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Recent judicial decisions regarding commitment under sexual predator statutes and commentary addressing the legal significance of psychopathy provide an interesting opportunity to reflect upon the exculpatory significance of psychopathy and the appropriate relationship between criminal conviction and police power civil commitment. This paper examines the legal significance of psychopathy for the purposes of criminal responsibility and of civil commitment under sexual predator statutes. By examining the significance of psychopathy for each of these legal institutions, it clarifies our understanding of the legal significance of psychopathy and of the relationship between these institutions. This process illuminates the defensible functions and boundaries of each institution and clarifies the nature of the impairment that should qualify an individual for confinement by each. This analysis interprets criminal conviction and police power commitment, including sexual predator commitment, as integrated institutions of social control intended to provide a coherent approach to psychopaths as well as to others who require state intervention under the police power. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Community psychiatric nurses (CPNs) have long been involved in the operations of the English Mental Health Acts. Research has shown that compulsory detention is not used uniformly or consistently. Rates of involuntary hospitalization are reported to vary widely across Europe, but there is some consensus on patient profiles. The ethnicity, social status and gender of the patient, the involvement of the police, the availability of care, problems caused to relatives, and the country and particular legislative system where these judgements take place, all influence who is compulsorily detained. This article reviews recent evidence from Europe and argues that involuntary psychiatric care can no longer be seen as entirely dependent on the symptoms and behaviour of the patient and that CPNs should be aware of and reflect upon these factors before invoking the detention process. [ABSTRACT FROM AUTHOR]

This paper explores some of the controversies in the debate regarding the justification of civil commitment. The sometimes conflicting values reflected in the mental health legislation, human rights principles, moral philosophy and psychiatric professional standards are discussed. In spite of the often substantial use of civil commitment in many countries, there are almost no scientifically sound studies addressing the outcome of coercive treatment. The paper establishes that the traditional arguments in favour of civil commitment, like lack of insight and competence as well as the effectiveness of civil commitment, are poorly founded. The paper concludes that there seems to be a general agreement that civil commitment of patients who are dangerous to themselves or others should be the responsibility of the mental health care system, while civil commitment for treatment purposes is more controversial and hard to justify. [ABSTRACT FROM AUTHOR]

Objective: Coercion during psychiatric admissions has been a topic of debate for many years. Although there has been considerable research on patients' perceptions of coercion, there has been no work on who places pressures on patients to be admitted. Method: This article integrates interview data from interviews with patients, admitting staff and family and friends to describe the pressures brought to bear on patients to be admitted. Results: Health-care professionals appear to be the most important source of pressures on patients, and to have the most impact on patients' perceptions of coercion. However, there are differences in type of pressure, and the pressures used by family and friends appear to having the most longstanding impact. Conclusion: Legal and clinical efforts to reduce the level of coercive pressures on patients need to recognize the importance of mental-health professionals, including especially those who are not legally mandated to participate in the admission process. [ABSTRACT FROM AUTHOR]

The article discusses New Zealand's medical laws in relation to compulsory treatments in the mental health field and the prevention of unlawful detentions. The coercive powers that are available under New Zealand's Mental Health (Compulsory Assessment and Treatment) Act 1992 are mentioned, along with the definition of "mental disorder" and the legal rights of mentally-ill individuals and potential patients. A necessity test is also examined.

The article focuses on meetings of the Virginia's Joint Subcommittee Studying Mental Health Services in the 21st century held in 2014. Topics include an overview of the Virginia's mental health services system, presented by Debra Ferguson, Director of Virginia Department of Behavioral Health & Developmental Services; Virginia's mental health commitment laws; and Children mental health issues in Virginia.

Self-binding directives (SBDs) are a special type of psychiatric advance directive by means of which mental health service users can give advance consent to compulsory hospital admission or treatment during a future mental health crisis. SBDs are legally binding in the Netherlands since 2008. On the 1st of January 2020, the Dutch Law on Special Admissions to Psychiatric Hospitals (Wet bijzondere opnemingen in psychiatrische ziekenhuizen; Bopz) was replaced by the new Law on Compulsory Mental Health Care (Wet verplichte geestelijke gezondheidszorg; Wvggz). This replacement brought with it various changes in the legal arrangement for SBDs. In this article, we expound the changes in the legal arrangement and assess the implications of these changes for the practical feasibility of SBDs. We argue that the procedures for arranging compulsory care based on an SBD in the new law are too complex and time-intensive for SBDs to yield their potential benefits. We close by proposing a workable mechanism of legal authorisation of compulsory care on the basis of an SBD. [ABSTRACT FROM AUTHOR]

