Civil commitment (i.e., civil involuntary hospitalization and treatment) is sometimes necessary to treat some psychiatric patients, especially those believed to be dangerous to themselves or others. In the State of Missouri, following the initial emergency petition for up to 96 hours involuntary detention and treatment, the psychiatrist may file with the probate court a petition for additional detention and treatment not to exceed 21 days. Subsequent petitions may be filed to extend the patient’s stay for up to 90 days, and then for up to a maximum of one-year commitment .
Teleconferencing saves time, improves productivity, enhances safety, and helps preserve patient dignity.
Traditional court proceedings, for those requesting extension beyond the original 96-hours, require all parties to be present in the courtroom. The psychiatrist and other hospital staff would necessarily leave their workplace and travel to the courthouse, resulting in loss of clinical productivity, which itself reduces time available for providing care to other patients. Because every such patient is believed to be dangerous to self or others, law enforcement necessarily has transported them in physical restraints, regardless of age, gender, or history of personal trauma. This was not only further traumatizing, but also demeaning for the patient.
After being ruled constitutional in 1993 , the American Psychiatric Association (APA) endorsed the use of videoconferencing as a means for conducting civil commitment hearings in 1998 . The 13th Judicial Circuit Court in Boone County, Missouri, implemented this modality in 2010 for civil commitment to the Missouri University Psychiatric Center (MUPC) and to the Truman Veterans Hospital in Columbia, Missouri. To the best of our knowledge, only three other hospitals in Missouri, one in the adjacent county of the 13th Judicial Circuit, use this technology.
The videoconferencing equipment bridges two distinct locations and sets of participants. The judge, the prosecutor, court clerk, marshal, and perhaps some witnesses would be at the courthouse. The patient, patient’s attorney, testifying psychiatrists and other staff witnesses, hospital court liaison, and hospital security staff would be in another “courtroom,” located in the originating mental health facility (Fig. 1). This “courtroom” replicates an actual courtroom, complete with the United States flag and the State Seal. Hospital staff would then escort the patients without need of law-enforcement restraints to this “courtroom,” which itself is located on the same floor as the adult inpatient units.
Since the implementation of videoconferencing at MUPC, an average of 250 cases per year have occurred, mostly for civil commitment, but also other cases including, but not limited to emergency guardianship hearings. The experience of all the parties involved in the process, including patients, has been positive overall. Boone County Circuit Judge Deborah Daniels says “Teleconferencing is far superior to traditional court hearing for civil commitments, as it is an efficient choice for patients, medical and legal staff involved in the process. It plays to the strengths rather than weaknesses of the system and does not interfere with the judicial process.”
We have found that this method has saved healthcare staff members’ time, improved productivity, enhanced patient and staff safety, and eliminated the burden and embarrassment of transportation in restraints by law enforcement. In particular, this process has helped preserve the dignity of the patient. We have found the only downside to this method is the initial investment on the equipment and dedication of space for the facility’s “courtroom.” However, its long-term savings easily offset that investment . Therefore, we highly recommend the use of teleconferencing with respect to most of the mental health hospitals dealing with involuntary admissions and perhaps some other court proceedings across the country.
Muaid Ithman, Ganesh Gopalakrishna, Bruce Harry, and Deepthi Bahl are with the Department of Psychiatry, University of Missouri-Columbia, Columbia, MO. Email: email@example.com.