Involuntary commitment

For involuntary treatment in non-hospital settings, see involuntary treatment.

Involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a psychiatric hospital (inpatient) or in the community (outpatient).

Criteria for civil commitment are established by laws, which vary between nations. Commitment proceedings often follow a period of emergency hospitalization, during which an individual with acute psychiatric symptoms is confined for a relatively short duration (e.g. 72 hours) in a treatment facility for evaluation and stabilization by mental health professionals—who may then determine whether further civil commitment is appropriate or necessary. If civil commitment proceedings follow, then the evaluation is presented in a formal court hearing where testimony and other evidence may also be submitted. The subject of the hearing is typically entitled to legal counsel and may challenge a commitment order through habeas corpus rules.

Historically, until the first third of the twentieth century or later in most jurisdictions, all committals to public psychiatric facilities and most committals to private ones were involuntary. Since then, there have been alternating trends towards the abolition or substantial reduction of involuntary commitment, a trend known as "deinstitutionalisation."

Purpose

In most jurisdictions, involuntary commitment is specifically applied to individuals found to be suffering from a mental illness that impairs their reasoning ability to such an extent that the laws, state, or courts find that decisions must or should be made for them under a legal framework. (In some jurisdictions, this is a distinct proceeding from being "found incompetent.")

Involuntary commitment is used to some degree for each of the following headings although different jurisdictions have different criteria. Some jurisdictions limit court-ordered treatment to individuals who meet statutory criteria for presenting a danger "to self or others." Other jurisdictions have broader criteria.

First aid

Training is gradually becoming available in mental health first aid to equip community members such as teachers, school administrators, police officers, and medical workers in recognizing and managing situations where evaluations of behavior might be appropriate. The extension of first aid training to cover mental health problems and crises is a quite recent development. A mental health first aid training course was developed in Australia in 2001 and has been found to improve assistance provided to persons with a mental illness or in a mental health crisis. This form of training has now spread to a number of other countries (Canada, Finland, Hong Kong, Ireland, Singapore, Scotland, England, Wales, and the United States). Mental health triage may be used in an emergency room to evaluate the degree of risk and prioritize treatment.

Observation

Observation is sometimes used to determine whether a person warrants involuntary commitment. It is not always clear on a relatively brief examination whether a person is psychotic or otherwise warrants commitment.

Containment of danger

Austria, Belgium, Germany, Israel, the Netherlands, Northern Ireland, Russia, Taiwan, Ontario (Canada), and the United States have adopted commitment criteria based on the presumed danger of the defendant to self or to others. People with suicidal thoughts may act on these impulses and harm or kill themselves. People with psychosis are occasionally driven by their delusions or hallucinations to harm themselves or others. People with certain types of personality disorders can occasionally present a danger to themselves or others.

This concern has found expression in the standards for involuntary commitment in every U.S. state and in other countries as the "danger to self or others" standard, sometimes supplemented by the requirement that the danger be "imminent." In some jurisdictions, the "danger to self or others" standard has been broadened in recent years to include need-for-treatment criteria such as "gravely disabled."

Deinstitutionalization

See also: Deinstitutionalisation

Starting in the 1960s, there has been a worldwide trend toward moving psychiatric patients from hospital settings to less restricting settings in the community, a shift known as "deinstitutionalization." Because the shift was typically not accompanied by a commensurate development of community-based services, critics say that deinstitutionalization has led to large numbers of people who would once have been inpatients being incarcerated in jails and prisons or becoming homeless. These scenarios occurred when outpatient services were not available or patients chose not to adhere to treatment outside the hospital. In some jurisdictions, laws authorizing court-ordered outpatient treatment have been passed in an effort to compel individuals with chronic, untreated severe mental illness to accept treatment while living outside the hospital (e.g. see Laura's Law, Kendra's Law).

Since the late 1960s the Italian physician Giorgio Antonucci questioned the basis themselves of psychiatry through the dismantling of the psychiatric hospitals Osservanza and Luigi Lolli and the liberation – and restitution to life – of the people there secluded.

