Civil commitment as a "street-level" bureaucracy: case-load, professionalization and administration.
This article applies street-level bureaucracy theories to "coping" patterns of behavior that developed in an involuntary commitment system. Daily procedures and routines of five Nebraska county boards of mental health and the attitudes of their members were studied. The results showed that the urban, high case-load, professionally-oriented board informally modified statutory procedures significantly to reduce face-to-face client contact, limit the scope of its decisions, and displace responsibility for the most ambiguous decisions to the treatment facility and board psychiatrist. Rural, low case-load, less professionally-specialized boards also modified the statutory procedures, but conducted the commitment process in a far more ambiguous, open-ended, and tense system with substantial face-to-face client contact. Both urban and rural boards had multifaceted role definitions; rural boards, however, had a more open-ended perception of their functions, and attempted more actively to modify antisocial behavior and redirect board subjects to sources of social counseling. Therefore, understanding street-level "coping" behavior in an actual commitment context is important to develop realistic changes in civil commitment systems and to preclude informal procedures that reduce a commitment system's effectiveness or undermine a proposed patient' s rights.
D000288:Administrative Personnel; D001294:Attitude to Health; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003657:Decision Making; D005555:Forensic Psychiatry / Q000331:legislation & jurisprudence*; D006801:Humans; D008962:Models, Theoretical; D009329:Nebraska; D010344:Patient Advocacy; D012423:Rural Health; D014504:Urban Health