Hospitalization, Arrest, or Discharge - Important Legal and Clinical Issues in the Emergency Evaluation of Persons Believed Dangerous to Others

• NCJ Number: 90681
• Journal: Law and Contemporary Problems Volume: 45 Issue: 3 Dated: (Summer 1982) Pages: 99-123
• Author(s): G A Huber; L H Roth; P S Appelbaum; T M Ore
• Date Published: 1982
• Length: 25 pages
• Publication Format: Article
• Language: English
• Country: United States of America

Annotation

This article considers the problems encountered by psychiatric emergency room personnel in evaluating potential dangerousness, develops a typology of dangerous persons seen in that setting, and explores the legal duties that force the mental health system to retain responsibility for controlling dangerous persons after an evaluation.

Abstract

Clinicians in psychiatric emergency rooms generally evaluate five types of potentially dangerous persons: (1) those dangerous to others because of mental illness, (2) those dangerous to others because of 'personality disorders,' (3) those with coexisting mental illness and dangerousness (causal relationship uncertain), (4) those manifesting extreme dangerousness to others with or without mental illness, and (5) those dangerous to others but not mentally ill. Thomas Szasz argues that the criminal justice system should be responsible for control of dangerous persons believed to be mentally ill, but for dangerous mentally ill or nonmentally ill persons to be sent to jails or prisons instead of being hospitalized requires emergency room clinicians to overcome not only difficult problems inherent in the prediction of dangerousness and assessing the causes of violent behavior but also problems in interpreting legal and medical definitions of mental disorder. Clinicians must also face practical issues involved in making transfers to the criminal justice system, problems in avoiding liability while attempting to reduce the probability that others will suffer future harm, and problems related to the legal and ethical principles of confidentiality. These complicated issues make it simpler for the clinician to hospitalize the person for mental health treatment. It is unlikely that this situation will change until there is a better understanding about the fundamental causes of a person's disordered, particularly violent, behavior. A total of 116 footnotes are provided.