Am J Psychiatry 1991; 148:28-33
Copyright © 1991 by American Psychiatric Association
Decision making in psychiatric civil commitment: an experimental analysis
RM Bagby, JS Thompson, SE Dickens and M Nohara
Department of Psychology, Clarke Institute of Psychiatry, Toronto, Ont., Canada.
OBJECTIVE: Legislation in Canada and the United States that was intended to
decrease the use of civil commitment has resulted in a paradoxical increase
in involuntary hospital admissions. To elucidate the reasons for this
increase, this study was designed to assess the relative importance of
various factors involved in the decision to commit a patient. METHOD: All
psychiatrists in Ontario were sent a questionnaire asking them to make
commitment decisions based on hypothetical case vignettes. Four factors
were systematically varied in the vignettes: the patients' legal
commitability, clinical treatability, alternative resources, and psychotic
symptoms. Completed questionnaires, with three vignettes each, were
returned by 495 respondents. RESULTS: All four variables were statistically
significant in the expected direction; legal commitability (i.e.,
dangerousness to self and/or others, inability to care for self) and
presence of psychotic symptoms accounted for the majority of the variance
in the final decision to commit. CONCLUSIONS: These results suggest that
psychiatrists in Ontario rely primarily on legally mandated factors (i.e.,
psychosis and dangerousness) in making their decisions to commit, although
a considerable amount of individual variation is also evident.
