Statutory change and 'street-level' implementation of psychiatric commitment

This paper assesses the impact of a statutory change in psychiatric commitment laws on the dangerousness of involuntarily committed civil patients in one metropolitan area. More restrictive local guidelines for commitment emphasizing assaultiveness were replaced by a new state law which expanded the criteria to those whose health might deteriorate from neglect. Using an interrupted time-series analysis, we find that changes in the proportion of persons hospitalized as dangerous (or assaultive) occurred more among normally less assaultive groups such as older, white and female patients than among normally more assaultive categories of younger, black and male patients. The less assaultive groups contained an increasing proportion of dangerous patients under the period of restrictive guidelines but the proportion dropped dramatically following the implementation of the less restrictive law. Groups typified by higher rates of assaultiveness remained at a relatively high level, unaffected by changes in the statutes or time. Given the relative stability in the numbers of OTA patients committed over time, the results suggest that changes in the proportion of patients said to be dangerous may be an artifact of the way petitioners for patients and providers make use of the mental health system.