Involuntary Commitment: Patient and Public Rights

Confinement to a mental health facility against one's will is involuntary commitment. This is true whether to protect the public or the individual from self-harm.

Involuntary commitment involves taking away a person's freedom for some time. There are legal procedures to ensure the patient's constitutional right to due process.

Another term for involuntary commitment is civil commitment. Civil commitment is the legal process where a judge decides if a person with a mental illness will be committed against their will.

This article provides a summary of patient rights on involuntary commitment. This includes grounds for commitment and state and federal laws.

Involuntary Commitment Law: A Brief History

Civil commitment proceedings start when a person is a danger to themselves or the public. Civil commitment requires statutory due process under state and federal laws. This was only sometimes the case. Patients' and the public's constitutional rights weren't protected until the 1970s.

In 1975, the U.S. Supreme Court decided O'Connor v. Donaldson, wherein they held that "A State cannot constitutionally confine... a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends..."

Under this decision, "mental illness" alone cannot result in an involuntary commitment. They must also be either:

• A danger to the public, or
• A danger to themselves

State civil commitment laws reflect this standard. These standards include state laws that allow for the confinement of habitual sex offenders.

Before 1975, mentally ill persons had little autonomy over their treatment and the commitment process. There was a presumption that the mentally ill were incompetent to make decisions. The state and family members made decisions for mentally ill persons as they saw fit. They believed in-patient care at state hospitals or private treatment facilities was beneficial. Almost anyone could commit a mentally ill person to in-patient care.

Patient Rights

A person with mental illness is still a person. They do not lose their civil rights because they are mentally ill. They also do not lose their rights because of a civil commitment. They have the right to refuse treatment. They also have the right to freedom from constraints and abuse.

They have the same rights under HIPAA as persons without a mental illness. In short, a person's rights do not end if they are under an involuntary commitment.

Civil Commitment Proceedings

Civil commitment proceedings are not only for mentally ill persons. Persons with substance abuse disorders can face civil commitment. Substance abuse is a mental health disorder, involving the use of illegal drugs, alcohol, or other substances.

The civil commitment of a mentally ill person varies by jurisdiction, but many follow similar steps.

Establishing a Treatable Mental Illness

The first step is establishing the person has a treatable mental illness. The person may already be in a mental health facility. Some get help through the local department of health or human services. The person must be a danger to themselves or others. Sometimes, the person may disclose a desire to cause serious harm to themselves or someone else. Or, depending on the severity of the person's mental illness, they clearly need a higher level of medical care.

Establishing Dangerousness

The next step in this process is to establish dangerousness. The mentally ill patient is a danger to themselves or other persons. This is clear when someone makes a threat to harm themselves or others. In many states, grave disability is grounds for involuntary commitment. A person with a grave disability cannot handle their basic needs. This includes bathing, food, and shelter.

Treatment

Finally, the person must need treatment. Treatment can include medications, different types of talk therapy, or alternative treatments. Alternative treatments can consist of restorative yoga or hiking. The mental health service provider should have a treatment plan and treatment record detailing all treatments. The treatment record should disclose any side effects of the proposed medications.

Some mental health institutions offer specific treatment programs for different illnesses.

In Institutions

Involuntary commitments happen in psychiatric hospitals or mental health facilities. Some patients go into treatment voluntarily. Some patients come prepared for their time in a mental health institution. Patients who expect an extended stay bring their own clothes and toiletries. If voluntary admission is part of crisis intervention, patients don't have time to gather personal items.

Waiting Period

Patients remain in-patient for a 72-hours for needs assessment and stabilization. During this time, mental health professionals evaluate their mental well-being. Social workers find appropriate community-based services. Almost anyone (a legal guardian or law enforcement) can refer someone for a mental health evaluation.

After a 72-hour waiting period, patients can leave unless their treatment team decides they need to stay. Legal guardians or conservators make this choice if their ward needs hospitalization. Patients can continue the voluntary admission. Or, the treatment team can seek an involuntary commitment if necessary. This is in-patient involuntary commitment.

Court Order

The mental health professionals petition the court for a court order if necessary. The petition's goal is a court order forcing the person into in-patient care against their will. In most states, a court order comes within two to three days of emergency confinement. Often a hearing takes a few days. The patient has a right to legal counsel during the hearing. Courts usually appoint an attorney.

If the court agrees that the patient is a danger to themselves or the community, they will issue an order. Patients are only confined for as long as is necessary for treatment. A release may come after later hearings.

Involuntary Commitment Laws

Federal law addressing involuntary commitment is part of criminal procedure. This includes the civil commitment of a sexually dangerous person.

Federal laws also address hospitalizing:

• Defendants found not guilty because of insanity
• Convicted persons who have mental diseases
• Imprisoned persons suffering from mental disorders
• Persons due for release but suffering from mental impairment

State Laws

Civil commitment laws in most states allow the following kinds of involuntary confinement:

• Emergency Hospitalization - A "psychiatric hold" that involves short-term confinement during a crisis for evaluation purposes
• In-Patient Civil Commitment - Longer-term confinement, often in a specialized unit
• Outpatient Civil Commitment - Often referred to as "mandated" or "assisted" outpatient treatment (AOT), this involves court-ordered mental health treatment

The following is a sampling of state involuntary commitment laws:

• Texas - The state presents a medical examination certificate and a supporting affidavit. The court appoints an attorney for the patient.
• Illinois - Anyone who believes an individual needs immediate hospitalization may present a petition for their commitment.
• California - An authorized person (peace officer, mental health professional, etc.) must establish probable cause for involuntary commitment. They must prove the patient is a danger to others, a threat to themselves, or is "gravely disabled as a result of the mental disorder."

Advocacy groups, like the Treatment Advocacy Center, help states reform their civil commitment laws.

Standards for Treatment and Confinement

Standards for involuntary treatment and confinement vary from state to state. The Federal Civil Rights of Institutionalized Persons Act of 1980 (CRIPA) protects patients' rights in state institutions.

In Florida, patients must receive notice of their rights in a care facility. These rights include the right "to receive the least-restrictive, available treatment" possible. Also, Florida prohibits using "restraints, seclusion, isolation," and other, more extreme measures. They are not used for punishment or the convenience of staff.

Get Help

The state can commit you or a loved one to a mental health facility. It must prove that confinement is necessary and follow due process. You or your loved one can defend against such a petition. Speak to a local healthcare law attorney for guidance.