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August 1988

Civil Commitment in the Psychiatric Emergency Room: II. Mental Disorder Indicators and Three Dangerousness Criteria

Author Affiliations

From the Mental Health and Social Welfare Research Group, School of Social Welfare, University of California, Berkeley (Drs Segal and Watson); the Department of Psychiatry, University of California, San Francisco (Drs Watson and Goldfinger); and Institute for Scientific Analysis, Berkeley (Drs Segal, Watson, and Goldfinger and Mr Averbuck).

Arch Gen Psychiatry. 1988;45(8):753-758. doi:10.1001/archpsyc.1988.01800320069009

• Proponents of return to a "need for treatment" standard for civil commitment contend that the current dangerousness standard forces psychiatrists to neglect severely ill patients in favor of those who are less ill but dangerous to others. Among 198 psychiatric emergency patients in five facilities, those rated as most dangerous on Three Ratings of Involuntary Admissibility, a reliable index of indicators employed by clinicians in evaluating danger to self, danger to others, and grave disability, were also most severely ill on diagnostic and symptomatic assessments of mental disorder. Clinicians' Global Ratings of patient dangerousness on the three criteria were similarly related to severity of diagnosis and symptoms. Perceived dangerousness was associated with major mental disorder and severity of most symptom types, especially impulsivity. Danger to self was the criterion related to the fewest indicators of mental disorder.

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