Capacity assessment and involuntary commitment in psychiatric and medical settings: Clinical, legal, and cultural considerations

Have you ever wondered what criteria need to be satisfied before a patient can be involuntarily admitted to a psychiatric hospital? Have you been puzzled when you learned your patients cannot be involuntarily committed to psychiatric facilities for alcohol use or abuse or for complications of head injuries? Have you been uncertain as to when you should embark on a capacity assessment and guardianship proceedings for those on medical and surgical services? Have you been unsure how cultural factors influence the expectations and attitudes of patients, family members, providers, and systems of care regarding involuntary admission? If you have, the following case vignettes and discussion should prove useful.