Civil commitment in the psychiatric emergency room. II. Mental disorder indicators and three dangerousness criteria

Abstract

Proponents of return to a "need for treatment" standard for civil commitment contend that the current dangerousness standard forces psychiatrists to neglect severely ill patients in favor of those who are less ill but dangerous to others. Among 198 psychiatric emergency patients in five facilities, those rated as most dangerous on Three Ratings of Involuntary Admissibility, a reliable index of indicators employed by clinicians in evaluating danger to self, danger to others, and grave disability, were also most severely ill on diagnostic and symptomatic assessments of mental disorder. Clinicians' Global Ratings of patient dangerousness on the three criteria were similarly related to severity of diagnosis and symptoms. Perceived dangerousness was associated with major mental disorder and severity of most symptom types, especially impulsivity. Danger to self was the criterion related to the fewest indicators of mental disorder.

Causal path model predicting assessment of Three Ratings of Involuntary Admissibility (TRIAD) severity of dangerousness scores from three components of mental disorder. Partial standardized regression coefficients, given with arrows, are significant at P<.01 (NS indicates not significant). Three equations delineate relationships: (1) x₁= 1.1 + 0.35×₂ + 0.02×₃ + 0.27×₄, R = .54, 29% of variance accounted for by predictors; (2) x₂ = 0.41 + 0.27×3 + 0.39×₄, R=.57, 33% of variance accounted for by predictors; (3) x₃ = 0.12 + 0.47×₄, R = .47, 22% of variance accounted for by predictors. In each question, n = 198, P<.001.