Friday, November 17, 2023

Virtual Civil Commitment Hearings May Result in Inaccurate Safety Decisions

During the height of the COVID-19 pandemic, many courts began conducting involuntary civil commitment hearings virtually with patients in the hospital. (Such hearings are used to determine if a person presents a threat to his/herself and/or others and needs court-ordered inpatient care.) As some courts continue to conduct virtual hearings in the pandemic’s aftermath, the authors of a Viewpoint in Psychiatric Services argue that such hearings may challenge the court’s ability to make fair and accurate commitment determinations.

“Every patient has the right to a formal hearing in which a hearing official considers all evidence and testimony and may order release from care unless specified criteria have been met,” wrote Stephanie Hare, Ph.D., of the University of Maryland School of Medicine and colleagues. “Although prior publications have discussed the ethics of virtual [civil commitment] hearings, we argue that this literature presents a one-sided view and highlights the convenience of virtual hearings for legal officials and counselors. What is needed is a thorough ethical analysis of the benefits versus costs (or risks or challenges) of virtual [civil commitment] hearings.”

Hare and colleagues outlined numerous ways in which virtual civil commitment hearings may compromise the ability of the court to make accurate safety determinations, including the following:

  • Court officials may miss important information when patients are muted: In some instances, patients may be muted during virtual hearings, perhaps to prevent disruptions. But muting patients, “may prevent them from providing vital information that can help to explain their perspective or behavior,” the authors wrote. It may also, “prevent the hearing officials from witnessing statements or behaviors that either affirm or refute safety risk.”
  • Court officials lose opportunities to observe patients’ symptoms when cameras are angled away: Patients’ cameras may be angled away from them to prevent disruptions. For example, if a patient has repeated, paranoid outbursts that interrupt the hearing, onsite staff may mute the patient and angle the camera away from him or her for convenience. This could limit officials’ direct observation of the patient’s symptoms, leading the officials to miss signs that the patient needs continued inpatient care.
  • Patients may grow frustrated due to the digital divide: The virtual format may make it difficult for patients to perceive court officials’ social or nonverbal cues, resulting in stress or frustration on the part of the patient. “This behavior could be interpreted by officials at the hearing as cause for safety concerns, when in fact the behavior may have simply been triggered by additional obstacles or stressors being placed before the patient,” the authors wrote. This could lead to overutilization of commitment decisions.
  • Patients may have a harder time communicating with their legal counselors: Less experience with digital technologies among patients may make it challenging for them to communicate with their legal counselors during prehearing meetings, as well as with officials during the hearing. This could further interfere with accurate commitment assessments.

The authors acknowledged that their views were based on their own experiences, and that different courts and hospitals could have different needs. “[W]e advise gathering feedback from various stakeholders in the [civil commitment] process about their experiences, including feedback from involuntarily admitted patients about their experiences with virtual technologies,” they wrote. “This feedback will not only provide fresh perspectives on key challenges but also help to ensure that the highest standards of fairness, accuracy, and integrity are maintained in the [civil commitment] process.”

For related information, see the Psychiatric Services report “Taking an Evidence-Based Approach to Involuntary Psychiatric Hospitalization.”

(Image: iStock/Rawf8)