Date of Conferral

12-12-2025

Date of Award

December 2025

Degree

Doctor of Social Work (DSW)

School

Social Work

Advisor

Savvas Georgiades

Abstract

An increasing focus on the recovery, rights, and autonomy of individuals with serious mental illnesses has led to ongoing debate regarding the practice and legal regulation of involuntary commitment (IVC). To ensure ethical and appropriate patient care throughout this complex process, more knowledge is needed about social workers’ decision-making process regarding the use of IVC. The purpose of this study was to investigate the decision-making processes associated with IVC for inpatient psychiatric treatment in North Carolina using the biomedical ethics framework. More specifically, the study addressed how licensed social workers describe their experiences and decision-making processes when determining whether to place clients under IVC while balancing legal and ethical responsibilities. Data were collected via interviews with 12 licensed clinical social workers who had worked for at least 1 year as a first evaluator for IVC placements. Thematic analysis revealed six themes: (a) holistic assessments within ethical boundaries; (b) ethics code, patient respect, and safety as main determinants of decision making; (c) knowledge of the patient and assessment of risk and protective factors as facilitators of decision making; (d) protection of patient autonomy balanced against risk of imminent harm; (e) beneficence and nonmaleficence are central principles in decision making; and (f) more training for magistrates, more clarity in policy, and more choice in facilities were recommended. The study may promote positive social change by educating future social workers about some of the challenges and associated best practices concerning IVC decisions. Other implications for positive social change include informing relevant social policy and future legislative actions.

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