI recruited from an Australian OBPI clinic. Measures completed were OBPI severity, disability related stress, family functioning and social support. Together the risk and resistance factors of severity and family functioning accounted for 28 % of the total variance in paternal psychological adjustment. Family functioning explained 12 % of the variance in psychological adjustment in addition to that explained by severity. These findings highlight the importance of considering paternal perceptions of OBPI severity and family functioning when providing health care to families of children with OBPI.     

Work role salience as a determinant of career maturity in high school students

It has often been contended that vocational or career maturity is largely determined by socioeconomic status and sex. But these, although surely important determinants, may function as such only because they determine commitment to working careers. This latter may itself be the immediate determinant of career maturity. In this study data were collected from some 382 students of whom about 55% were girls, using a Personal Data Blank, the Salience Inventory, and the Career Development Inventory. Measures of career and home commitment were obtained from the second, while measures of career or vocational maturity were derived from the last-named instrument. Canonical correlations and variance analyses were done to examine the roles of SES and sex when combined with career commitment. Four hypotheses received full support, three were partially supported, and one was not supported.     

An examination of the assumptions of specialization, mental disorder, and dangerousness in sex offenders

Sex offenders have been singled out for differential treatment by the legal and mental health systems. This article attempts to inform law reform efforts and criminal justice mental health policy by examining the assumptions underlying differential legal and mental health treatment of sex offenders. These assumptions include the theories that sex offenders are mentally disordered and in need of treatment, specialists in sex crimes, and more dangerous than other criminal offenders. Empirical findings demonstrate that sex offenders are not specialists in sex crimes and are not mentally disordered. Examination of past research suggests that sex offenders are not at more risk than other criminal offenders to commit future sex crimes. Implications of research findings for selective prosecution of sex crime cases, mental health policy, sex offender legislation, and predictions of future dangerousness are discussed. Proposals for future research needs and law reform are presented.     

Visuospatial working memory,auditory discrimination,and attention

ABSTRACT

The present study examined the degree to which tests of visuospatial storage capacity tap into domain-general storage and attention processes. This was done by comparing performance of visuospatial memory tasks with performance on sound-based sensory discrimination tasks. We found that memory task- and discrimination task performance both tapped into a cross-modality factor (visual and auditory). We further examined the degree to which this common variance could be explained by attention control and sustained attention. These attention factors accounted for roughly 60% of the variance in memory. This indicates that tests of visuospatial memory capacity reflect more than modality-specific memory.     

Level of commitment,mutuality of commitment,and couple well-being

Interdependence theory identifies level of dependence and mutuality of dependence as two key properties of interdependent relationships. In ongoing relationships, these structural properties are subjectively experienced in terms of commitment–dependence level is experienced as greater or lesser commitment level, and mutuality of dependence is experienced as greater or lesser perceived mutuality in partners’commitment levels. We examined the associations of these variables with couple well-being using data from two three-wave longitudinal studies. One study examined partners in dating relationships and the second study examined partners in marital relationships. Consistent with predictions, both level of commitment and perceived mutuality of commitment accounted for unique variance in couple well-being: Couples exhibited greater adjustment to the degree that the partners were highly committed to their relationship and to the degree that their commitment levels were mutual. Mediation analyses revealed that the association of mutuality of commitment with couple well-being is partially mediated by negative affect (e.g., anxiety, guilt) and partially to wholly mediated by trust level; perceived mutuality of power is not a reliable mediator of this association.     

Pre- versus postdecisional deliberation and goal commitment: The positive effects of defensiveness

Building on Gollwitzer's (1990) mindset theory of action phases, it is proposed that the effects of assigned balanced deliberation on subsequent goal commitment are moderated by people's pre- versus postdecisional status. A balanced deliberation and impartial assessment of pros and cons is expected to reduce goal commitment in predecisional individuals, whereas a distortion of the assigned balanced deliberation and a partial focus on the pros of goal pursuit should defend and strengthen goal commitment in postdecisional individuals. Indeed, in Study 1, assigned deliberation on the pros and cons of pursuing a focal goal promoted stronger reported goal commitment in participants who had decided to pursue this goal, but reduced goal commitment for people who had not yet made such a decision. In Study 2, the same pattern of results emerged when goal commitment was indicated by planning to act on the goal. Study 3 replicated findings using a different decision status manipulation and goal persistence as a measure of commitment. Finally, results of Study 4 suggested that the increase in commitment produced by defensive postdecisional deliberation is consequential as it was found to drive real-life behavior by promoting goal-directed action. Moreover, Study 2: deliberation effects on subsequent planning activity, Study 3: deliberation effects on goal persistence, Study 4: deliberation effects on real-life behavior explored the underlying process and provided evidence that it is the partial focus on the pros of goal pursuit, meant to defend existing goal commitment, that drives postdecisional deliberation's strengthening effects on goal commitment. Implications for mindset theory, goal commitment theory, and decision making are discussed.