Distractors and Distressors in Involuntary Status Decision-Making

This article examines a series of emotive and judgmental descriptors that from time to time are availed of in the context of civil commitment of patients by both clinicians and mental health review tribunals. Those which are scrutinised are: 'insightless', 'non-compliant', 'promiscuous', 'absconder', 'violent', 'substance dependent', 'disorganised', 'poor hygiene', 'impaired judgment' and 'personality disordered'. Decisions of the Victorian Mental Health Review Board are used to illustrate the issues. The argument is put that it is necessary for clinicians and review tribunals alike to 'unpack' such descriptors, use them with great care, always assess whether they are justified by reliable, contemporary evidence, probe their contexts, and decide whether they are the product of subjective judgments which may have alternative explanations.