Sectioned Research Articles

A person suffering: On danger and care in mental health law

The law of mental health authorizes involuntary detention in a psychiatric facility, in the absence of wrongdoing, of competent persons suffering from mental disorder likely to result in harm. Some jurisdictions are said to justify detention exclusively on the basis of danger prevention alone, thus predicating any ensuing treatment on the detainee’s categorical dignitary right to refuse treatment even while detained. Other jurisdictions are said to justify detention also on the basis of the detainee’s need of treatment, thus rendering the authorization to detain as a concomitant authorization to apply compulsory treatment. This article argues that ‘dangerousness’ is conceptually insufficient to justify detention in a psychiatric facility. If danger prevention per se were the only purpose of detention, then a psychiatric facility could perhaps be viewed as a permissible, but certainly not as the necessary, locus of authorized detention. Two propositions follow from this observation. The first is that need of treatment, in addition to danger prevention, must be a criterion of mental health law detention. The article formulates this proposition through a detailed reading of the detention provision in the Ontario (widely regarded as a ‘dangerousness’ jurisdiction) Mental Health Act and relevant case law. The second proposition is that, as much as the right to refuse treatment, regular and ongoing access to treatment is, therefore, a necessary condition of the justifiability, if any, of mental health law detention. The article develops this proposition through analysis of recent Ontario case law on the constitutionality of mental health law detention. The upshot is that failure to offer treatment is as inconsistent with constitutionally recognized liberty interests as the imposition of treatment in the absence of consent. By way of conclusion, the article focuses on what might be called the turn to criminal law to elaborate and affirm, by analogy, the rights of mental health law detainees. The article suggests that, while helpful, the turn to criminal law, because it brings into relief the dimension of danger to others, may also obscure the specific conceptual core of mental health law addressing danger to self.

Building an Integrated Data Infrastructure to Examine the Spectrum of Suicide Risk Factors in Philadelphia Medicaid.

While there are many data-driven approaches to identifying individuals at risk of suicide, they tend to focus on clinical risk factors, such as previous psychiatric hospitalizations, and rarely include risk factors that occur in nonclinical settings, such as jails or emergency shelters. A better understanding of system-level encounters by individuals at risk of suicide could help inform suicide prevention efforts. In Philadelphia, we built a community-level data infrastructure that encompassed suicide death records, behavioral health claims, incarceration episodes, emergency housing episodes, and involuntary commitment petitions to examine a broader spectrum of suicide risk factors. Here, we describe the development of the data infrastructure, present key trends in suicide deaths in Philadelphia, and, for the Medicaid-eligible population, determine whether suicide decedents were more likely to interact with the behavioral health, carceral, and housing service systems compared to Medicaid-eligible Philadelphians who did not die by suicide. Between 2003 and 2018, there was an increase in the number of annual suicide deaths among Medicaid-eligible individuals, in part due to changes in Medicaid eligibility. There were disproportionately more suicide deaths among Black and Hispanic individuals who were Medicaid-eligible, who were younger on average, compared to suicide decedents who were never Medicaid-eligible. However, when we accounted for the racial and ethnic composition of the Medicaid population at large, we found that White individuals were four times as likely to die by suicide, while Asian, Black, Hispanic, and individuals of other races were less likely to die by suicide. Overall, 58% of individuals who were Medicaid-eligible and died by suicide had at least one Medicaid-funded behavioral health claim, 10% had at least one emergency housing episode, 25% had at least one incarceration episode, and 22% had at least one involuntary commitment. By developing a data infrastructure that can incorporate a broader spectrum of risk factors for suicide, we demonstrate how communities can harness administrative data to inform suicide prevention efforts. Our findings point to the need for suicide prevention in nonclinical settings such as jails and emergency shelters, and demonstrate important trends in suicide deaths in the Medicaid population.

COVID-19, Mink-Bowman, and Court-Ordered Psychiatric Services in Oregon.

