THE TREATMENT OF DANGEROUS PATIENTS IN MANAGED CARE - PSYCHIATRIC-HOSPITAL UTILIZATION AND OUTCOME

The legal criteria for civil commitment dictates that individuals must be mentally ill, and either a danger to themselves, a danger to other s, or substantially impaired in their ability to provide for their bas ic needs. These criteria, which have been adopted as medical necessity criteria by managed care programs, may result in a change in the clin ical mix of the psychiatric inpatient population. The present study as sesses the incidence of dangerousness among psychiatric inpatients and compares dangerous and nondangerous patients in terms of characterist ics and treatment outcomes. The results indicate that for a large regi onal managed cave program, 30% of psychiatric inpatients have a histor y of dangerousness in the past year. Patients who are rated as dangero us to others during admission have higher rates of complications for t reatment and psychiatric disorders such as residential and vocational instability, family disruption, and higher premorbid dysfunction. They are also more likely to engage in disruptive and aggressive behavior during their hospital stays. Despite the higher incidence of acute and long-term dysfunction for dangerous patients, their hospitalization l ength of stay was comparable to that of patients not rated as dangerou s. (C) 1997 Elsevier Science Inc.