ABSTRACT
In considering the decision-making process by psychiatrists concerning involuntary detention, this chapter discusses the legislative framework in which psychiatry is practised, the individuals involved, and factors in the illness or particular symptoms that lead to a diagnosis of a mental illness which necessitate such intrusion. Factors in the illness which increase the likelihood of commitment include symptoms suggestive of psychosis such as delusions of persecution or external control, intense affect, disordered thought or behaviour, lack of insight, intense suicidality, and evidence of poor judgement. Decision-making in relation to involuntary treatment has become increasingly crisis driven, with an emphasis on dangerousness, often considered in terms of risk. The availability of resources is one of the potent influences on the decision to recommend involuntary detention. The problem of substance abuse by mentally ill persons adds to the dilemma faced by psychiatrists in deciding whether to recommend involuntary treatment.
