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James Walkup, PhD, James Satriano, PhD, Danielle Barry, MS, Pablo Sadler, MD, MPH and Francine Cournos, MD

James Walkup is with the Institute for Health, Health Care Policy and Aging Research and Danielle Barry is with the Department of Psychology, Rutgers University, New Brunswick, NJ. James Satriano is with the New York State Office of Mental Health, New York, NY. Pablo Sadler and Francine Cournos are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY.

Correspondence: Requests for reprints should be sent to James Walkup, PhD, Institute for Health, Health Care Policy and Aging Research, 30 College Ave, New Brunswick, NJ 08903 (e-mail: walkup{at}rci.rutgers.edu).

Objectives. Using opinion data from experts, we examined the context of the argument for mandatory testing of psychiatric patients.

Methods. Vignettes were distributed to experts on HIV and mental illness. Respondents were asked to provide appropriateness ratings for different hypothetical clinical decisions regarding HIV management.

Results. Respondents were reluctant to impose testing without informed consent in most circumstances. The presence of risk factors or danger to another increased appropriateness ratings modestly.

Conclusions. Despite experts’ tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals.

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