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 or in the community.
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 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. 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. 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, 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
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.
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 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 = United Nations=
United Nations General Assembly, "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 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
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 Notes
References Atkinson, Private and Public Protection:
Civil Mental Health Legislation, Edinburgh, Dunedin Academic Press
1 Rosenhan, D.L.. On being sane in insane places" Science 179, 250-258.
2 Spitzer, R.L.. 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.. 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.. 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 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 - search using "mental health act" for the latest version of the act
Mental health review board site - the official site of the MHRB
Keys to Commitment 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
"AlterNet: Movie Mix: Must-See Indy Film Exposes Cruel Teen Correction Programs".
Retrieved 2007-07-08. Baker Act Reporting Center
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