148518 Involuntary Commitment: Barriers to optimal service delivery

Tuesday, November 6, 2007

Elizabeth Lloyd McGarvey, EdD , Department of Public Health Sciences, University of Virginia, Charlottesville, VA
Cheryl Koopman, PhD , Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA
Jeff Raynor, MD , Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA
Rebecca Angevine, MPH , Department of Public Health Sciences, University of Virginia, Charlottesville, VA
Richard Bonnie, LLB , Institute of Law, Psychiatry & Public Policy, Unniversity of Virginia Law School, Charlottesville, VA
Psychiatric interventions for crisis care through the legal mechanism of civil commitments are a reality across the U.S. With a comprehensive, community-based system of adequately funded mental health services that are accessible by all and provided in the least restrictive environment, optimal service delivery is envisioned. However, there are barriers to optimal mental health service delivery resulting in less than optimal outcomes. This study investigates barriers to optimal mental health service delivery in one Southern state and associated issues related to the process of civil commitment. A qualitative study including stakeholders in the civil commitment process was conducted. Focus groups, dialogue groups and interviews were used to gather data. Participants included consumers of mental health services, families of consumers, mental health care providers, Special Justices/Judges, Appointed Counsel, Magistrates and others. Analytic procedures guided by the principles of Grounded Theory were used in the analyses. Over 160 individuals participated in a statewide study. Themes emerged across and within groups including the problem of the stigma of mental illness, lack of knowledge among the public and professionals that mental illnesses are biologically based brain disorders that are treatable, problems with law enforcement being involved in facilitating the care of consumers with mental illness, lack of alternative options for service delivery in the community, reimbursement issues, and others. Barriers to optimal mental health service delivery include system issues; resource issues; differences in mental health service delivery assumptions and beliefs; ethical issues, legal issues; and individual human rights issues, among others.

Learning Objectives:
1. Discuss the rationale for an involuntary commitment of a consumer with serious mental illness. 2. List 5 barriers related to successful community-based service delivery that may be related to the need for involuntary commitment. 3. Identify issues related to mandatory outpatient commitment.

Keywords: Mental Illness, Mental Health Services

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.