Clinicians' Decision Making About Involuntary Commitment

OBJECTIVE: Clinicians' decision making about involuntary commitment was examined, with a focus on the effects of patient and clinician characteristics and bed availability on decisions to detain patients, the first step in involuntary commitment. METHODS: Eighteen psychologists and social workers in the emergency service of a community mental health center completed the Risk Assessment Questionnaire for 169 consecutive patients they deemed to present some degree of risk. Forty-two patients were detained. RESULTS: Three underlying constructs were significantly associated with a patient's overall risk rating, which in turn predicted the decision to detain. Two were clinician characteristics: the clinician detention ratio, which reflects the proportion of patients detained by the clinician in the past three months, and the setting in which the evaluation occurred, either an in-house emergency service or a mobile crisis unit. The availability of detention beds in the community was also a significant predictor of whether a patient would be detained. No patient characteristic, including diagnosis, sex, age, or insurance status, was significantly related to the detention decision. CONCLUSIONS: The findings suggest that the decision-making process is influenced by multiple factors, such as setting, the clinician's tendency to detain patients, and the availability of detention beds.