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.     

Risk for Suicide among Medicaid Beneficiaries

Demographic, diagnostic, and service expenditure characteristics of Florida Medicaid enrollees who died by suicide were investigated. Among persons receiving Medicaid and Supplemental Security Income (SSI), findings indicate the most powerful predictors of suicide were involuntary psychiatric examination, mental health hospitalization, and high mental health service use. Among Medicaid enrollees not receiving SSI, strongest suicide predictors were mental health hospitalization, high expenditures for physical health medications, and involuntary psychiatric examination. Findings suggest reducing involuntary psychiatric examinations and mental health hospitalizations while improving physical health may reduce suicide in the Medicaid population. Comprehensive hospital discharge planning, adherence monitoring with follow‐up care, training mental health providers in assessing suicide lethality, and providing adequate assessment time are all crucial to achieve these objectives.     

The effects of legislative reform on civil commitment admission rates: A critical analysis

Many jurisdictions across North America have revised their statutes pertaining to the criteria for civil commitment with the legislative intent to either increase or decrease the use of involuntary hospitalization. The impact of these revised statutes has been examined in many jurisdictions, but there has been no consensus regarding their effectiveness in changing the rates of involuntary admissions. The present article reviews the literature from a methodological perspective, comparing the differing analyses, results and interpretations. When the legislative revision has sought to expand medical prerogative, results indicate a sustained increase in civil commitments. When legislation has aimed at limiting medical discretion, there was an immediate decline in civil commitment rates, but a subsequent increase in the period following the initial post-reform declines. These results are discussed in terms of readmission trends, deinstitutionalization, and the possible reaction of mental health professionals who perceive legislation as an unnecessary constraint in the treatment of the mentally ill.     

Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were used to examine youth receiving out-of-home treatment. Propensity score matching was used to examine the effect of out-of-home treatment on outcomes. Males, older youth, and youth with prior involuntary examinations, felony charges, misdemeanor charges, or inpatient psychiatric treatment were more likely to be placed in treatment group care. Treatment foster care placement was more likely for youth with prior treatment foster care episodes. Propensity matching results indicated that youth in treatment foster care had greater reductions in felony charges, and were less likely to return to out-of-home treatment in the following 6 months. While often placed in group care settings, youth with prior criminal justice encounters, especially for felony charges, may be better served in treatment foster care programs.     

Attention and ageing: Measuring effects of involuntary and voluntary orienting in isolation and in combination

The cueing paradigm provides an established method for eliciting involuntary and voluntary attention shifts. Involuntary orienting is traditionally measured with non‐predictive peripheral cues and voluntary orienting with predictive central arrows. Recent studies with young adults have established that predictive central arrows trigger a combination of involuntary and voluntary orienting, raising the possibility that previous studies – including those with older adults – misinterpreted their findings with central arrow cues as isolating the effects of voluntary attention. The present experiment applied different cueing conditions that measured involuntary orienting, voluntary orienting, and involuntary and voluntary orienting in combination in older adults. The results show that past studies of voluntary orienting in older adults confound involuntary and voluntary orienting. Cueing effects in a condition that for the first time isolated voluntary orienting (predictive number cues) with older adults were significant, and comparable to effects for younger adults, demonstrating that older adults successfully utilize cues to direct their spatial attention strategically. A similar normal pattern of orienting was observed for involuntary orienting. Our study provides a methodology that can be applied effectively to isolate and investigate the effects of age on voluntary and involuntary attention.     

老年人与青年人阅读空格文本的注视位置效应

采用EyeLink2000眼动仪,以14名老年人和14名青年人为被试,探讨他们阅读空格汉语文本的注视位置效应.阅读材料分为正常无空格文本和词间空格文本两种.结果发现:(1)在阅读词间空格文本和正常无空格文本时,老年人与青年人都表现出单次注视的首次注视是位于词的中心,多次注视的首次注视是位于词的开头;(2)老年人阅读正常无空格文本时对词尾的注视概率显著低于词间空格文本,而青年人则没有差异.结果表明老年人与青年人在阅读空格文本时存在注视位置效应.     

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.     

Memory and goal setting: the response of older and younger adults to positive and objective feedback

Earlier research suggested that goal setting for memory does not have the same advantages for older adults as for younger adults. Using ideal goal-setting conditions with individualized goals, the authors compared goals plus positive feedback, goals plus objective feedback, and control. Performance increased over trials and was higher for both goal conditions than for control. The positive feedback condition showed the highest goal commitment and motivation. Older adults showed strong performance gains and more motivation and goal commitment than the young. The results showed that older adults can benefit from goal setting under optimal learning and feedback conditions.     

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.     

