Aviram U
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08903.
Bull Am Acad Psychiatry Law. 1993;21(2):195-211.
Screening services are a central feature of New Jersey's new civil commitment law. This law, more commonly referred to as the screening law, exemplifies a nationwide trend in civil commitment legislation, attempting to balance liberty interests and the need to treat the mentally ill. Screening services, designated as the preferred process of entry into involuntary hospitalization, were expected to prevent unnecessary commitment and to provide community mental health services. When deemed necessary, commitment in local general hospitals rather than in state mental hospitals was to occur. This paper reports results of a study of screening centers that were already in operation in New Jersey prior to the implementation of the new law. It assesses the function of screening services and their potential impact on the commitment process in light of the objectives of the law. Data were obtained from in-depth interviews with key informants from the screening centers as well as from their environment, and from statistical reports on hospitalizations in state hospitals, admissions to screening centers, and admissions to psychiatric inpatient units of general hospitals. Analysis suggests that without more resources for alternative community facilities, screening services cannot achieve their objectives and the new reform may not live up to expectations. Shortage of alternatives to hospitalization and lack of incentives to develop and use them appeared to be counterproductive to achieving the objectives of the law. The availability of screening service and psychiatric units in general hospitals for involuntary hospitalization, on one hand, and the lack of alternatives in the community, on the other, may actually lead to inappropriate commitments and an increase in the number of civil commitments. Furthermore, findings indicated that screeners encouraged hospitalization readily even if other, less restrictive environments could have been pursued. Screening centers may become "gate openers" instead of playing their expected role as "gate keepers."
筛查服务是新泽西州新的民事强制收治法的核心特征。这部法律，更常被称为筛查法，体现了民事强制收治立法的全国性趋势，试图平衡自由权益与治疗精神疾病患者的需求。筛查服务被指定为非自愿住院的首选进入程序，旨在防止不必要的强制收治，并提供社区心理健康服务。在认为必要时，应在当地综合医院而非州立精神病院进行强制收治。本文报告了一项对在新法律实施之前已在新泽西州运营的筛查中心的研究结果。根据该法律的目标，评估了筛查服务的功能及其对强制收治程序的潜在影响。数据来自对筛查中心及其周边关键信息提供者的深入访谈，以及关于州立医院住院情况、筛查中心入院情况和综合医院精神科住院单元入院情况的统计报告。分析表明，如果没有为替代社区设施提供更多资源，筛查服务就无法实现其目标，新的改革可能无法达到预期。住院替代方案的短缺以及缺乏发展和使用这些方案的激励措施，似乎不利于实现该法律的目标。一方面，综合医院提供筛查服务和精神科单元用于非自愿住院，另一方面，社区缺乏替代方案，这实际上可能导致不适当的强制收治，并增加民事强制收治的数量。此外，研究结果表明，即使可以采用其他限制较少的环境，筛查人员也很容易鼓励住院治疗。筛查中心可能会成为“开门者”，而不是发挥其预期的“守门人”作用。
