Implications of the Donaldson decision: a model for periodic review of committed patients.

In 1976 the Connecticut Valley Hospital, the Yale University School of Law, and the department of psychiatry of the Yale School of Medicine, undertook a project in which all involuntary patients at the hospital, a total of 107, were reviewed by three interdisciplinary panels, each composed of a law student, a psychiatric resident, and a hospital social worker. The major purposes of the project were to identify those patients entitled to release under the Donaldson criteria, to develop a model review procedure, and to assess the need for alternative placements. The panels found no patients resembling Kenneth Donaldson, but they did find 53 per cent of the patients inappropriately detained on involuntary status. However, in most cases the recommendation was transfer to a nursing home because of the patient's high degree of disability. The authors emphaxize the importance of periodic external reviews of commitment status.