The Netherlands became State Party to the United Nation Convention on the Rights of Persons with Disabilities (CRPD) in 2016, a treaty that holds great promise for promoting and protecting human rights of persons with mental disorders. Yet, the Dutch government also made explicit reservations to the Convention. On 1 January 2020, the Netherlands introduced a new mental health law, the Compulsory Mental Health Care Act (CMHCA), which aims to strengthen the legal status of persons with psychiatric illnesses. To which extent does the new Dutch mental health law comply with the regulations as outlined in the CRPD? In this article, we examine how coercive interventions, specifically the elements of competence, involuntary treatment and involuntary admission are regulated in the domestic legislation and compare them to the CRPD approach. A normative analysis combined with literature review helps to understand the law, reveal the gaps and uncover the barriers that remain. Is there a need to reassess the domestic legal provisions allowing for coercive treatment, and if so, what advancements are required? After all, should the CRPD be strictly adhered to at all times? [ABSTRACT FROM AUTHOR]

The practice of involuntary psychiatric commitment is central to the acute treatment of persons with severe mental illness and others in psychiatric crisis. Deciding whether a patient should be admitted involuntarily requires weighing respect for autonomy against beneficence, considering the clinical needs of the patient, and navigating ambiguous legal standards. The relative dearth of information about the impact of involuntary commitment on objective patient outcomes complicates matters ethically, legally, and clinically. To address this gap in the literature, we sought to determine the association between temporary psychiatric holds and length of stay and readmission rates among a retrospective sample of adult patients admitted to a large psychiatric hospital with diagnoses of schizophrenia, schizoaffective disorder, mania, and other psychotic disorders. In total, we identified 460 patients and 559 unique encounters meeting our inclusion criteria; 90 of the encounters were voluntary (involving a temporary psychiatric hold) and 469 were involuntary. Univariable and multivariable analyses suggested that temporary psychiatric holds were not significantly associated with either length of stay or readmission rate. These findings are relevant to clinicians who must decide whether to admit a patient involuntarily, as they suggest that making a patient involuntary is not associated with differences in length of stay or readmission risk. [ABSTRACT FROM AUTHOR]

Mentally disordered patients may be said to have rights in two senses: negative rights to freedom from arbitrary detention or interference with their person," and positive rights to expect a certain minimum standard of service, be that in terms of treatment as an in-patient, or as a patient in the community. The Labour government has appointed a 'scoping group' to carry out a root-and-branch review of the Mental Health Act 1983. The 1983 Act was mainly concerned with in-patient treatment. The group is to look at the scope for introducing further compulsory powers in the community, enhancing the rights of carers and relatives, and is to take account of recent British and Strasbourg case law. The primary impact of the Convention on psychiatric patients has been in relation to protection against arbitrary detention under Article 5, unsoundness of mind being one of the permitted grounds of deprivation of liberty under Article 5 (1) (e). This article explores the potential impact of Convention rights in developing what Gostin referred to in the early 1980s as a 'new legalism'. The new legalism linked concern for traditional rights to due process and review by the courts or other external bodies with the 'ideology of entitlement' to adequate treatment and services. The article outlines the current policy context of mental health services and looks at the development by the European Court of Human Rights of positive Convention rights to services out of Article 5, whose purpose seems at first sight to be the protection of due process rights. It examines the relevance of Convention rights to community powers.(n1) [ABSTRACT FROM AUTHOR]

Examines the civil commitment laws and national future trends in California. Development of medications to treat the mentally ill; Restriction of state power to commit mentally ill persons against their will; Change of the civil commitment of procedures of some state to end past histories of long hospitalizations without any review.

Investigates the relation between England and the Saint Mary of New Bethlehem hospital in London, England which was used to confine the insane during the eighteenth and nineteenth centuries. Origin of the hospital; What was the founders' intention for the hospital; Details on the life of Goffredo de Prefetti, a bishop; Background information on the hospital.

The article examines the issue of involuntary outpatient commitment and its implications for social workers working in the mental health system. In layman's language, involuntary outpatient commitment is the legal and psychosocial process whereby an allegedly mentally disordered and dangerous person is forced to undergo mental health treatment or care in an outpatient setting. It is opined that judges are reluctant to commit people to preventive commitment. When they do, almost half of the people committed are inappropriate candidates for this type of commitment. Inappropriate outpatient commitments most frequently occur when the judge is convinced that further treatment is advisable but feels that the legal evidence is insufficient to justify inpatient commitment. It is opined that involuntary out-patient commitment should be used cautiously; and it requires much more of the mental health system than traditional commitment does. Likewise, involuntary outpatient commitment requires more time from mental health staff and judges, more resources, knowledge of these resources, supervision of patients, monitoring of the commitment conditions, and a system of revoking the commitment.

