North Carolina Resident Psychiatrists Knowledge of the
Commitment Statutes: Do They Stray from the
Legal Standard in the Hypothetical Application
of Involuntary Commitment Criteria?
Andrew R. Kaufman
Published online: 14 July 2010
Ó Springer Science+Business Media, LLC 2010
Abstract Objectives are to examine North Carolina (NC) resident psychiatrists knowledge
of commitment statutes and their willingness to involuntarily admit hypothetical patients
who do not meet statutory criteria. It is hypothesized that the need for transportation may be a
salient factor. In one vignette the patient had schizophrenia and the other alcohol dependence.
The respondents were asked to make a decision about commitment and to rate how 9 speciﬁed
factors affected their decision. Sixty-one residents responded. Thirty percent answered
incorrectly about statutory provisions for ‘mental illness’ and ‘dangerousness’, 10%
answered incorrectly that grave disability does not meet the dangerousness criterion, and
41% answered incorrectly about the NC statutory language of the ‘least restrictive alterna-
tive’ principle. While neither hypothetical patient met the commitment standard, 74% of
respondents would involuntarily admit the patient with psychotic illness and 87% would
involuntarily admit the patient with alcohol dependence. Training in commitment standards
with clinical vignettes should be conducted with residents to protect patient rights.
Keywords Civil commitment of mentally ill Á Patient rights Á
Least restrictive alternative Á Residency education
With the construction of the ﬁrst U.S. state psychiatric hospitals during the pre-Civil War
era came the ﬁrst legislation regulating mandatory hospitalization of the mentally ill .
Commitment laws have evolved from their parens patrie roots in British common law,
which required only that treatment was needed, toward modern standards based upon
dangerousness . In North Carolina, as in all other states , civil statute provides for
A. R. Kaufman (&) Á B. Way
Department of Psychiatry, State University of New York Upstate Medical University,
750 East Adams Street, Syracuse, NY 13210, USA
Psychiatr Q (2010) 81:363–367