CLINICIAN DECISION-MAKING ABOUT INVOLUNTARY COMMITMENT

Objective: Clinicians' decision making about involuntary commitment wa s examined, with a focus on the effects of patient and clinician chara cteristics and bed availability on decisions to detain patients, the f irst step in involuntary commitment. Methods: Eighteen psychologists a nd social workers in the emergency service of a community mental healt h center completed the Risk Assessment Questionnaire for 169 consecuti ve patients they deemed to present some degree of risk. Forty-two pati ents were detained. Results: Three underlying constructs were signific antly associated with a patient's overall risk rating, which in turn p redicted the decision to detain. Two were clinician characteristics: t he clinician detention ratio, which reflects the proportion of patient s 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 co mmunity was also a significant predictor of whether a patient would be detained. No patient characteristic, including diagnosis, sex, age, o r insurance status, was significantly related to the detention decisio n. Co,Conclusions: The findings suggest that the decision-making proce ss is influenced by multiple factors, such as setting, the clinician's tendency to detain patients, and the availability of detention beds.