The inappropriateness of “least restrictive alternative” analysis for involuntary procedures with the institutionalized mentally ill

1983 ◽  
Vol 11 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Thomas G. Gutheil ◽  
Paul S. Appelbaum ◽  
David B. Wexler
Keyword(s):  
Mentally Ill ◽  
Historical Review ◽  
Ethical Analysis ◽  
Involuntary Treatment ◽  
Alternative Analysis ◽  
Emergency Medication ◽  
Least Restrictive Alternative

The concept of the least restrictive alternative has been misunderstood and probably misapplied in relation to involuntary interventions common on inpatient wards: seclusion, restraint, and forced emergency medication. A brief historical review of the doctrine of the least restrictive alternative is presented, followed by a clinical and ethical analysis of problems in its application. The least restrictive alternative is demonstrated to be an inappropriate model for dealing realistically with issues raised by involuntary treatment of the institutionalized mentally ill.

Outcomes for Psychiatric Patients following First Admission: Relationships with Voluntary and Involuntary Treatment and Ethnicity

2001 ◽  
Vol 88 (3_suppl) ◽  
pp. 1012-1014 ◽  
Author(s):  
Kimberlyn Gray Houston ◽  
Marco Mariotto ◽  
J. Ray Hays
Keyword(s):  
Sex Differences ◽  
Ethnic Differences ◽  
Mentally Ill ◽  
Psychiatric Patients ◽  
Involuntary Treatment ◽  
Psychiatric Admission ◽  
Severely Mentally Ill ◽  
Desirable Outcome ◽  
Admission Status ◽  
Male Patients

Research suggests that there are ethnic differences in hospitalization outcomes for severely mentally ill patients. This study examined ethnic and sex differences in admission status, rapid readmission, and discharge placement of 487 patients on their first psychiatric admission. There were sex differences in admission status with significantly more male patients being involuntarily admitted than female patients. Ethnic differences in placement at discharge were not supported, but involuntarily admitted patients were over-represented in the less desirable outcome categories.

Scottish Views of Mental Illness

1968 ◽  
Vol 13 (6) ◽  
pp. 211-216
Author(s):  
Una Maclean
Keyword(s):  
Mental Illness ◽  
Random Sample ◽  
Mentally Ill ◽  
General Public ◽  
Historical Review ◽  
Medical Schools ◽  
Structured Interview ◽  
Personality Factors ◽  
The Public ◽  
Treatment Facilities

A brief historical review of Scottish attitudes to the mentally ill is followed by a description of the 1966 Edinburgh survey of opinion on mental illness. This was carried out by structured interview on a random sample of the Edinburgh population. Part of the instrument, which had been carefully pretested and developed for this purpose, was submitted to 12 consultants in the professorial teaching units of Scottish University Medical Schools. The psychiatrists' opinions were compared with those of the general public and several differences were discovered. The public were more fearful and less optimistic than the specialists and their ideas of the causation of mental illness were connected with environmental rather than personality factors. Since the younger, better educated members of the community held views closest to those of the psychiatrists it is suggested that the opinion gap would probably lessen still further, encouraging more patients to seek specialist attention and putting extra pressure upon the available treatment facilities.

Attitudes of Psychiatric Patients and their Relatives to Involuntary Treatment

1991 ◽  
Vol 25 (2) ◽  
pp. 231-237 ◽  
Author(s):  
Nicholas H.S. Adams ◽  
R. Julian Hafner
Keyword(s):  
Mental Illness ◽  
Psychiatric Hospital ◽  
Mentally Ill ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
South Australia ◽  
Involuntary Treatment ◽  
Psychiatric Outpatient ◽  
Handicapped People ◽  
Negative Statements

In 1979 a Guardianship Board assumed responsibility in South Australia for the welfare of those mentally ill or handicapped people unable to look after their own health or safety, or to manage their own affairs. This study examines the attitudes to guardianship and involuntary treatment of 79 patients referred to the Board from a psychiatric hospital, all of whom were under guardianship at the time of the study. Forty-seven of their relatives took part in the project, which included measures of patients' psychiatric symptoms and relatives' punitiveness. Although almost 70% of patients objected to Guardianship in principle, they made more positive than negative statements about it. Nearly 60% rated involuntary treatment, including medication, as helpful. Patients reported a level of psychiatric symptoms less than half of that of a psychiatric outpatient sample. Relatives were strongly in favour of Guardianship, stating frequently that it allowed an improved relationship between themselves and the patient. Patients who believed that they were suffering from a mental illness were comparatively happy about being under Guardianship, and a belief that the patient was mentally ill was significantly associated with reduced ex-trapunitiveness in relatives.

The Least Restrictive Alternative to Involuntary Hospitalization, Outpatient Commitment: Its Use and Effectiveness

1982 ◽  
Vol 10 (1) ◽  
pp. 81-96 ◽  
Author(s):  
Virginia Aldigé Hiday ◽  
Judge Rodney R. Goodman
Keyword(s):  
Success Rate ◽  
Mentally Ill ◽  
Outpatient Treatment ◽  
Civil Commitment ◽  
Time Frame ◽  
High Success Rate ◽  
Involuntary Hospitalization ◽  
Outpatient Commitment ◽  
Select Group ◽  
Least Restrictive Alternative

For two years, all court-ordered outpatient treatment in one civil commitment court was followed for the maximum time of an initial commitment, three months. Based on involuntary readmissions and involuntary commitments, outpatient commitment for the dangerously mentally ill was found to have a high success rate; only 12.5% of the respondents were involuntarily rehospitalized during the time frame. For the select group of respondents ordered to outpatient treatment by this court, outpatient commitment provided an effective, less restrictive alternative to involuntary hospitalization.

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