Civil Commitment Policies Notes

  • Civil Commitment Policies Overview

  • Involuntary civil commitment is a legal process where individuals are committed to psychiatric institutions without their consent, for evaluation, treatment, and stabilization.

  • Applies to individuals with mental illness, chemical dependency, or harmful behaviors.

  • States differ in laws regulating hold duration, initiators of holds, judicial oversight, and rights during holds (Hedman et al., 2016).

  • The U.S. Supreme Court views civil commitment as a significant curtailment of liberty (SAHMSA, 2019).

  • Criteria for Civil Commitment

  • Certain standards must be met to initiate civil commitment:

    1. Dangerous behaviors present clear and present danger to self or others.
    2. Behaviors stem from a recognized mental illness or disability.
    3. Behaviors are amenable to treatment.
    4. Individual is unable or unwilling to consent to treatment.

  • Types of Civil Commitment

  • Three main types:

    1. Emergency Hospitalization for Evaluation
      • Social workers in 31 states can initiate this; lasts up to 72 hours.
    2. Inpatient Civil Commitment
      • Occurs after a judge evaluates if the emergency criteria continue to apply.
    3. Outpatient Civil Commitment
      • Individuals are mandated to follow a treatment plan in the community.

  • Standards for Dangerousness

  • Dangerousness criteria vary: it can involve threats to self (suicidal ideation) or to others (homicidal ideation).

  • Grave disability standards exist where individuals cannot provide for their essential needs.

  • Ten states also use inability to meet basic needs as a criterion for civil commitment.

  • Initiation of Civil Commitment

  • In all states, police can initiate emergency holds; however, social workers and other mental health professionals have the authority in 31 states.

  • Family members may initiate holds in 22 states.

  • Emergency Detention Process

  • Steps typically include:

    1. Pre-petition screening.
    2. Notification of rights to the individual.
    3. Assessment of behaviors and exploring least restrictive options.
    4. Completing court petition for commitment.

  • Historical Context of Civil Commitment

  • Early years (1800-1899): Primarily jails and almshouses for treatment, leading to state-run institutions initiated by advocates like Dorothea Dix.

  • Mid-20th century (1900-1950s): Legal protections established for individuals, including attorney access and jury trials.

  • 1960s-1970s: Deinstitutionalization movement initiated, with emphasis on community care through legislation like the Community Mental Health Centers Act of 1963.

  • Mental Health Courts and ACT Programs

  • Mental health courts address underlying issues of criminal offenders with mental illness, offering treatment plans to avoid jail.

  • Assertive Community Treatment (ACT) programs aim to reduce hospitalizations through comprehensive community-based care.

  • Vulnerable Populations Affected by Civil Commitment

  • Includes individuals with substance use disorders, severe mental illnesses, and those with developmental disabilities, among others.

  • Each group faces unique challenges related to civil commitment processes and outcomes.