Define civil commitment and identify the common criteria.
Describe the civil commitment process and types of civil commitment.
Discuss the role coercion may play in civil commitment.
Describe the clinical practice involved in civil commitment.
Identify the relevance of the right to refuse treatment and make one's own treatment decisions.
Introduction to Civil Commitment
Civil Commitment: Refers to the involuntary hospitalization or mandated treatment of individuals experiencing mental illness who may pose a danger to themselves or others.
Viewed as one of the more contentious aspects of mental health law due to its implications for individual rights (Morris, 2020).
Legal Basis: Originates from the doctrine parens patriae (parent of the nation), which posits that the state has a duty to care for individuals who cannot care for themselves, particularly those who are mentally ill.
Contrasting Doctrine: Police Power - emphasizes protecting society from dangerous individuals rather than assisting the individual.
Historical Context
Civil commitment practices evolved from the medical model, rooted in a belief that the mentally ill need treatment, historically allowing commitment with minimal formal requirements.
Concerns about abuses and deprivation of rights in the 1960s led to significant legal reforms.
Landmark Cases:
Lake v. Cameron (1966): Court ruled that less restrictive alternatives must be considered for commitment.
Lessard v. Schmidt (1972): Established procedural safeguards for individuals facing civil commitment.
O'Connor v. Donaldson (1975): Legalized the rights of non-dangerous mentally ill individuals to be released from commitment.
Evidence of a decline in commitments from 558,000 in 1955 to about 132,000 by 1980 (Kiesler & Simpkins, 1993).
Shift in focus from parens patriae to police power, and the need for formal procedures to protect individuals facing commitment.
Criteria for Civil Commitment
1. Mental Illness
Definition Discrepancies: Legal definitions usually narrower than psychological definitions outlined by DSM.
Excluded Disorders: Common mental disorders like intellectual developmental disorder, substance abuse, and certain personality disorders often excluded from commitment criteria.
Severity Considerations: Some statutes stipulate that individuals must demonstrate a significant impairment affecting their decision-making ability for commitment.
2. Dangerousness
Dangerousness to others is typically assessed through threat of bodily harm. Definitions may vary statewide.
Danger to Self: Statutes may interpret this broadly, sometimes as suicidal ideation without clear definitions.
Hindsight Bias: The labeling effect on individuals currently hospitalized impacts perceptions of mental illness.
3. Grave Disability
Definition: Individuals are unable to provide for their basic needs, often serving as a more frequently cited reason for civil commitment.
Young Individuals: The majority impacted are typically aged 21-35, showing that grave disability is a primary driver of civil commitment (Turkheimer & Parry, 1992).
4. Need for Treatment
Though historically important, need for treatment is frequently incorporated into the criteria of mental illness and is not sufficient alone for commitment.
Process of Civil Commitment
Two Paths:
Formal Commitment: Requires a petition to the court, hearings, evaluations, and extensive legal protections.
Emergency Commitment: Authorized by law enforcement or mental health professionals for immediate but temporary holds (usually from 24 hours to several days).
Emergency holds account for 1.27 to 1.44 million commitments annually (Morris, 2021).
Outpatient Commitment
Allows individuals to engage in treatment while not residing in a psychiatric hospital.
Kendra's Law: In New York, legislation requiring specific criteria before an individual can be committed as an outpatient, including need for supervision and history of poor treatment compliance.
Three forms of outpatient commitment: traditional, preventative, and conditional release.
Coercion in Civil Commitment
Coercion involves using threats or pressures to compel hospitalization, affecting the clinician-client relationship.
Research Findings:
30% of patients involuntarily committed reported coercive experiences.
Both voluntary and involuntary patients may feel coerced.
Discussions on coercion can significantly affect treatment outcomes and patient engagement.
Ethical Considerations and Patient Rights
Recognizing the right to refuse treatment is paramount, raising questions about autonomy and informed consent.
Competency Assessments: Tools like the MacCAT-T assess an individual’s competency to participate in treatment decisions (Grisso & Appelbaum, 1998).
Conclusion
Civil commitment laws, their historical roots, and contemporary implications remain critical for protecting both individual rights and public safety in mental health.
Key Terms
Coercion: The practice of compelling individuals to undergo treatment or commit them to a facility against their will.
Conditional Release: The release of a patient from a facility under specific conditions.
Grave Disability: A term used to describe an individual's inability to care for themselves.
Parens Patriae: The state's duty to protect the vulnerable in society.
Police Power: The state's authority to act in the interest of public safety.