Developments in Mental Health Law

Volume 31, Issue 6, October 2012

The Issue explores the topic of Advance Directives with three pieces: (1) Promoting Use of Advance Directives by People with Serious Mental Illness under Virginia’s Health Care Decisions Act: Implementation Study Update; (2) Survey of Stakeholder Knowledge, Experience and Opinions about Mental Health Advance Directives in Virginia Published; and (3) Advance Directives: A Tool for Reducing Coercion

Use of Longer Periods of Temporary Detention to Reduce Mental Health Civil Commitments

Tanya Nicole Wanchek, Ph.D., J.D. and Richard J. Bonnie, LL.B.

Objective: This study examined whether lengthening the holding period for an individual experiencing a mental health crisis under a temporary detention order (TDO) can reduce the number and length of postTDO involuntary hospital commitments. Methods: Data from the Virginia Court System were matched to the Commonwealth of Virginia Medicaid claims database for July 1, 2008, through March 30, 2009. The final data set included 500 Medicaid recipients who had a mental health diagnosis and at least one TDO during the study period. Covariates included sex, race, age, primary diagnosis, and Community Service Board serving the individual. Logistic and multivariate regression models were used. Results: Longer TDO periods were correlated with an increased probability of a dismissal of the commitment petition rather than hospitalization after a TDO. Among individuals who were hospitalized, longer TDO periods were correlated with an increased likelihood of voluntary hospitalization, rather than involuntary commitment, and shorter hospitalizations, although the net care time (TDO period plus post-TDO hospitalization) increased for individuals whose TDO length was greater than 24 hours. Conclusions: Longer TDO periods were correlated with shorter hospital stays and fewer involuntary commitments. These findings support previous work showing that short TDO periods provide insufficient time to stabilize and evaluate individuals. More research is needed to establish a causal link between TDO length and health outcomes. (Psychiatric Services 63:643–648, 2012; doi: 10.1176/

Developments in Mental Health Law

Volume 31, Issue 5, July 2012

Topics: Affordable Care Act Upheld As Tax - Medicaid Expansion Would Significantly Impact Behavioral Health Care; Study Presented to JCHC Finds Longer Periods of Temporary Detention Lead to Reduction in Civil Commitments; Inspector General Presents “Failed TDO,” Barriers to Discharge and Forensic Services Reports to JCHC

Developments in Mental Health Law

Volume 31, Issue 2, February 2012

Topics: Virginia Settles DOJ CRIPA/ADA Investigation; Three Virginia Jurisdictions Establish Specialized Mental Health Dockets; Recently Decided Cases: Fourth Circuit Finds Federal Commitment of Sexually Dangerous Persons Does Not Violate Equal Protection, California Supreme Court Rules Court Has Discretion Whether to Permit Competent Defendant to Represent Self, Maine Supreme Judicial Court Finds Right to Competency in Post-Conviction Proceedings