Developments in Mental Health Law

Volume 32, Issue 3, July 2013

The lead article in Volume 32, Issue 3 is authored by the DMHL Editor, who explores the domain of public policy regarding gun prohibitions for people with mental illness. This timely piece includes exposition of historical and legal issues under the topic. "Recently Decided Cases" informs of recent decisions in federal courts.

Developments in Mental Health Law

Volume 32, Issue 2, April 2013

This issue features a helpful overview of "Mental Health Related Provisions of the Patient Protection and Affordable Care Act and the Potential Impact of Medicaid Expansion in Virginia." Other items of special interest are an "Update" from the 2013 Virginia General Assembly, and "Recently Decided Cases" in several state and federal courts.

Decisions to Initiate Involuntary Commitment: The Role of Intensive Community Services and Other Factors

Elizabeth Lloyd McGarvey, Ed.D., MaGuadalupe Leon-Verdin, M.S., Tanya Nicole Wanchek, Ph.D., J.D., and  Richard J. Bonnie, LL.B.

Objective: This study examined the predictors of actions to initiate involuntary commitment of individuals experiencing a mental health crisis. Methods: Emergency services clinicians throughout Virginia completed a questionnaire following each face-to-face evaluation of individuals experiencing a mental health crisis. Over a one-month period in 2007, a total of 2,624 adults were evaluated. Logistic hierarchical multiple regression was used to analyze the relationship between demographic, clinical, and service-related variables and outcomes of the emergency evaluations. Results: Several factors predicted 84% of the actions taken to initiate involuntary commitment. These included unavailability of alternatives to hospitalization, such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment; and clinical factors related to the commitment criteria, including risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence. Conclusions: A lack of intensive communitybased treatment and support in lieu of hospitalization accounted for a significant portion of variance in actions to initiate involuntary commitment. Comprehensive community services and supports for individuals experiencing mental health crises may reduce the rate of involuntary hospitalization. There is a need to enrich intensive community mental health services and supports and to evaluate the impact of these enhancements on the frequency of involuntary mental health interventions. (Psychiatric Services 64:120–126, 2013; doi: 10.1176/