On January 2,1979, the state of Missouri enacted new mental health laws. In this tandem study the impact of the change in law at an acute urban mental health center in St. Louis, Missouri, was examined in two specific areas: involuntary civil commitment and involuntary electroconvulsive therapy (ECT). The first part of this examination was conducted by comparing all patients (N = 86) who were referred to court to determine their need for involuntary civil commitment from July 1, 1980, to June 30, 1982, to a nonadjudicated control group (N = 87). The second part of this examination was conducted by comparing all patients (N = 19) who were referred to court to determine their need for involuntary ECT from July 1,1979, to June 30,1983, to a voluntary ECT recipient control group (N = 24). A large series of statistical comparisons were made.
The major finding to emerge from these data was that clinicians were selectively referring to court a group of patients with histories of recurrently becoming both dangerous and noncompliant with hospitalization. In addition, it appears that voluntary ECT is used conservatively and involuntary ECT is used very conservatively.