Delays in commitment and treatment court proceedings worsen psychiatric and other medical conditions.

OBJECTIVE: Adversarial hearings in hospital commitment and de novo treatment proceedings, or court hearings, delay psychiatric treatment in many jurisdictions. In Massachusetts, the "treatment over objection" process requires a court petition. For state hospital patients, the delay to treatment is an initial 34 day waiting period in addition to continuances of court hearings that extend treatment delays. This study examined the frequency of adverse medical events due to delayed court hearings within a forensic state hospital in the US. METHODS: The study reviewed all (n = 355) treatment petitions filed by a Massachusetts forensic hospital from 2015 and 2016. The incidence and nature of adverse events (e.g. patient/staff assaults, milieu disruptions) and acute medical symptoms (e.g. catatonia, acute psychosis), before and after the Court granted a petition for treatment, were analyzed by two raters. Adverse events included patient and staff assaults, acute psychiatric symptoms, and milieu problems. RESULTS: 82.6 % of treatment petitions led to involuntary treatment, 16.6 % were withdrawn by the medical petition filer, and only 0.8 % petitions were denied by the judge. Adversarial hearings occasioned an average delay of 41 days from treatment petition filing to receipt of standing treatment in addition to statute required delays. Once treatment was court-approved, all types of adverse events were significantly reduced. CONCLUSIONS: Results established that the court treatment hearing scheme exacerbates health and safety risks to patients with serious mental illness. Increasing physician and court personnel awareness of these risks is likely key to enhancing a patient-focused, rights-oriented approach to these matters. This and other recommendations is proposed for jurisdictions that deal with this problem around the world.

Burden of proof: the evidence clinicians require before implementing an intervention.

BACKGROUND: Greater implementation of evidence-based practice for children and adolescents is a current emphasis in the mental health field; however, there is a need to understand how best to disseminate these interventions and convince community clinicians to use them. METHOD: A sample of 255 clinicians reported on the likelihood that they would use an intervention given various types of evidence. RESULTS: Case studies and clinical trials with an active or placebo control group scored as the most preferred types of evidence; however, more positive attitudes toward evidence-based practice predicted preferences for clinical trials, but were not related to case studies. CONCLUSION: Implementation of evidence-based practice may be improved by greater dissemination of case studies demonstrating the use of these interventions in 'real world' settings. In addition, fostering a greater appreciation of research-derived interventions among clinicians appears necessary.