How bad is civil commitment? A study of attitudes toward violence and involuntary
D. Mossman and K. J. Hart,
Bull. Amer. Acad. Psychiatry & the Law
21(2): 181-94, 1993.
Civil commitment statutes throughout the nation authorize involuntary hospitalization for persons
who are believed dangerous to others, even though clinicians' ability to predict violence is imperfect.
Decision-makers faced with ambiguous evidence about future violence must make either-or
decisions about involuntary hospitalization. Such decisions can be characterized as "true positives"
(hospitalization of a person who would have acted violently if released), "true negatives" (nonviolent
person is not hospitalized), "false positive" (nonviolent person is hospitalized), or "false negative"
(person is released and subsequently acts violently). This paper presents two pilot studies of attitudes
about false negative and false positive decisions, and explains how Decision Theory can use
information gleaned from such studies to establish optimal decision thresholds for initiating
involuntary hospitalization. Subjects expressed a broad range of implicit tolerances for false negative
and false positive predictions. Though most subjects preferred being hospitalized for three days to
being the victim of a knife-wielding attacker, a substantial minority preferred being attacked to being
hospitalized. The article briefly explores the practical implications of these findings, which include
an implicit endorsement of stringent commitment policies that would release a large fraction of
potentially violent persons.