Need for treatment and New York's revised commitment laws: An empirical assessment

Abstract

In recent years, psychiatric and law journals have been concerned with the nature and impact of “the new commitment laws.” The emphasis in these laws is alleged to be on patients’ civil liberties, alternatives to hospital commitment, and community based treatment resources (Shore, 1978; Cockerham, 1981; Gove et al., 1982). These laws appear to be informed in part by the following elements of the 1972 American Psychiatric Association position statement: (1) most persons who need hospitalization should be admitted voluntarily; (2) community based outpatient facilities should be used in place of inpatient hospital admissions as far as possible; (3) involuntary care should be reserved for persons who may harm themselves or others; and (4) involuntarily committed persons who are hospitalized should be provided full legal rights of due process. Despite these aims, which have not always been incorporated perfectly in the new laws, the most recent theoretical literature indicates that the criteria for involuntary hospitalization and due process are so vague that they are ultimately unworkable and ill-advised (Diamond, 1974; Arons, 1977; Schoenfeld, 1977; Toews et al., 1980; Langman, 1980; Shah, 1981a, 1981b; Wexler, 1981). Furthermore, most of the empirical studies of the impact of the new laws indicate, first, that a sizable portion of involuntarily committed patients are not admitted to inpatient care following the mandatory observation period; second, that involuntary commitments continue to outnumber voluntary admissions; third, that patient recidivism is increasing; and finally, as Hiday (1983, p, 114) recently put it, “there is still lingering deference to psychiatric recommendation, commitment without evidence of facts of dangerousness, and passive or nonadversary counsel.” These generalizations may be drawn from the Gudeman et al. (1976) study of Hawaii patients; Luckey & Berman’s (1979, 1981) studies in Nebraska; Miller & Fiddleman’s (1981, 1982) and Hiday’s (1982) studies in North Carolina; Haupt & Ehrlich’s (1980) study of Pennsylvania patients; Lipsitt & Lelos’ (1981) study in Massachusetts, Shore et al. (1981) study of Oregon patients, and Hiday’s (1983) recent review of studies in mental health law. New York State’s revised commitment laws have not yet been empirically