Focuses on the outpatient civil commitment scheme for the mentally ill in North Carolina. Historical background and design of the outpatient commitment scheme; Constitutional difficulties with the implementing statute; Practical problems with administration of the scheme; Prospect of forcible medication.

This article cites a study that examined diagnostic and demographic characteristics of six groups of voluntary and committed patients over a three-year period in order to assess the impact of a change in civil commitment procedures in the state of Missouri. Committed and voluntary patients differed on the basis of several demographic and behavioral variables, including diagnosis, employment status, and instances of serious physical harm recorded on admission. No differences were found between patients committed under the old law and patients committed under the new law.

The article cites a study which used step-wise multiple regression procedures to predict length of hospitalization of 225 defendants acquitted by reason of insanity in New York state. There is a lack of adequate information on those factors that might influence the length of hospitalization of criminal defendants who, after a verdict of "not guilty by reason of insanity" (NGRI), are hospitalized mandatorily. Subjects in the present study were all 225 persons who were adjudicated insane during the period September 1, 1971 to June 30, 1976. In accordance with New York law, after the NGRI verdict, all subjects were committed mandatorily to a state civil mental hospital. The study focused on total patient hospital days from the post-acquittal hospitalization until April 30, 1980. Using a forward stepwise procedure 21 variables available at the time of mandatory hospitalization were analyzed by means of the regression equation method. As results of the study indicate, the development of a meaningful predictive equation for length of hospitalization employing the 21 variables available on hospitalization for NGRI acquittees, was not possible.

The article examines the U.S. Supreme Court ruling in the case of Foucha vs. Louisiana which held that a state may not confine an insanity acquittee indefinitely in a mental institution once he has regained his sanity, solely on the basis of his continuing dangerousness. The author argues that an acquittee should be released once he is no longer insane. He challenges the Court's holding on equal protection grounds, explaining some similarities and differences between dangerous insanity acquittees and other sane-but-dangerous offenders. Finally, he stresses that the heightened standard of scrutiny created by Justice O'Connor in her concurrence, while appearing to protect the interests of insanity acquittees, does not go far enough; ultimately, her standard will have little practical impact on their release.

Investigates the effects of a state commitment law in New Jersey that combines use of the dangerousness criterion, screening for less restrictive alternatives and a new mental health structure. Commitments by year and type of hospital; Proportion of screenings by year and type of hospital; Factors accounting for increase in commitments; Failure to realize a decrease in state-hospital commitments.

The right to refuse treatment seems well established for psychiatric patients. Individual states, however, have very different procedures for managing this right and for overriding the refusal. Oregon’s administrative procedure for override depends on an evaluation by an independent examining psychiatrist. This article empirically examines the 432 refusals leading to override requests in three Oregon psychiatric institutions in 1983 and 1984. Treatment refusal was found to be a common occurrence in all age groups. Those who refused treatment were seriously ill, unemployed, singled individuals with previous psychiatric hospitalizations. Most refused treatment because of denial of their illness or delusional thinking about medication. Most refusals were overridden following the independent psychiatrist’ examination. Because of the significant cost of the override procedure to the patient and the mental health system, the authors propose a new procedure which combines parts of the current procedures with a requirement that, at the time of the civil commitment hearing. [ABSTRACT FROM AUTHOR]

This paper explores the development of the informed consent doctrine as it relates to psychiatric practice. The contribution of the issues of civil commitment and the right to refuse treatment to current developments in the informed consent doctrine is also addressed. Special informed consent issues are related to specific categories of psychiatric treatments. Basic informed consent requirements in psychiatry are seen as still in the formative stages but he constitutional law and common-law foundations for further developments are outlined. The complicated clinical, ethical, and legal issues involved in modern psychiatric treatment are stimulating new interest and concern about the informed consent doctrine throughout medical practice. [ABSTRACT FROM AUTHOR]

The evolution of civil commitment procedures is seen as reflecting changing social and ethical values regarding individual liberty versus protection of self and others. The dilemma of dealing with the modern suicidal patient places the psychiatrist at the interface of conflicting a societal expectations. The legal aspects of civil commitment are seen as not necessarily compatible with the best clinical course for the suicidal patient. The relationship of the process of the civil commitment to the process of treatment is briefly explored. [ABSTRACT FROM AUTHOR]

Presents several books on behavioral science. "Child Abuse in Huntingtons Disease," by L. S. Pearlstein and C. B. Brill; "Child Custody—A Study of Families After Divorce," by D. A. Luepnitz; "Mental Disabilities and Criminal Responsibility," by D. McDonald and H. Fingaret; "Sexual Phenomena, Hypnosis, and Nitrate-Oxide Sedation," by C. Lambert.

