An empirical comparison of the stone and dangerousness criteria for civil commitment

Compulsory admission of mentally ill patients in European Union Member States

BACKGROUND AND AIMS

A standardised and systematic analysis of commitment laws in the European Union Member States is still missing. This study aimed at gathering, describing and analysing information on the differences or similarities of legal frameworks for involuntary placement and treatment of mentally ill patients across the European Union Member States.

METHOD

Information was gathered by means of a detailed questionnaire filled in by experts from all EU Member States. Legal criteria for compulsory admission and details of the assessment and decision process of compulsory admission are outlined.

RESULTS

Although common patterns among Member States can be identified upon comparison of crucial legislative or procedural details, these patterns are far from being consistent across all analysed items or approaches. With regard to compulsory admission quotas no significant influence of legal commitment criteria and the involvement of judicial authorities could be found, but Member States with an obligatory inclusion of a legal representative during the commitment procedure showed significantly lower compulsory admission quotas.

CONCLUSION

Results of this study show the strong necessity for further research in this field. Common international health reporting standards as annually updated involuntary placement rates detailed for regular and emergency cases seem to be essential.

Mental health law: an idea whose time has passed

In this paper I argue that specific mental health law should not exist and should be replaced by modern guardianship law which is non-discriminatory and which intervenes according to need rather than diagnostic classification. Substituted consent provided by a guardian protects the patient and the treatment provider. Custody to prevent danger to others should remain with courts rather than informal proceedings where individual rights to freedom are less carefully protected. Special mental health law stigmatises people with mental illness and degrades their treatment. It also diminishes the standing of the psychiatric profession which advocates the continuation of such laws.

Involuntary Commitment in the Prehospital Setting

Introduction:

Suicidal patients who refuse prehospital transport pose a difficult problem for emergency medical services. A survey was conducted in an attempt to assess the current strategies for involuntary transport of such patients.

Methods:

The medical directors of 135 of the largest EMS systems in the United States were mailed a questionnaire requesting descriptions of the operating procedures for dealing with suicidal patients who refuse transport.

Results:

Fifty-nine of 130 questionnaires (45%) were returned. Seventeen emergency medical services (EMS) systems (29%) serve populations of less the 250,000, while 41 (69%) serve populations greater than 250,000. Cumulatively, respondents represent an excess of 2.1-million EMS responses per year, of which 0.5%-10.0% involve behavioral emergencies. Eleven of the 59 responding systems (19%) have urritten, explicit policies guiding the management of suicidal patients who refuse to be transported. Involuntary commitment proceedings are initiated in the prehospital setting in 25 of the 59 services (42%). Of these 25, the initiation of commitment proceedings is performed by the following (more than one may apply to a given system): 11 (44%) by base-station physicians, six (24%) by the emergency medical technician (EMT), 23 (92%) by a police officer, and five (20%) by family or friends. Ten of the 59 systems (17%) require a mental health delegate to authorize commitment. Two physicians can mandate involuntary commitment in one of the responding systems. Of the 25 systems that actually perform involuntary commitment in the prehospital setting, seven (28%) have established policies. Of the 34 systems which do not perform involuntary prehospital commitment, four (12%) have policies to guide the care of suicidal patients who refuse care.

Conclusion:

Suicidal patients commonly confront emergency medical services, yet many systems lack explicit policies for dealing with such patients. Widely varied strategies are used to authorize transport of patients who are suicidal and refuse to be transported.