Factors in the Use of Coercive Retention in Civil Commitment Evaluations in Psychiatric Emergency Services

OBJECTIVE: The authors examined whether factors other than civil commitment criteria influence the involuntary retention of patients who are evaluated for civil commitment in psychiatric emergency services in California general hospitals. METHODS: Logistic regression analysis was used to determine whether admission criteria, institutional constraints, social biases, and procedural justice indicators contributed to the use of coercive retention in the evaluations of 583 patients in the psychiatric emergency services of nine California county general hospitals. RESULTS:Of the 583 patients, 109 (18.7 percent) were retained against their wishes. Clinicians relied primarily on admission criteria in making the decision to retain a patient, which suggests that patients were generally afforded procedural due process during the evaluation in the psychiatric emergency service. Staff workload was a possible factor in violations of due process. CONCLUSIONS: Psychiatric emergency services need additional resources to ensure procedural due process protection for patients who are being evaluated for civil commitment.