COVID-19 strongly affected referral of individuals from Oregon's courts and the ability of Oregon State Hospital (OSH) to accept patients. Despite acceleration in the decline in civil commitment, competency to stand trial (CST) admissions increased, causing a bed crisis at OSH, which in turn affected community hospitals and jails. In 1993, the Ninth Circuit Court of Appeals mandated admission of jail detainees to OSH within seven days after a judicial order for CST evaluation or restoration. During COVID, as the number of such patients increased to crisis proportions, average jail detention times exceeded seven days. An inevitable judicial process intensified in the U.S. District Court of Oregon after OSH requested a COVID-related modification of the seven-day limit. This commentary demonstrates more clearly than in the past that there is a negative correlation between civil commitment and competency restoration as components of an interrelated system. After updating the situation in Oregon, this article ends with suggested interventions to improve Oregon's civil and criminal commitment processes, hoping for better care of patients and improved administration of justice.

Turmeric extract gel and honey in post-cesarean section wound healing: A preliminary study

Background: Delivery by cesarean section (SC) increases the risk of a surgical site infection (SSI). Therapy from health services and complementary therapy reduce the risk of infection and accelerate the wound-healing process. This study compared wound healing after SC with a turmeric extract gel and original Trigona honey. Methods: Female white rats (Rattus novergicus) with pre- and post-testing and a control group were included in this experiment, which was conducted in June-July 2022. The test animals were 56 female white rats, 2-4 months old, weighing 150–350 g. The treatment group was divided into three subgroups with application of 50% and 75% turmeric extract gel and Trigona honey. The turmeric was given twice daily, and the honey was divided into two applications of twice a day and once a day. Wounds were assessed using the Reeda Scale. Results: The fastest wound healing occurred in the group given Trigona honey twice daily. Redness, ecchymosis, and edema disappeared in this group on day 9 (score 0), and granulation tissue formed on day 9. The group that was administered 50% and 75% turmeric gel extract and Trigona honey once a day healed by days 12 and 15, respectively; all three of these interventions were better than the control group. Conclusions: Administering Trigona honey twice daily was more effective for accelerating wound healing than the 50% or 75% turmeric extract gel. Original Trigona honey has the potential to be a post-SC wound healing agent.

Restriction of the Rights and Coercion of Patients in a Psychiatric Hospital: The Opinion of People With Mental Disorders and Psychiatrists

Objectives: Restriction of the rights of patients in a psychiatric hospital, isolation and fixation, compulsory treatment, and round-the-clock monitoring are negatively perceived by them, contribute to the stigma of a psychiatric hospital, and prevent timely access to psychiatric help We assessed the opinions of patients in psychiatric hospitals and psychiatrists about coercion and violence in the provision of psychiatric care for recommendations on their prevention. Methods: An anonymous survey of psychiatrists and patients was conducted in psychiatric hospitals in three regions. Data were analyzed using descriptive and non-parametric statistical methods. Results: Psychiatrists and patients were positive about the coercive measures in the psychiatric hospital. Physical restraint was considered the prerogative of orderlies by 64.5% of psychiatrists and 35.4% of patients. According to 19.6% of doctors and 28.4% of patients, a psychiatrist can independently apply physical restraint to aggressive patients. Injections of sedative drugs by a psychiatrist personally were considered justified by 81.3% of physicians and 64.6% of patients. Most patients and physicians noted that the psychiatrist needed to be involved in the application of physical restraint to an aggressive patient. Discussion: Psychiatry is currently dominated by an archaic paternalistic model of doctor-patient relations and the delegation of additional functions of social control to psychiatrists. The introduction of a contractual model is required for more effective interaction between the psychiatrist and the patient.

A Life-Affirming Palliative Care Model for Severe and Enduring Anorexia Nervosa.

Some individuals with severe and enduring anorexia nervosa experience dramatically degraded quality of life in the face of refractory illness and compulsory treatment. We propose a palliative care (PC) model for this group of patients that aims to support their unique goals of care, improve social-professional function, reduce physical suffering, and honor the whole person. Far from representing a pre-hospice model, a PC model for those with severe and enduring anorexia nervosa instead provides an alternative to current practices in hopes of meaningfully improving quality of life and outcomes.