This article reports on the substantial changes made by the U.S. Congress on October 12, 1984, in the rules governing the insanity defense contained in the Comprehensive Crime Control Act. As part of the shift away from the rights of the criminal toward the interests of society, a shift also evident in recent Supreme Court decisions, this new anti-crime package makes it tougher for defendants to gain pretrial and presentencing release, increases penalties for bail jumping, authorizes judges to impose supervision on defendants after prison terms are complete, and stiffens penalties for drug trafficking. The legislation also creates a commission to write uniform sentencing guidelines binding judges in federal cases unless they dissent in writing and legislates for the first time how the insanity defense should be used in federal insanity trials.

Focuses on the justifications for involuntary psychiatric commitment and the procedure by which such commitment is accomplished. Constitutional standards that justify civil commitment; Pro-Treatment critics versus Pro-Rights critics; Evidentiary requirements for civil commitment; Limited case study of commitment hearings in a public mental hospital in Virginia.

In this comment on the decisions of the California Supreme Court in Tarasoff v. Regents of the University of California, Dr. Stone argues that if society wishes to introduce greater safeguards into involuntary civil commitment procedures, it must be willing to accept an increased risk from those of the mentally disturbed who are potentially violent. Although there are circumstances in which it will be appropriate for the psychotherapist to warn the police of danger posed by his patient, it is counterproductive to impose upon psychotherapists a duty to provide additional or alternative protection by warning potential victims. Such a duty, he explains, is incompatible with an effective therapeutic relationship and would deter both patients and therapists from undertaking treatment, thereby further increasing the risk of violence to which society is exposed. [ABSTRACT FROM AUTHOR]

Discusses problems created by compulsory civil commitment in the U.S. Limitations on the state's power to commit; Procedures required to ensure a fair and accurate determination; Rights and obligations of hospitalized individuals.

Discusses about the concept of outpatient civil commitment (OPC). Effect of OPC to rehospitalization;Effectiveness of OPC; Process of terminating OPC.

Discusses the perpectives of mental health service consumers on mandatory treatment. Opposition to the concept of forced treatment; Effect of forced medication; Basis of mandatory treatment on recovery and healing.

Examines the therapeutic jurisprudence of mandatory treatment. Rights of mental patients; Administration of mandatory treatment; Provisions of mandatory treatment.

Discusses the experiences and perspectives of families of persons with severe, persistent mentall illness regarding mandatory psychiatric treatment. Risk of mandatory treatment; Role of family in mandatory testing; Difficulty of families' in the decisions they make regarding mandatiry testing.

This article introduces the articles published in the April 1977 issue of the periodical "Law & Society Review." The convergence of the articles in this issue is the product of independent research upon two problems of widespread concern. An article examines civil commitment of the mentally ill in very different jurisdictions: urban California and rural North Carolina. A gap that plagues all contemporary western legal institutions is the divergence between procedural ideals and practices. Both groups of articles also provide additional examples of the selectivity of legal institutions. One reason for this selectivity is that legal institutions in capitalist societies are reactive rather than proactive. Family, neighbors, and bystanders initiate civil commitment of the mentally ill. Even when the police are involved, they are almost always responding to a citizen's call. A complex interrelationship between what an individual feels he has a right to expect from others, what the individual believes will happen if he asserts that the expectation has been disappointed, banters against access to informal and formal institutions in which such a grievance may be asserted, and the failure of those institutions to conform to substantive and procedural rules, or to provide the remedy proffered, ensure that legal institutions will continue to be used selectively by those who need them least.