Before the 1960s deinstitutionalization there were earlier efforts to free psychiatric patients. Doctor Philippe Pinel (1745–1826) ordered the removal of chains from patients.

There was a study of 269 patients from Vermont State Hospital done by Courtenay M. Harding, PhD and associates, about two-thirds of the ex-patients did well after deinstitutionalization.

Around the world

Main article: Involuntary commitment internationally

United Nations

United Nations General Assembly (resolution 46/119 of 1991), "Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care" is a non-binding resolution advocating certain broadly drawn procedures for the carrying out of involuntary commitment. These principles have been used in many countries where local laws have been revised or new ones implemented. The UN runs programs in some countries to assist in this process.

Politically motivated abuses

Main article: Psikhushka

At certain places and times, the practice of involuntary commitment has been used for the suppression of dissent, or in a punitive way.

In the former Soviet Union, psychiatric hospitals were used as prisons to isolate political prisoners from the rest of society. The official explanation was that no sane person would oppose the Soviet government and Communism. British playwright Tom Stoppard wrote Every Good Boy Deserves Favour about the relationship between a patient and his doctor in one of these hospitals. Stoppard was inspired by a meeting with a Russian exile.

In 1927, after the execution of Sacco and Vanzetti in the United States, a demonstrator named Aurora D'Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a rally in support of the anarchists.

See also

• 5150 (Involuntary psychiatric hold)
• Baker Act
• Civil confinement
• Criminal justice
• Involuntary treatment
• John Hunt
• Medical law
• Political abuse of psychiatry
• Rosenhan experiment
• Special commitment center
• Ulysses contract
• Voluntary commitment

References

• Atkinson, (2006) Private and Public Protection: Civil Mental Health Legislation, Edinburgh, Dunedin Academic Press
• ¹ Rosenhan, D.L. (1973). On being sane in insane places" Science 179, 250-258.
• ² Spitzer, R.L. (1975). On pseudoscience in science, logic in remission, and psychiatric diagnosis: A critique of Rosenhan's "On being sane in insane places." Journal of Abnormal Psychology, 84, 442-452.
• ³ Perlin, M.L. (1993/1994). The ADA and Persons with Mental Disabilities: Can Sanist Attitudes Be Undone? Journal of Law and Health, 8 JLHEALTH 15, 33-34.
• ⁴ Torrey, E. Fuller. (1997). Out of the Shadows: Confronting America's Mental Illness Crisis. New York: John Wiley and Sons.
• Black Hands of Beijing: Lives of Defiance in China's Democracy Movement, by George Black and Robin Munro, New York: John Wiley & Sons, Inc., 1993.
• Tsesis, Alexander, Protecting Children Against Unnecessary Institutionalization, South Texas Law Review, vol. 39, p. 995 (1998) papers.ssrn.com
• Public Service: Committed to healing: Involuntary commitment procedures.
• UN Resolution of persons with mental illness

External links

• National Mental Health Consumers' Self-Help Clearinghouse
• Victorian legislation and parliamentary documents (Australia) - search using "mental health act" for the latest version of the act
• Mental health review board site (Victoria, Australia) - the official site of the MHRB
• Keys to Commitment (A Guide for Family Members) by Robert J. Kaplan, J.D.
• State-by-state chart of U.S. commitment laws
• Psychiatric Imprisonment in Oregon
• Rogers Law, concerning involuntary treatment/commitment in Massachusetts
• Comprehensive Journal Article Discussing Civil Commitment Law and Reform Regarding Sex Offenders
• National Resource Center on Psychiatric Advance Directives
• Baker Act Reporting Center (related to Florida's Civil Commitment Statute)
• National Alliance on Mental Illness
• Unjustified Psychiatric Commitment in the USA
• "Getting Someone to Psychiatric Treatment Can Be Difficult and Inconclusive" New York Times January 18, 2011