A reliable prototype index, Three Ratings of Involuntary Admissibility (TRIAD), was developed to reflect the way psychiatric emergency room clinicians apply legal criteria for involuntary commitment. The interrater reliability coefficients--Pearson's r--of the TRIAD system for rating patients are 0.94, danger-to-self score; 0.89, danger-to-other score; 0.77, grave-disability score; and 0.89, total-admissibility score. TRIAD scores accounted for 82 percent of 89 disposition decisions in two metropolitan county hospital psychiatric emergency rooms. Study results indicate that (1) psychiatric emergency room clinicians shared constructs of danger to self, danger to others, and grave disability; (2) these constructs are reliably applied in actual cases; (3) TRIAD is a valid reflection of these constructs; and (4) case disposition is predictable from the severity of the patient's status with regard to these criteria.

The authors developed Three Ratings of Involuntary Admissibility (TRIAD) to reflect the way clinicians in psychiatric emergency rooms apply legal criteria for the involuntary commitment of patients. Using TRIAD to rate patients on danger to self, danger to others, and grave disability, psychiatric social workers observing patients and clinicians correctly predicted 82 percent of 89 dispositions in two metropolitan county hospitals. These results indicate that clinicians agree on the meaning of the legal criteria and are able to apply them consistently.