One hundred persons who were committed involuntarily to mental hospitals on 72-hour holds under California's Lanterman Petris-Short Act (1967). and who filed writs of habeas corpus were observed during petition hearings. Involuntary commitment criteria were frequently "bargained down" from dangerous to others, dangerous to self, and gravely disabled during the 72-hour hold to gravely disabled at petition hearing. Most frequently used criteria for continued hospitalization as gravely disabled included prior hospitalization, refusal to take medication, and failure to cooperate with the hospital system. Persons adjudged dangerous to self were generally suicidal in action or talk. Although a minority of person judged at the petition hearing to be dangerous to others were assaultive or threatening, evidence for the imminence and seriousness of dangerousness was not offered. [ABSTRACT FROM AUTHOR]

Court proceedings and records were analyzed to evaluate statutory reform of mental commitment procedure in one state with a typical statute. A marked improvement over practice described in previous research was found: court proceedings were not rapid and perfunctory. However, the court still often deferred to psychiatric opinion even when a preponderance of evidence showed it to be unsubstantiated. [ABSTRACT FROM AUTHOR]

Civil commitment recently has come to replace the insanity defense as the most controversial issue in mental health law. While the resident population of state mental hospitals has plummeted in the past decade, cries that commitment be abolished altogether are heard with no decrease in fervor. Many others feel that the pendulum has swung too far, that patients' rights and community care have been seized upon by fiscally conservative legislatures to cease providing any care at all to mentally disordered persons. The philosophical and constitutional arguments for and against civil commitment have been well articulated. No breakthroughs appear on the horizon in such "basic" research areas as diagnostic reliability, predictive accuracy, or the efficacy of therapeutic treatment. Therefore, the best hope for improving public policy in dealing with the psychologically disturbed lies not in increasingly redundant polemics or in rehashing familiar data on the primitive level of mental health expertise. Rather, the task at hand is empirically to exploit the numerous social experiments currently under way in the area of commitment reform so that in the future we might make a more informed assessment of the array of policy alternatives.

Responsibility for the civil commitment process currently is shared between the justice and mental health systems. Neither system, however, owes substantial loyalty to the goals of civil commitment. The result, as documented in numerous empirical studies, is that the ostensible goals of the process are routinely subverted in favor of other systemic interests. Most reform efforts to date, focused on altering legal rules to conform to doctrinal desiderata, have ignored this problem, leading to uneven and disappointing outcomes. A systems perspective on these problems suggests that one means of dealing with systems whose loyalty to a task is questionable is to create an independent system with the incentives to give primacy to the task in question. The implications of this analysis for civil commitment are explored. [ABSTRACT FROM AUTHOR]

This study followed a large, statewide sample of civil commitment candidates both in and out of the hospital for 6 months following their postcourt hearings to determine their postcourt dangerousness. It objectively measures dangerousness by dividing it into five legal components of behavior: (1) type, (2) object, (3) frequency, (4) weapon/means, and (5) severity of outcome. Using data from ward charts, readmission evaluations, recommitment affidavits, and arrest and community mental health center records, it describes candidates' dangerousness in terms of those five components and compares that dangerousness with the alleged dangerous behavior that brought them into the civil commitment process. It finds that candidates do not tend to be dangerous in the 6 months following their court hearings. [ABSTRACT FROM AUTHOR]

The research literature on the treatability of forensic patients is sparse and fragmented. Employing available studies, we argue for a radical rethinking of treatability within the criminal justice system as a complex predictive task that tests the very limits of clinical competence. Issues that must be addressed in examining treatment needs of mentally disordered offenders include (a) making cross-situational predictions, (b) determining the relationship, if any, between the mental disorder and criminal behavior, and (c) establishing the likelihood of treatment compliance, favorable treatment response, and the availability at some future date of recommended interventions. [ABSTRACT FROM AUTHOR]

Despite the demonstrated prevalence of severe mental disorder among jail detainees and the legal mandate to provide mental health services, most jails do not have the resources to incorporate traditional, time-consuming psychological assessment techniques into their routine intake process. As a result, a number of mentally ill jail detainees remain undetected and untreated. This study outlines the development of the "Referral Decision Scale" (RDS), which detects persons who have a high probability of having a severe mental disorder so that they can be given a complete diagnostic evaluation. The 14-item RDS was statistically derived using discriminant analysis from data collected via the NIMH Diagnostic Interview Schedule on 728 randomly selected male jail detainees and then validated on 1,149 prison inmates. The final validated version of the RDS had an overall sensitivity of 0.791, specificity of 0.987, and positive and negative predictive value of 0.791 and 0.013, respectively. Since these statistics far exceed current detection rates, the RDS is likely to facilitate the diversion of mentally ill detainees in situations where it is impractical to administer psychological examinations to all incoming inmates. Training requirements for the RDS and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

