Abstract：
Adversarial hearings in hospital commitment and de novo treatment proceedings, or court hearings, delay psychiatric treatment in many jurisdictions. In Massachusetts, the \"treatment over objection\" process requires a court petition. For state hospital patients, the delay to treatment is an initial 34 day waiting period in addition to continuances of court hearings that extend treatment delays. This study examined the frequency of adverse medical events due to delayed court hearings within a forensic state hospital in the US.
The study reviewed all (n = 355) treatment petitions filed by a Massachusetts forensic hospital from 2015 and 2016. The incidence and nature of adverse events (e.g. patient/staff assaults, milieu disruptions) and acute medical symptoms (e.g. catatonia, acute psychosis), before and after the Court granted a petition for treatment, were analyzed by two raters. Adverse events included patient and staff assaults, acute psychiatric symptoms, and milieu problems.
82.6 % of treatment petitions led to involuntary treatment, 16.6 % were withdrawn by the medical petition filer, and only 0.8 % petitions were denied by the judge. Adversarial hearings occasioned an average delay of 41 days from treatment petition filing to receipt of standing treatment in addition to statute required delays. Once treatment was court-approved, all types of adverse events were significantly reduced.
Results established that the court treatment hearing scheme exacerbates health and safety risks to patients with serious mental illness. Increasing physician and court personnel awareness of these risks is likely key to enhancing a patient-focused, rights-oriented approach to these matters. This and other recommendations is proposed for jurisdictions that deal with this problem around the world.
The study reviewed all (n = 355) treatment petitions filed by a Massachusetts forensic hospital from 2015 and 2016. The incidence and nature of adverse events (e.g. patient/staff assaults, milieu disruptions) and acute medical symptoms (e.g. catatonia, acute psychosis), before and after the Court granted a petition for treatment, were analyzed by two raters. Adverse events included patient and staff assaults, acute psychiatric symptoms, and milieu problems.
82.6 % of treatment petitions led to involuntary treatment, 16.6 % were withdrawn by the medical petition filer, and only 0.8 % petitions were denied by the judge. Adversarial hearings occasioned an average delay of 41 days from treatment petition filing to receipt of standing treatment in addition to statute required delays. Once treatment was court-approved, all types of adverse events were significantly reduced.
Results established that the court treatment hearing scheme exacerbates health and safety risks to patients with serious mental illness. Increasing physician and court personnel awareness of these risks is likely key to enhancing a patient-focused, rights-oriented approach to these matters. This and other recommendations is proposed for jurisdictions that deal with this problem around the world.
摘要：
目标：医院承诺和从头治疗程序中的对抗性听证会，或者法庭听证会，在许多司法管辖区延迟精神病治疗。在马萨诸塞州,“处理反对”过程需要法院请愿。对于州立医院的病人来说，治疗的延迟是最初的34天等待期，此外还有延长治疗延迟的法庭听证会。这项研究调查了由于美国法医州立医院的法院听证会延迟而导致的不良医疗事件的发生频率。
方法：该研究回顾了2015年至2016年马萨诸塞州法医医院提交的所有（n=355）治疗申请。不良事件的发生率和性质(例如，患者/工作人员攻击，环境中断)和急性医学症状(例如卡顿，急性精神病)，在法院批准治疗申请之前和之后，由两名评估者分析。不良事件包括患者和工作人员的攻击，急性精神症状,和环境问题。
结果：82.6%的治疗请求导致非自愿治疗，16.6%被医疗请愿人撤回，只有0.8%的申请被法官拒绝。除了法规要求的延误外，对抗性听证会从提出治疗申请到接受常规治疗平均延迟了41天。一旦治疗获得法院批准，所有类型的不良事件均显著减少.
结论：结果确定，法院治疗听证方案加剧了严重精神疾病患者的健康和安全风险。提高医生和法院人员对这些风险的认识可能是增强以患者为中心的关键，对这些问题采取以权利为导向的方法。这项建议和其他建议是针对世界各地处理这一问题的司法管辖区提出的。
方法：该研究回顾了2015年至2016年马萨诸塞州法医医院提交的所有（n=355）治疗申请。不良事件的发生率和性质(例如，患者/工作人员攻击，环境中断)和急性医学症状(例如卡顿，急性精神病)，在法院批准治疗申请之前和之后，由两名评估者分析。不良事件包括患者和工作人员的攻击，急性精神症状,和环境问题。
结果：82.6%的治疗请求导致非自愿治疗，16.6%被医疗请愿人撤回，只有0.8%的申请被法官拒绝。除了法规要求的延误外，对抗性听证会从提出治疗申请到接受常规治疗平均延迟了41天。一旦治疗获得法院批准，所有类型的不良事件均显著减少.
结论：结果确定，法院治疗听证方案加剧了严重精神疾病患者的健康和安全风险。提高医生和法院人员对这些风险的认识可能是增强以患者为中心的关键，对这些问题采取以权利为导向的方法。这项建议和其他建议是针对世界各地处理这一问题的司法管辖区提出的。
