Psychiatric Quarterly

, Volume 81, Issue 4, pp 363–367 | Cite as

North Carolina Resident Psychiatrists Knowledge of the Commitment Statutes: Do They Stray from the Legal Standard in the Hypothetical Application of Involuntary Commitment Criteria?

Original Paper


Objectives are to examine North Carolina (NC) resident psychiatrists knowledge of commitment statutes and their willingness to involuntarily admit hypothetical patients who do not meet statutory criteria. It is hypothesized that the need for transportation may be a salient factor. In one vignette the patient had schizophrenia and the other alcohol dependence. The respondents were asked to make a decision about commitment and to rate how 9 specified factors affected their decision. Sixty-one residents responded. Thirty percent answered incorrectly about statutory provisions for ‘mental illness’ and ‘dangerousness’, 10% answered incorrectly that grave disability does not meet the dangerousness criterion, and 41% answered incorrectly about the NC statutory language of the ‘least restrictive alternative’ principle. While neither hypothetical patient met the commitment standard, 74% of respondents would involuntarily admit the patient with psychotic illness and 87% would involuntarily admit the patient with alcohol dependence. Training in commitment standards with clinical vignettes should be conducted with residents to protect patient rights.


Civil commitment of mentally ill Patient rights Least restrictive alternative Residency education 


  1. 1.
    Appelbaum PS: A history of civil commitment and related reforms in the United States: lessons for today. Edited remarks presented on December 9, 2005 in Richmond, Virginia, at a conference on “Reforming the Involuntary Commitment Process: A Multidisciplinary Effort” sponsored by the Virginia State Bar at the behest of Virginia Chief Justice Leroy Roundtree Hassell, SrGoogle Scholar
  2. 2.
    Brooks RA: Psychiatrists’ opinions about involuntary civil commitment: Results of a national survey. Journal of the American Academy of Psychiatry and the Law 35:219–228, 2007PubMedGoogle Scholar
  3. 3.
    Luchins DJ, Cooper AE, Hanrahan P, et al.: Psychiatrists’ attitudes toward involuntary hospitalization. Psychiatric Services 55:1058–1060, 2004CrossRefPubMedGoogle Scholar
  4. 4.
    Mathews v. Eldridge, 492 F.2d 1230 (United States Supreme Court 1976)Google Scholar
  5. 5.
    Kaufman AR: Should we use law enforcement for emergency transportation of people with mental illness? American Journal of Psychiatry 164, 2007Google Scholar
  6. 6.
    Brasch J, Glick RL, Cobb TG, et al.: Residency training in emergency psychiatry: A model curriculum developed by the education committee of the American association for emergency psychiatry. Academic Psychiatry 28:95–103, 2004CrossRefPubMedGoogle Scholar
  7. 7.
    Lewis CF: Teaching forensic psychiatry to general psychiatry residents. Academic Psychiatry 28:40–46, 2004CrossRefPubMedGoogle Scholar
  8. 8.
    Hoop JG: Hidden ethical dilemmas in psychiatric residency training; the psychiatry resident as dual agent. Academic Psychiatry 28:183–189, 2004CrossRefPubMedGoogle Scholar
  9. 9.
    Engelman NB, Jobes DA, Berman AL, et al.: Clinician’s decision making about involuntary commitment. Psychiatric Services 49:941–945, 1998Google Scholar
  10. 10.
    Appelbaum PS: Least restrictive alternative revisited: Olmstead’s uncertain mandate for community-based care. Psychiatric Services 50:1271–1280, 1999PubMedGoogle Scholar
  11. 11.
    Wu LT, Ringwalt C: Use of substance abuse services by young uninsured American adults. Psychiatric Services 56:946–953, 2005CrossRefPubMedGoogle Scholar
  12. 12.
    Pescosolido BA, Monahan, J. Link, et al.: The public’s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health 89:1339–1345, 1999CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of PsychiatryState University of New York Upstate Medical UniversitySyracuseUSA

Personalised recommendations