Comparing music- and food-evoked autobiographical memories in young and older adults: A diary study

Previous research has found that music brings back more vivid and emotional autobiographical memories than various other retrieval cues. However, such studies have often been low in ecological validity and constrained by relatively limited cue selection and predominantly young adult samples. Here, we compared music to food as cues for autobiographical memories in everyday life in young and older adults. In two separate four-day periods, 39 younger (ages 18–34) and 39 older (ages 60–77) adults recorded their music- and food-evoked autobiographical memories in paper diaries. Across both age groups, music triggered more frequent autobiographical memories, a greater proportion of involuntary memories, and memories rated as more personally important in comparison to food cues. Age differences impacted music- and food-evoked memories similarly, with older adults consistently recalling older and less specific memories, which they rated as more positive, vivid, and rehearsed. However, young and older adults did not differ in the number or involuntary nature of their recorded memories. This work represents an important step in understanding the phenomenology of naturally occurring music-evoked autobiographical memories across adulthood and provides new insights into how and why music may be a more effective trigger for personally valued memories than certain other everyday cues.     

‘The witness who saw, /he left little doubt’: a comparative consideration of expert testimony in mental disability law cases in common and civil law systems

The question of how courts assess expert evidence—especially when mental disability is an issue—raises the corollary question of whether courts adequately evaluate the content of the expert testimony or whether judicial decision making may be influenced by teleology (‘cherry picking’ evidence), pretextuality (accepting experts who distort evidence to achieve socially desirable aims), and/or sanism (allowing prejudicial and stereotyped evidence). Such threats occur despite professional standards in forensic psychology and other mental health disciplines that require ethical expert testimony. The result is expert testimony that, in many instances, is at best incompetent and at worst biased. The paper details threats to competent expert testimony in a comparative law context—in both the common law (involuntary civil commitment laws and risk assessment criminal laws) and, more briefly, civil law. We conclude that teleology, pretextuality, and sanism have an impact upon judicial decision making in both the common law and civil law. Finally, we speculate as to whether the new United Nations Convention on the Rights of Persons with Disabilities is likely to have any impact on practices in this area. Copyright © 2009 John Wiley & Sons, Ltd.     

老年人和大学生决策规则稳定性的比较研究

遵守规则是理性决策的必要条件。本研究考察了222名大学生和157名老年人进行选择活动时所遵循的规则的稳定性。研究发现,大学生的选择与老年人相比,具有显著的“不规则”倾向,然而此倾向在老年人中并不存在。在面对假设的超市折扣卡时,大学生的“非规则”选择显示出他们在一定程度上缺乏理性,而老年人的“精明”决策进一步证明其与日常生活相关联的复杂认知能力如判断和推理等在老龄期依然处于较高的水平。     

U.S. involuntary mental health commitment statutes: requirements for persons perceived to be a potential harm to self

The civil commitment statutes of all 50 states and the District of Columbia were reviewed to determine: (1) What is required for a person who is believed to be at serious and imminent risk of self-harm to be eligible for involuntary hospitalization; and (2) Whether an attempt to involuntarily hospitalize was required or was merely an option when the requirements found in number 1 were met. The analysis revealed that nearly 85% of the jurisdictions require dangerousness to self to be the result of a mental illness, and only two jurisdictions mandate attempts at involuntary commitment if a person is deemed to be an imminent harm to self. These results have implications for practice with individuals who are suicidal.     

A content analysis of involuntary autobiographical memories: examining the positivity effect in old age

Although research on autobiographical memory is growing steadily, very little is known about involuntary autobiographical memories that are spontaneously recalled in everyday life. In addition, very few studies have examined the actual content of autobiographical memories and how the content might change as a function of age. The present study carried out a content analysis of involuntary autobiographical memories recorded by young (N = 11) and old (N = 10) volunteers over a period of 1 week. A total of 224 memories were classified into 17 categories according to the type of content recalled (e.g., births, holidays, school). The results support the socioemotional theory of ageing (Carstensen, Isaacowitz & Charles, 1999) by showing that although young and old adults recalled a similar number of memories with a typically positive content (e.g., holidays, special occasions), older adults recalled very few memories with a typically negative content (e.g., accidents, stressful events). Moreover, even when such negative memories were recalled, they were rated by older adults as neutral or even positive. This so-called positivity effect in old age could not be entirely explained by participants' ratings of mood at the time of recall. Theoretical and practical implications of these findings for ageing and autobiographical memory research are discussed.     

Synesthesia and number cognition in children

Grapheme-color synesthesia, when achromatic digits evoke an experience of a specific color (photisms), has been shown to be consistent, involuntary, and linked with number concept in adults, yet there have been no comparable investigations with children. We present a systematic study of grapheme-color synesthesia in children aged between 7 and 15 years. Here we show that such children (but not children with phoneme-color synesthesia) experience involuntary difficulties in numerical tasks when digits are presented in colors incongruent with their photisms. Synesthesia in children may thus have important consequences for certain aspects of numerical cognition.     

