A national survey of psychiatrists and state mental health directors regarding involuntary civil commitment

Involuntary civil commitment is a controversial area where the tensions between medicine and law are accentuated. This project had two parts. The first was to compile the non-emergency involuntary civil commitment laws of all U.S. states, since initial reforms of the late 1960's through 2001, and to create variables from that research. The second part was a survey of psychiatrists and state mental health directors regarding their attitudes toward and experience with civil commitment, and to determine the respondents' familiarity with civil commitment laws. The psychiatrist sample consisted of 1500 randomly selected members of the American Psychiatric Association living in the United States. All state mental health directors were also sent a similar survey. The project's aim, in addition to determining respondents' views, was to use the data gained in the legislative study as well as other state-level data (such as region of the country and state mental health spending) in analyzing survey responses. The usable response rates were 48.38% for the psychiatrists (a rate comparable to other surveys of psychiatrists) and 80.39% for the state mental health directors. Results were mostly consistent with prior surveys, showing for example support for traditional grounds for commitment (danger to self and others) with limited support for commitment on the basis of serious mental illness, alcohol and drug addiction, and sexual predator status, although there were significant differences between the two respondent groups. Respondents also showed relative unfamiliarity with the grounds for commitment in their jurisdiction. There was little evidence that state-level variables had significant effects on most of the questionnaire responses. The most important determinant of what commitment grounds respondents wanted was respondents' beliefs about the grounds in existing law. It was concluded that more education about commitment grounds was advisable, and that respondents were apparently influenced by existing law in choosing what grounds respondents wanted to be law.