Civil Commitment to Treatment for Substance Use Disorders

Civil Commitment to Treatment for Substance Use Disorders

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA.

We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA. We merged state-level policy and treatment admissions data for 1992-2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility. When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10-1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04-1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08-1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00-1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72-0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78-0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions. Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness.

Field Reliability of Forensic Mental Health Evaluations of Offenders for Post-Prison Civil Commitment

ABSTRACT This study examined the field reliability of forensic mental health examiners’ opinions in pre-parole evaluations. The California Offenders with Mental Health Disorders (OMD) statute allows for the post-incarceration commitment to a state hospital for treatment as a condition of parole. Reliability is critical in these evaluations because the triers of fact rely on them for their determinations. We expect to find variability among opinions, not only on the final opinions but also on each criterion. We compared three expert opinions on 98 cases to determine the level of interrater agreement. Agreement rates varied by agency, evaluator, and the forensic question posed. We found higher reliability for criteria that were more reliant on past factors and lower reliability for those criteria based on factors present at the time of the assessment. Imprecisely defined legal constructs, unknown individual evaluator characteristics, contextual factors, and passage of time between the evaluations impede reliability.

State-of-the-art paradigm of corticosteroid therapy for immune-mediated inflammatory kidney diseases

Since 1950's corticosteroids (CS) have remained the cornerstone of immunosuppressive therapy for immune-mediated kidney diseases. However multiple adverse events, associated with the prolonged CS therapy, became the basis for the development of novel treatment approaches. Current evidence supports the implementation of the steroid-sparing regimens for the treatment of different types of glomerulonephritis. Randomised controlled trial PEXIVAS demonstrated the efficacy and safety of early steroid tapering, starting from the second week of therapy, in patients with ANCA-associated vasculitis with kidney involvement. Several trials showed the efficacy of oral prednisolone 0.3-0.5 mg/kg/daily as a part of multitarget therapy for severe proliferative lupus nephritis. A combination of calcineurin inhibitors and low-dose CS are effective for remission induction in membranous nephropathy, as well as the steroid-free rituximab regimen for the patients with moderate risk of disease progression. Medium dose CS showed promising effect in patients with IgA-nephropathy. Long-term high dose CS remain the standard-of-care for the treatment of minimal change disease and focal segmental glomerulosclerosis, however patients with steroid-dependent and relapsing disease tacrolimus and rituximab can help to achieve steroid-sparing effect. The role of CS pulse-therapy is currently debated, nevertheless it remains a compulsory treatment in several conditions. Thus, overall trend is directed towards the minimization of the maximal doses of CS and/or treatment duration. However, to implement this approach morphological verification of the diagnosis and personalized assessment of the potential risk and benefit are required.

Association of Pregnancy-Specific Alcohol Policies With Infant Morbidities and Maltreatment

Research has found associations of pregnancy-specific alcohol policies with increased low birth weight and preterm birth, but associations with other infant outcomes are unknown. To examine the associations of pregnancy-specific alcohol policies with infant morbidities and maltreatment. This retrospective cohort study used outcome data from Merative MarketScan, a national database of private insurance claims. The study cohort included individuals aged 25 to 50 years who gave birth to a singleton between 2006 and 2019 in the US, had been enrolled 1 year before and 1 year after delivery, and could be matched with an infant. Data were analyzed from August 2021 to April 2023. Nine state-level pregnancy-specific alcohol policies obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System. The primary outcomes were 1 or more infant injuries associated with maltreatment and infant morbidities associated with maternal alcohol consumption within the first year. Logistic regression, adjusting for individual-level and state-level controls, and fixed effects for state, year, state-specific time trends, and SEs clustered by state were used. A total of 1 432 979 birthing person-infant pairs were included (mean [SD] age of birthing people, 32.2 [4.2] years); 30 157 infants (2.1%) had injuries associated with maltreatment, and 44 461 (3.1%) infants had morbidities associated with alcohol use during pregnancy. The policies of Reporting Requirements for Assessment/Treatment (adjusted odds ratio [aOR], 1.28; 95% CI, 1.08-1.52) and Mandatory Warning Signs (aOR, 1.18; 95% CI, 1.10-1.27) were associated with increased odds of infant injuries but not morbidities. Priority Treatment for Pregnant Women Only was associated with decreased odds of infant injuries (aOR, 0.83; 95% CI, 0.76-0.90) but not infant morbidities. Civil Commitment was associated with increased odds of infant injuries (aOR, 1.26; 95% CI, 1.08-1.48) but decreased odds of infant morbidities (aOR, 0.57; 95% CI, 0.53-0.62). Priority Treatment for Pregnant Women and Women With Children was associated with increased odds of both infant injuries (aOR, 1.12; 95% CI, 1.00-1.25) and infant morbidities (aOR, 1.08; 95% CI, 1.03-1.13). Reporting Requirements for Child Protective Services, Reporting Requirements for Data, Child Abuse/Neglect, and Limits on Criminal Prosecution were not associated with infant injuries or morbidities. In this cohort study, most pregnancy-specific alcohol policies were not associated with decreased odds of infant injuries or morbidities. Policy makers should not assume that pregnancy-specific alcohol policies improve infant health.