Guardianship determinations by judges, attorneys, and guardians

Guardianship is intended to protect incapacitated individuals through the appointment of a surrogate decision maker. Little is known about how judges, attorneys, and professional guardians assess the need for guardianship, to what extent they apply statutory guidelines when making these determinations, and how their decisions compare. Three groups of participants (probate judges, elder law attorneys, and professional guardians) read vignettes portraying older adults that varied in the extent to which the evidence supported the appointment of a guardian. They were asked about the appropriateness of various resolutions. Participants were reluctant to endorse full guardianship even when warranted by the evidence and preferred informal, family-based interventions that do not involve legal action. Professional groups did not always agree on the appropriate resolutions, suggesting that one's professional orientation may play a role in perceptions of older adults.     

What Right to Die?

This letter first discusses two meanings of a "right to die." In the popular sense, the term refers to a right to refuse life-sustaining treatment. In the strict sense, the term signifies an affirmative right to obtain death--a right to suicide. The letter then explores the legal implications of a suicide right. This right would extend to competent adults, mature minors, and probably also incompetent persons. Counselors would have to inform clients of the suicide option. Intervention to prevent suicide could trigger civil liability. Suicidal intentions would not justify involuntary commitment. Consent would become a defense to homicide.     

Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals

Mental health consumer advocates have long argued that involuntary treatment frightens persons with mental disorder and thus deters them from voluntarily seeking help. We surveyed 85 mental health professionals and 104 individuals with schizophrenia spectrum conditions to assess their experience with and perceptions of involuntary treatment and other treatment mandates. Of the clinicians, 78% reported that overall they thought legal pressures made their patients with schizophrenia more likely to stay in treatment. Regarding involuntary outpatient commitment, 81% of clinicians disagreed with the premise that mandated community treatment deters persons with schizophrenia from seeking voluntary treatment in the future. Of the consumer sample, 63% reported a lifetime history of involuntary hospitalization, while 36% reported fear of coerced treatment as a barrier to seeking help for a mental health problem-termed here "mandated treatment-related barriers to care." In bivariate analyses, reluctance to seek outpatient treatment associated with fear of coerced treatment (mandated treatment-related barriers to care) was significantly more likely in subjects with a lifetime history of involuntary hospitalization, criminal court mandates to seek treatment, and representative payeeship. However, experience with involuntary outpatient commitment was not associated with barriers to seeking treatment. Recent reminders or warnings about potential consequences of treatment nonadherence, recent hospitalization, and high levels of perceived coercion generally were also associated with mandated treatment-related barriers to care. In multivariable analyses, only involuntary hospitalization and recent warnings about treatment nonadherence were found to be significantly associated with these barriers. These results suggest that mandated treatment may serve as a barrier to treatment, but that ongoing informal pressures to adhere to treatment may also be important barriers to treatment.     

Gender‐of‐author differences in study design of older adult friendship surveys

This research extends literature documenting gender differences in choice of quantitative or qualitative methods by examining whether men and women make different decisions regarding study design within one type of quantitative method—survey research. The population consists of 117 surveys (1960–1999) of older adults about friendship. We find that the use of communal methods, especially by women scholars, increased over time, and researchers who are women are more likely to use “communal” survey methods than researchers who are men. The gender difference in use of communal methods is not necessarily explained by essential differences between men and women or even by gender differences in commitment to feminist research as previous scholars have argued; rather, it is possibly explained by structured differences in access to resources to do agentic research.     

Potential erosion of psychotherapist-patient privilege beyond California: dangers of "criminalizing" Tarasoff.

The "dangerous patient exception" to psychotherapist-patient privilege, adopted almost a decade before the celebrated case of Tarasoff v. Regents of the University of California (1976), was mentioned in a footnote to that decision in the context of an analogy. Although intended to permit testimony in civil commitment proceedings, this exception has been used to "criminalize" the Tarasoff duty in California. California courts eroded the privilege initially primarily to permit victims to sue psychotherapists and later to require psychotherapists to testify against their patients in criminal proceedings and appear to have confused evidentiary privilege and confidentiality. If consistent, similar reasoning in California in the future should allow therapists to testify against their patients if they were civilly committed in the past for dangerousness and attorneys to testify against their clients in criminal cases if at some earlier time they believed their clients represented a risk of future harm. Although most other jurisdictions may not word their privilege exceptions for civil commitment in the same way as California, most states have some type of privilege exception for civil commitment that could allow for such an interpretation. The United States Supreme Court in Jaffee v. Redmond (1996) found a psychotherapist-patient privilege, but stated in a footnote that an exception to the privilege would exist if a serious threat of harm to the patient could be averted only by means of disclosure by the therapist. Other jurisdictions have begun to consider these issues. Rather than being unique to California, similar reasoning could lead to the "criminalization" of Tarasoff in other jurisdictions and thereby compel therapists outside California to testify against their patients in criminal proceedings.