The dangerousness criterion for civil commitment fails to specify which mental disorders justify commitment. This ambiguity is highlighted by the fact that there are patients with personality disorders or substance abuse who may be dangerous but for whom we have few effective treatments. A possible solution might be provided by adopting the American Psychiatric Association guidelines which consider severity of mental disorder and treatability in its criteria.
References
1.
Mental Patient Protection Act, STATS.-Que., C-44, as amended, 1972.
2.
Mental Health Act, REV.-STATS.-Ont., C-262, as amended, 1980.
3.
MonahanJ., ShahS.A.Dangerousness and commitment of the mentally disordered in the United States.Schizophr Bull1989; 15: 541–553.
4.
SegalS.P., WatsonM.A., GoldfingerS.M.Civil commitment in the psychiatric emergency room II: mental disorder indicators and three dangerousness criteria.Arch Gen Psychiatry1988; 45: 753–758.
5.
ShamsieS.J.Antisocial adolescents: our treatments do not work, where do we go from here?Can J Psychiatry1981; 26(5): 357–364.
6.
CleckleyH.The mask of sanity.New York: Mosby,1982.
7.
YochelsonS., SamenowS.E.The criminal personality.New York: Jason Aronson Inc.,1976.
8.
GundersonJ.G.Borderline personality disorder.Washington DC: American Psychiatric Press Inc.,1984.
9.
FineM.A., SamsoneR.A.Dilemmas in the management of suicidal behaviour in borderline personality disorder.Am J Psychother1990; 44: 160–171.
10.
AppelbaumP.S.Hospitalization of the dangerous patient: legal pressures and clinical responses.Bull Am Acad Psychiatry Law1984; 12: 323–329.
11.
AppelbaumP.S.The new preventive detention: psychiatry's problematic responsibility for the control of violence.Am J Psychiatry1988; 145: 779–785.
12.
BeckJ.C.The therapist's legal duty when the patient may be violent.Psychiatr Clin North Am1988; 11: 665–679.
13.
WulsinL.R., BursztajnH., GutheilT.G.Unexpected clinical features of the Tarasoff decision: the therapeutic alliance and the “duty to warn”.Am J Psychiatry1983; 140: 601–603.
14.
HoffmanB.The criminalization of the mentally ill.Can J Psychiatry1990; 35(2): 166–169.
15.
SchwarzC.J., GreenfieldG.P.Charging a patient with assault of a nurse on a psychiatric unit.Can Psychiatr Assoc J1978; 23 (4): 197–200.
16.
Diagnostic and statistical manual of mental disorders, third edition, revised., Washington DC: American Psychiatric Press Inc.,1987.
17.
McFarlandB.H., FaulknerL.R., BloomJ.D.Investigators' and judges' opinions about civil commitment.Bull Am Acad Psychiatry Law1989; 17: 15–24.
18.
RothL.A commitment law for patients, doctors, and lawyersAm J Psychiatry1979; 136: 1121–1127.
19.
MonahanJ., RuggieroM., FriedlanderH.D.Stone-Roth model of civil commitment and the California dangerousness standardArch Gen Psychiatry1982; 39: 1267–1271.
20.
HogeS.K., SachsG., AppelbaumP.S.Limitations of psychiatrists' discretionary civil commitment authority by the Stone and dangerousness criteria.Arch Gen Psychiatry1988; 45: 764–769.
21.
Guidelines for legislation on the psychiatric hospitalization of adults.Am J Psychiatry1983; 140: 672–679.
22.
Arboleda-FlorezJ., HollyH.How Alberta psychiatrists view commitment criteria and the problem of predicting dangerousness.Can J Psychiatry1984; 29(1): 38–41.
23.
RichertR.A., MoyesA.H.Reasons for involuntary commitment in Manitoba and Ontario.Can J Psychiatry1983; 28(5): 358–361.