К проблеме правовой природы дел о лишении и ограничении дееспособности гражданина

The article deals with the issue of the nature of cases on the restriction and deprivation of a citizen’s legal capacity. It is shown that historically these cases are considered according to the rules of special proceedings in civil proceedings, which does not correspond to their controversial nature. Legal relations that develop regarding the deprivation of a citizen’s legal capacity or its restriction are public law, since the corresponding legal status can be assigned to a citizen only by a court decision — that is, a public authority. It is proposed, by analogy with cases of involuntary hospitalization of a citizen in a medical organization, to consolidate the consideration of cases of deprivation and restriction of a citizen’s legal capacity in the course of administrative proceedings. In this case, the applicant and the citizen himself must be endowed with the legal status of a party to the case. Considering that the citizen is the ‘weak party’ in the cases under consideration, the court must be procedurally active.

Appraising Jackson-based unrestorability to competence to stand trial: The demonstration model.

Under United States law, criminal prosecution may not proceed against a defendant who is incompetent to participate in this process. The vast majority of defendants who are adjudicated incompetent to stand trial (IST) will subsequently regain sufficient capacities to be adjudicated competent to stand trial (CST). However, a small subgroup of defendants do not show sufficient improvement in clinical functioning and functional-legal capacities to regain CST. Under Jackson v. Indiana (1972), such individuals should be adjudicated unrestorably IST, with associated actions (e.g., dropping of criminal charges, civil commitment, transfer to a less restrictive environment or released) specified under the particular jurisdictional statutes. But the present practices associated with the evaluation of unrestorability do not appear well supported by research. In particular, statutorily specified evaluative procedures are overly dependent on prediction in some instances and allow an unnecessarily long restoration period in others. In the present article, we propose and describe an alternative approach-the Demonstration Model-that would address both challenges, providing a more consistent and standard approach to assessing CST and the possibility that a defendant may not recover needed capacities within the foreseeable future. Implementation of this approach can potentially guide restoration planning and intervention, decrease unsupported reliance upon prediction in favor of observing and documenting the results of selected interventions, and provide legal decision-makers with clearer and more transparent evidence, while acknowledging the liberty interests of IST defendants set forth in Jackson. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Crime and victimization outcomes following civil rights limits to the use of compulsory treatment

