Involuntary patients in general hospitals: a positive view.

Recently, the admission of involuntary patients to open, general hospital psychiatric units has become a controversial issue. This article suggests that the admission of involuntary patients to open psychiatric units in general hospitals is perfectly feasible, without negative consequences, and is congruent with the goal of community treatment. This viewpoint will be supported with data obtained from a university hospital that has accepted involuntary patients on an open psychiatric unit for its entire nine-year history without negative consequences. Leeman I.~ raises a number of concerns about involuntary patients in general hospital units. He asserts such patients are hard to manage, difficult to control, and dangerous. He states that involuntary patients may disturb a milieu therapy oriented unit. He cites such patients' lack of motivation, need for seclusion, and locked doors as potential problems in a milieu. He further contends that unusually long lengths of stay in this patient popUlation may cause problems with utilization review. Such patients are said to be indigent, to generate little revenue, and to require special attention given to patient rights. Leeman asserts the image of a general hospital may be destroyed by admitting such patients, in view of the past difficulty in establishing psychiatric services in general hospitals. Most of what has been written on the subject of involuntary patients in open treatment is of recent vintage and negative in tone. Flamm: suggests the need to "guard against some growing efforts to convert general hospital units into miniature state hospitals." Gove-l found that committed patients are poor, more often single, more often male, more seriously ill, and more difficult to manage than similar voluntary patients. However, Gove's study also found a slightly greater improvement in committed patients as compared to voluntary patients. Other studies have tended to find higher incidences of schizophrenia;' and belligerence or aggression in committed patients as compared to voluntary patients. Lin and others assert committed criminal patients are manipulative, have long stays, are difficult to manage, and experience secondary gains for staying "sick." There are those whose perceptions of committed patients are not so grim. Mueller7 describes 20 "criminally insane" patients transferred to open units from closed settings. Nineteen of these individuals went on to do well in aftercare settings outside the hospital and presented little in the way of difficulties in open settings. Only one failed secondary to recidivism. Crowder,s in a paper published at the same time as Leeman's, argues for