title: Decisions to initiate involuntary commitment: the role of intensive community services and other factors.
abstract: OBJECTIVE
  This study examined the predictors of actions to initiate involuntary commitment of individuals experiencing a mental health crisis.
  
  
  METHODS
  Emergency services clinicians throughout Virginia completed a questionnaire following each face-to-face evaluation of individuals experiencing a mental health crisis. Over a one-month period in 2007, a total of 2,624 adults were evaluated. Logistic hierarchical multiple regression was used to analyze the relationship between demographic, clinical, and service-related variables and outcomes of the emergency evaluations.
  
  
  RESULTS
  Several factors predicted 84% of the actions taken to initiate involuntary commitment. These included unavailability of alternatives to hospitalization, such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment; and clinical factors related to the commitment criteria, including risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence.
  
  
  CONCLUSIONS
  A lack of intensive community-based treatment and support in lieu of hospitalization accounted for a significant portion of variance in actions to initiate involuntary commitment. Comprehensive community services and supports for individuals experiencing mental health crises may reduce the rate of involuntary hospitalization. There is a need to enrich intensive community mental health services and supports and to evaluate the impact of these enhancements on the frequency of involuntary mental health interventions.
authors.affiliation: Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA. rel8s@virginia.edu
authors.forename: Elizabeth Lloyd
authors.initials: EL
authors.lastname: McGarvey
authors.forename: MaGuadalupe
authors.initials: M
authors.lastname: Leon-Verdin
authors.forename: Tanya Nicole
authors.initials: TN
authors.lastname: Wanchek
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bonnie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000458:organization & administration / Q000600:supply & distribution*; D003657:Decision Making; D004637:Emergency Services, Psychiatric; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D062072:Patient Acuity; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data*; D012306:Risk; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014768:Virginia / Q000453:epidemiology; D055815:Young Adult