The Impact of Broadened Civil Commitment Laws on Length of Stay in a State Mental Hospital

Goffman E. , Asylums (Doubleday, Garden City, N.J. 1961); Wing J. , Institutionalization of Mental Hospitals, Journal of Social and Clinical Psychology 1: 38 (1962).

Scheff T.J. , Being Mentally Ill, 1st ed. (Aidine, Chicago, 1966); Miller D. Schwartz M. , County Lunacy Commission Hearings: Some Observations of Commitment to a State Mental Hospital, Social Problems 1(14): 26 (Summer 1966); L. Kutner, The Illusion of Due Process in Commitment Proceedings, Northwestern University Law Review 57(4): 383 (September/October 1982).

Lessard v. Schmidt, 349 F. Supp. 1078 (E.D. Wisc. 1972); vacated and remanded, 414 U.S. 473 (1974); order on remand, 379 F. Supp. 1376 (E.D. Wisc. 1974); vacated and remanded, 421 U.S. 957 (1975); order reinstated on remand, 413 F. Supp. 1318 (E.D. Wisc. 1976).

Lanterman-Petris-Short Act (LPS), Cal. Welf. and Inst. Code §§5000 et seq. (West 1984).

Id. at §§5254, 5256, 5300-9.

For Nebraska , see Luckey J.W. Berman J.J. , Effects of a New Commitment Law on Involuntary Admissions and Service Utilization Patterns, Law and Human Behavior 3(3): 149 (1979). For Arizona, see Wexler D.B. , Mental Health Law and the Movement Toward Voluntary Treatment, California Law Review 62(3): 671 (May). For California, see ENKI Research Institute, The Burden of the Mentally Disordered on Law Enforcement (ENKI, Chatsworth, Cal., 1973; C.A.B. Warren, Involuntary Commitment for Mental Disorder: The Application of California's Lanterman-Petris-Short Act, Law and Society Review 11(4): 629 (Spring 1977); H.R. Lamb, A. Sorkin, J. Zusman, Legislating Social Control of the Mentally Ill in California, American Journal of Psychiatry 138(3): 334 (March 1981). For Washington see J.L. Durham, G.L. Pierce, Beyond Deinstitutionalization: A Commitment Law in Evolution, Hospital and Community Psychiatry 33(3): 216 (March 1982); G.L. Pierce, M.L. Durham, W. Fisher, The Impact of Broadened Civil Commitment Standards on Admission to State Mental Hospitals, American Journal of Psychiatry 142(1): 104 (January 1985).

Wanck B. , Two Decades of Involuntary Hospitalization Legislation, American Journal of Psychiatry 141(1): 33, 36–37 (January 1984).

Abramson M.F. , The Criminalization of Mentally Disordered Behavior: A Possible Side Effect of a New Mental Health Law, Hospital and Community Psychiatry 23(4): 101, 103–5 (April 1972).

Talbott J.A. , Stopping the Revolving Door: A Study of Readmission to a State Hospital, Psychiatric Quarterly 48(2): 159 (1974).

Appleby L. Desai P.N. , Documenting the Relationship Between Homelessness and Psychiatric Hospitalization, Hospital and Community Psychiatry 36: 732 (July 1985).

Bassuk E. Gerson J. , Deinstitutionalization and Mental Health Services, Scientific American 238: 46 (1978); Appleby and Desai, supra note 10.

Stone A.A. , Overview: The Right to Treatment—Comments on the Law and Its Impact, American Journal of Psychiatry 132(11): 1125 (November 1975); C.D. Stromberg, A.A. Stone, A Model State Law on Civil Commitment of the Mentally Ill, Harvard Journal on Legislation 20(2): 275 (Summer 1983).

Durham M.L. La Fond J.Q. , The Empirical Consequences and Policy Implications of Broadening the Statutory Criteria for Civil Commitment, Yale Law and Policy Review 3 (2): 395 (Spring 1985); Rubinstein L.S. , The American Psychiatric Association's Proposals on Civil Commitment, Clearinghouse Review 17: 558 (1983); Rubinstein L.S. , APA's Model Law: Hurting the People It Seeks to Help, HOSPITAL and Community Psychiatry 39(9): 968 (September 1985).

Treffert D.A. Krajeck R.W. , In Search of a Sane Commitment Statute, Psychiatric Annals 6: 283 (1976).

See Durham and Pierce, supra note 6, at 217.

Pierce, Durham, and Fisher, supra note 6, at 105; Pierce G.L. Durham M.L. Fisher W. , The Impact of Public Policy and Publicity on Admission to State Mental Health Hospitals, Journal of Health Politics, Policy and Law (in press).

Pierce, Durham, and Fisher, supra note 6, at 106.

See Durham and La Fond, supra note 13.

See Pierce, Durham, and Fisher, supra note 16.

We limit our discussion to one hospital for two reasons. First, previous analyses (see Pierce, Durham, and Fisher, supra note 6, at 106) show that shifts in hospital utilization patterns following the 1979 ITA were significantly different for the two state hospitals. Consideration of both facilities would be beyond the scope of this paper. It could be misleading to pool outcomes observed at both hospitals. Moreover, information on hospital bed and staffing resources—a critical component of this analysis—were available to the authors for Western State Hospital only.

Gross A. Clark V. , Survival Distributions: Reliability Applications in the Biomedical Sciences (Wiley, New York 1975).

Hanson B.L. , A Statistical Model for Length of Stay in a Mental Hospital, HEALTH SERVICES RESEARCH 8(1): 37 (Spring 1973); J. Reuter, M. VonKorff, Chronic Patients in Mental Health Centers, Administration in Mental Health 7(3): 187 (Spring 1980).

We do not examine the potential indirect effect of the 1979 ITA on voluntary admission because these admissions declined to insignificant levels at Western State Hospital in the period following the 1979 legal change (see Pierce, Durham, and Fisher, supra note 16).

The average monthly utilization rate represents the average daily patient census per number of beds.

For an analysis of the likely reason for this increase, see our discussion of the MacFarland murder case in Pierce, Durham, and Fisher, supra note 16.

Extra beds were crammed into the wards, causing overcrowding of patients. In some instances, patients brought to Western State Hospital for emergency treatment and evaluation had to be placed in beds in hallways while awaiting available bedspace (personal communication with Dave Padgett, Division of Mental Health, DSHS, Olympia, Wash., July 23, 1985).

Petersen v. Washington State, 671 P.2d 230 (Wash. 1983).

Quasim L. , Annual Report on the Involuntary Treatment Act (Mental Health Division, Washington State Department of Social and Health Services, September 1984).

In Durham and La Fond (supra note 13) we discuss evidence that gravely disabled patients do remain hospitalized longer than patients committed for dangerousness. While the scope of the present paper does not allow examination of this question, it is clear that further analysis is essential.

See Durham and La Fond, supra note 13.

For a discussion of the APA Model Law see Appelbaum P. , Key Provisions of APA's Model Law, Hospital and Community Psychiatry 36(4): 967 (September 1985).