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August 1988

Limitations on Psychiatrists' Discretionary Civil Commitment Authority by the Stone and Dangerousness Criteria

Author Affiliations

From the Department of Psychiatry, the Law and Psychiatry Program (Drs Hoge and Appelbaum and Mr Greer) and the Forensic Evaluation Clinic (Drs Appelbaum and Hoge), Massachusetts Medical Center, Worcester, and the Department of Psychiatry, the Acute Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston (Drs Sachs and Gordon).

Arch Gen Psychiatry. 1988;45(8):764-769. doi:10.1001/archpsyc.1988.01800320080011

• The dangerousness-oriented commitment criteria of Massachusetts were compared with the paternalistic Stone model of commitment in an emergency setting. In a sample of 1062 patients, the Stone criteria were more restrictive than the dangerousness-oriented criteria; 91 patients were committable by the Stone model compared with 218 under the present statute. A second comparison of only those patients who refused treatment yielded similar findings—52 patients were committable according to the Stone criteria compared with 80 under the Massachusetts statute. The greater restrictiveness of the Stone criteria in each comparison was in large part the result of the requirement that the treatment decisions of the patient be incompetent; in the broader sample, the criterion of major patient distress had a comparable impact. A comparison of patients committable under both standards with those patients currently committable who would be excluded under the Stone standard revealed significant differences. The dually committable patients were more likely to be psychotic, to meet statutory criteria for grave disability, and to be diagnosed as manic. The implications of the findings are discussed.