Community treatment orders (CTOs) have been associated with reduced crime/victimization-risk. Australia's ratification of the U.N. Convention on the Rights of Persons with Disabilities (CRPD) enabled patient-rights-advocacy to limit CTO-assignment to persons lacking decision-making-capacity. This effort was accompanied by a 15% reduction in CTO-utilization. Has this change affected crime/victimization-involvements of patients with schizophrenia-diagnoses? In Victoria Australia, the study considers crime/victimization-involvement among three patient-groups recruited with the same sampling-algorithm in the decade before (2000–2009, N = 14,711) and after (2010–2019, N = 10,702) CRPD-ratification. Each group is its own-control. Each group's positive-outcome across decades would be “no increase” in crime/victimization-involvement or in the ratio of the group's incident-rates to the State's. Following CRPD-ratification, first-hospitalized-patients with at least one CTO-assignment doubled their involvement in major crime-perpetrations (from 13% to 27%), non-CTO-hospitalized-patients almost doubled (from 10% to 18%), and 11% of outpatients were involved when none were before. Overall, a third (34%) were victimized-by-major-crime up from 28%, with 25% of outpatients experiencing victimization when none had before. Increases were most evident in major-crimes, led by assaults/abductions. Capacity-constraints on compulsory-treatment are associated with increases in crime/victimization-involvement, a transfer of responsibility for patients with schizophrenia-diagnoses from the mental-health-system to the criminal-justice-system, validation of dangerousness stereotypes, and growing negative family impact.

Prevalence of Attention Deficit/Hyperactivity Disorder Symptoms in Male Patients with Civil Commitment Caused by Alcohol and/or Substance use Disorder

Giriş: Dikkat Eksikliği/Hiperaktivite Bozukluğu (DEHB) günlük yaşamda önemli bozulmalara neden olmaktadır. DEHB'de alkol ve madde kullanım bozukluklarının (AMKB) sıklığı genel toplumdan daha yüksektir. Amaç: AMKB ile ilişkili sorunlar nedeniyle zorunlu tedavi için hastaneye yatırılan hastalarda çocukluk ve erişkinlik döneminde DEHB belirtilerinin yaygınlığını ve DEHB ile ilişkili sorunları araştırmayı amaçladık. Gereç ve Yöntem: Örneklem 100 AMKB hastasından oluşmuştur. Sosyodemografik özellikleri, olası DEHB ve alkol-madde ile ilişkili sorunları içeren bir sosyodemografik veri formu kullanılmıştır. DEHB belirtilerini belirlemek için Wender Utah Derecelendirme Ölçeği ve Yetişkin DEB/DEHB Derecelendirme Ölçeği uygulanmıştır. Bulgular: Zorunlu tedavi kararı verilen AMKB hastalarının %38'inin çocukluk döneminde, %20'sinin ise yetişkinlik döneminde DEHB belirtileri gösterdiğini saptadık. Hastaların yarısından fazlası adli sorunlar yaşamıştı ve suç öyküsüne sahipti (sırasıyla %54 ve %55). AMKB'li hastaların çoğunluğu adli, eş, aile veya sağlıkla ilgili birden fazla alanda sorun yaşamıştı (%63). Okul hayatında disiplin cezası almak, zorunlu askerlik hizmetini tamamlamak, askerlikte hava değişimi almak ve adli olaya karışmak DEHB ile ilişkili bulunmuştur. Sonuç: Tanı konmamış ve tedavi edilmemiş DEHB yaşam boyu zorluklara ve AMKB 'ye yol açabilir. DEHB tedavisinde kullanılan ilaçların kötüye kullanım potansiyeli tartışmalı olsa da, DEHB belirtileri kontrol altına alınmadığında, alkol ve/veya madde kullanımının eşlik ettiği potansiyel sorun alanlarında daha ciddi sonuçlar ortaya çıkmaktadır. Bu çalışma DEHB'ye bağlı olarak yaşam boyu ortaya çıkabilecek sorun alanlarını AMKB çerçevesinde ortaya koymaktadır.

A Critical Appraisal of Compliance with the Compulsory Treatment and Care for Victims of Gunshot Act 2017