This research note presents data about mentally disordered offenders (MDOs) treated in inpatient psychiatric services. Data are derived from 1980 admission surveys by the Survey and Reports Branch, National Institute of Mental Health (NIMH). These data report for the first time inpatient services provided to MDOs by non-Federal general and private hospitals. A total of 31,773 MDOs were admitted, with 85% going to state and county mental hospitals. The largest group, including admissions for evaluation, was ISTs (58%), followed by mentally disordered prisoners (32%), NGRIs (8%), and MDSOs (3%). Women and whites tended to be over-represented among MDOs as compared to prison and jail inmates. Clear diagnostic differences by legal status were found, with schizophrenia predominant among NGRIs (81%) and alcohol and drug abuse disorders more frequent among ISTs. Overall, state and county hospitals in both 1967 and 1980 were the primary locus of care for mentally disordered offenders. [ABSTRACT FROM AUTHOR]

Two factors thought to influence jurors' penalty decisions in capital trials--the nature of the crime committed and the defense's portrayal of the convicted offender's character--were examined. Mock jurors were death-qualified and exposed to one of twelve simulated penalty trials. Each "trial" was comprised of one of three capital crimes and one of four defense strategies. Jurors were least punitive in "robbery-murder" conditions and most punitive in "multiple murder" conditions. A conceptual argument against capital punishment was the most effective defense; a -mental illness" defense was the least effective. Penalty decisions were mediated by three attributional variables: (a) juror perceptions of the defendant's volition. (b) juror perceptions of the defendant's future dangerousness, and (c) juror perceptions of the relative competency of the opposing attorneys. [ABSTRACT FROM AUTHOR]

During the past decade the courts have taken an increasingly active rule in shaping the physical facilities that house environmentally captive individuals. Perhaps the most influential of these cases was Wyatt v. Stickney (1972), which has been cited as a basis for standards promulgated by other courts (e.g., Davis v. Hubbard, 1980), for model standards (Staff, 1977), and for changes made by administrators fearing litigation (Sommer & Kroll, 1979). Despite this widespread acceptance, there was no apparent empirical basis for, or validation of, the standards. The purpose of the present study was to assess the validity of the behavioral assumptions underlying the Wyatt standards regarding physical changes intended to ensure patient privacy. Patient perceptions of privacy were examined on two units in a facility that met the standards mandated in Wyatt. The results demonstrated that although some of the court's assumptions were valid, several were not, and that overall the standards in this influential case do not ensure patient privacy for the institutionalized mentally ill. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Several states have revised their civil commitment statutes in recent years. A majority of the recent revisions reflect judicial directives to provide more explicit commitment criteria, but in some instances, criteria have been broadened in reaction to the difficulty of getting some individuals hospitalized under strict criteria. Such statutory changes have impacted considerably on both process and outcome of the civil commitment system. Adoption of explicit commitment criteria has resulted most visibly in substantial reduction of hospital admissions and census. The present study examines the impact of explicit changes in commitment criteria in Florida following the 1982 enactment of amendments to the Baker Act. A total of 80 commitment hearings are reviewed before and after the law took effect to determine procedural effects of the law on degree of defense counsel advocacy, client dispositions, and on the court's adherence to more explicit criteria. State hospital admissions, discharge, and census information is examined in order to identify the larger impact of 1982 statutory changes on the commitment system. Evidence from hearings and state data suggests that changes in the Florida law impacted significantly on both process and outcome of the civil commitment system. Clients referred to commitment hearings are more dangerous, and may represent a new "hard-core" group remaining after more explicit eligibility criteria are applied by local intake, and emergency detention facilities. State hospital admissions and census in Florida declined significantly following enactment of the 1982 law, consistent with findings from other states enacting similar statutory reforms. Implications for deinstitutionalization policy and administration are discussed. [ABSTRACT FROM AUTHOR]

The introduction of a dangerousness standard for civil commitment over the last 15 years has fueled considerable concern regarding the proper role for the mental health professional in this exercise of state power. Research and debate regarding this question has focused overwhelmingly on the low validity of dangerousness predictions, and calls for the abolition of this standard have arisen from several camps. Recently, however, a growing number of commentators have proposed an ameliorationist position, arguing that it is impossible for mental health professionals to avoid the task of assessing and managing dangerousness, and that the field must develop techniques for doing it better, rather than insisting that it cannot be done. This paper argues that establishment of a descriptive research base in this area has been generally overlooked, but that such knowledge is necessary in order to assess the feasibility of the ameliorationist position. [ABSTRACT FROM AUTHOR]