Changes in the legal status of mental patients and hospital management.

The recent legal, ethical, and therapeutic concerns over the appropriateness of involuntary psychiatric hospitalization have led many states to modify their civil commitment procedures. One change has been to limit involuntary commitment to a specified interval. If the hospital wishes to continue an involuntary hospitalization beyond this authorized period, a judicial hearing is required during which the hospital must justify extension. Since this requirement for a periodic judicial hearing impinges on the autonomy of hospital management, the hospital has an interest in circumventing it. This report investigates the possibility that the hospital staff circumvents hearing requirements by transferring patients from involuntary to voluntary hospitalization. Data regarding patient status changes under the limited commitment model in Florida have been collected and are presented. The data support the argument that a major function of changes to voluntary status is the circumvention of hearing requirements. The data also suggest that this circumvention subverts the therapeutic reason for permitting status changes.