Aim: The practice of demanding police report before gunshot injury victims receive medical care in Nigeria has led to needless loss of life in several instances. The practice stems from the (mis)application of the Robbery and Firearms (Special provision) Act 1984. Thus, the Compulsory Treatment and Care for Victims of Gunshot Act 2017 was enacted to mandate expedite medical treatment for gunshot victims without demand for police report.
 Methods: Adopting the doctrinal research methodology, this paper assessed the legacy of the Robbery and Firearms Act on the treatment of gunshot injury victims. It equally examined medical practitioners’ level of compliance with the provisions of the Compulsory Treatment and Care for Victims of Gunshot Act 2017 and the legal implication of non-compliance, while highlighting remedial options available under the law.
 Results: The study found that despite the provisions of the Compulsory Treatment and Care for Victims of Gunshot Act 2017, gunshot victims are still haunted by the ghost of the Robbery and Firearms (Special Provision) Act. Medical practitioners are still uneasy about the treatment of gunshot casualties without police reports due to apprehension about police harassment.
 Conclusion: This paper concludes that the lack of publicity about the current realities of the law and lack of coordination between medical practitioners, police officers and other key stakeholders is responsible for non-compliance with the Act.
 Recommendation: The study therefore recommends the need for enforcement of professional and penal sanctions against erring medical practitioners who fail to provide expedite medical treatment for gunshot injury victims.

Potential Effects of Dobbs v. Jackson Women's Health on Civil Commitment Law.

Since the publication of the U.S. Supreme Court's decision in Dobbs v Jackson Women's Health in June of 2022, much attention has been paid to the direct effects of that decision on reproductive health care for pregnant or potentially pregnant individuals; and to the potential effects of the Court's approach in Dobbs to other established precedent related to privacy and autonomy, such as rights to contraception and marriage equality.This Article will explore another potential negative consequence of Dobbs; its potential effect on the constitutional parameters of the law of civil commitment and involuntary medication of the mentally ill.The foundational Supreme Court case establishing the parameters of the State's right to involuntarily commit an individual to a mental institution was decided only two years after Roe v. Wade.In 1975, the Supreme Court in O'Connor v Donaldson held that an individual has a liberty interest in "prefer[ring] one's home to the comforts of an institution," and that a State could not, "without more," confine a non-dangerous individual.The two-prong test of requiring a showing of both mental illness and dangerousness to one's self or to others has remained the cornerstone of civil commitment law ever since.The language and analysis of O'Connor is similar to that of Roe, the abortion rights case overturned by Dobbs.In particular, the grounding of the right to avoid civil commitment in the individual liberty and privacy interests are common themes in the two cases.The current Court, in its decision in Dobbs, has cast substantial doubt on the continued vitality of that analysis; and one can easily imagine a reconceptualization of O'Connor along the lines of Dobbs that substantially alters the requirements for civil commitment. In particular, the reliance in Dobbs and other recent Supreme Court opinions on historical precedent as a linchpin of originalist analysis could lead the Court to search for justifications in colonial or 19th-century mental health practices, time periods which predate modern psychiatric science.This Article will explore the parallels in approach between Roe and O'Connor, and will suggest ways in which the post-Dobbs Supreme Court majority might disrupt the civil commitment status quo, including potential expansion of civil commitment or other detention of pregnant individuals for the protection of the fetus; and possible relaxation of the dangerousness requirement for civil commitment articulated in O'Connor.

Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA.

Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A. Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics. While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment. Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.

Gender Differences in Civil Commitment Hearing Experience for Persons Who Use Opioids.

Civil commitment has increasingly served as a court-based legal intervention for severe opioid use, but little research has examined the civil commitment (CC) hearing process from the perspective of the person who is committed. Despite documented gender differences in opioid use and experiences within the legal system, past research has also not investigated gender differences in perceptions of the CC process for persons who use opioids. Participants were 121 persons (43% female) with opioid use who were interviewed upon arrival at the CC facility about their experience of the CC hearing process in Massachusetts. Two thirds of participants were taken to the commitment hearing by police, and 59.5% shared a cell with others while waiting. Overall, the commitment intake process at the courthouse took over 5 hours. Participants spent, on average, less than 15 minutes with their lawyer before the hearing, and a majority of CC hearings lasted less than 15 minutes. Once transferred to a CC facility, opioid withdrawal management began within 4 hours. Compared with women, men reported longer wait times between the hearing and transfer, as well as longer wait times for withdrawal management at the facility ( P < 0.05). Women perceived worse interactions with the judge and greater dissatisfaction with the commitment process compared with men ( P < 0.05). There were few gender differences in the experience of CC. However, overall, participants reported a lengthy court process and low levels of perceived procedural justice.