DANGEROUSNESS, STRESS, AND MENTAL-HEALTH EVALUATIONS

Many jurisdictions require psychiatrists to assess patient 'dangerousness' in the process of involuntary hospitalization. Considerable research indicates that psychiatric prediction of dangerous behavior is rather inaccurate, the principal error being one of overprediction. Inaccuracy may result, in part, from the psychiatrist's role in the health care system. The Mental Health Associate (MHA) role, not sharing some of these structural disadvantages, is hypothesized to yield more accurate predictions of patient 'dangerousness. However, a follow up study of clients originally assessed on potential dangerousness indicated that MHA predications did not significantly differentiate between those actually manifesting dangerous behavior and those who did not. Further investigation revealed that incidence of stress events was significantly associated with the occurrence of dangerous behavior during the follow-up period and affected the accuracy of MHA assessments. MHA predictions significantly differentiated between those manifesting dangerous behavior and those who did not when stress was low during the follow-up period, but MHA predictions for those who experienced high stress conditions were less accurate. Implications of these findings for the process of attributing dangerousness for involuntary commitment are discussed.