The effects of statutory change on the civil commitment of the mentally ill.

Abstract

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.

Civil commitment: A review of empirical research

“…Post definitional change candidates were significantly more dangerous than earlier ones in that they presented higher ratings on a dangerousness scale and showed more evidence of threats, attempts, and acts of harm directed against others. Even these post change candidates, however, were not highly dangerous: their average dangerousness rating was 2.6 on a 10 point scale; only 16 of 40 candidates performed any statutorily defined dangerous behavior; and 58% of that behavior consisted of threats, not acts (Peters et al, 1987). Peters et al (1987) also evaluated Florida's contemporaneous change in the criterion from "in need of care or treatment" to inability of "surviving alone or with the help of willing and responsible family or friends, including available alternative services."…”

“…Even these post change candidates, however, were not highly dangerous: their average dangerousness rating was 2.6 on a 10 point scale; only 16 of 40 candidates performed any statutorily defined dangerous behavior; and 58% of that behavior consisted of threats, not acts (Peters et al, 1987). Peters et al (1987) also evaluated Florida's contemporaneous change in the criterion from "in need of care or treatment" to inability of "surviving alone or with the help of willing and responsible family or friends, including available alternative services." No changes were noted in ratings on an "inability to care for self' scale or in number of cases with such evidence.…”

“…By this measure, they found no significant increase in violence after the LPS Act although there was a large increase in the number of involuntary patients and in the number of involuntary patients held as dangerous-to-others. Peters et al (1987) evaluated Florida's change in the definition of dangerousness from a vague "likely to injure himself or others" to a more specific "caus-ing, attempting or threatening ... harm within 20 days of the commitment proceeding." Post definitional change candidates were significantly more dangerous than earlier ones in that they presented higher ratings on a dangerousness scale and showed more evidence of threats, attempts, and acts of harm directed against others.…”

“…Some states amended their criteria to bring the dangerousness definition in line with court decisions requiring behavioral evidence; some raised their standard of proof to "clear and convincing" follownig the US Supreme Court's ruling in Addington v. Texas (Peters et al, 1987); and some amended their statutes simply to alleviate practical administrative problems, such as in changing responsibility for transportation to and from a state mental hospital. More recently, a few states have reversed the thrust of restrictive commitment by broadening their original commitment criteria ftom only violent behavior to include "grave disability" (Durham and LaFond, 1986).…”

A comparison of respondents in initial and recommitment hearings.

“…A considerable gap between the letter and practice of the law has been well documented for initial commitment hearings (Grouse, Avellar, & Biskin, 1982;Lipsitt & Lelos, 1981;Peters, Miller, Schmidt, & Miller, 1987;Wexler, 1981). Given the demographic, clinical, and treatment differences between respondents in initial and recommitment hearings, it will be important to assess whether this gap is even greater in recommitment hearings and whether the common practice of devising a single statute to regulate both the commitment and recommitment process is appropriate (Van Duizend, McGraw, & Keilitz, 1984).…”