Involuntary Commitment: Patient and Public Rights

Confinement to a mental health facility against one's will, whether to protect the public from danger or to protect the individual from self-harm, is referred to as involuntary commitment. Certain legal procedures must be followed to ensure that the patient's constitutional rights aren't violated. The civil commitment process in the United States began during colonial times, but it would take more than 200 years for these laws and procedures to finally recognize the rights of patients (and the public).

The following is a summary of patient and public rights with respect to involuntary commitment, including the grounds for commitment; state and federal laws; commitment proceedings; and standards for treatment and confinement.

Involuntary Commitment Law: A Brief History

Civil commitment proceedings may be carried out if the state or federal government declares someone a danger to themselves or the general public. Civil commitment requires due process under all state and federal laws, but this wasn't always the case. The constitutional rights of patients, as well as those of the public, weren't necessarily protected until courts began forcing the issue in the 1970s.

Specifically, the U.S. Supreme Court decided in 1975 (O'Connor v. Donaldson) 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..."

This decision established the standard that a finding of "mental illness" alone is not enough to confine a patient against their will; they must also be either:

• A danger to the public (invoking the state's inherent police powers); or
• A danger to themselves (the legal doctrine of "parens patriae").

This ruling would soon be reflected in state civil commitment laws and procedures, including state laws that allow for the confinement of habitual sex offenders.

Involuntary Commitment Laws

Federal law addressing involuntary commitment is generally limited to criminal procedure, including civil commitment of a sexually dangerous person as well as hospitalization of:

• Defendants found not guilty by reason of insanity;
• Convicted persons suffering from mental disease;
• Imprisoned persons suffering from mental disease; and
• Persons due for release but suffering from mental disease.

Civil commitment laws in most states authorize the following kinds of involuntary confinement and treatment:

1. Emergency Hospitalization - Often referred to as a "psychiatric hold," this typically involves a limited confinement in response to a crisis for evaluation purposes.
2. Inpatient Civil Commitment - This is a longer-term confinement, typically in effect until the court determines the patient no longer meets civil commitment criteria.
3. Outpatient Civil Commitment - Often referred to as "mandated" or "assisted" outpatient treatment (AOT), this involves court-ordered mental health treatment while the patient continues to live in the community (a handful of states haven't adopted this option, including Maryland and Massachusetts).

The following is a sampling of state involuntary commitment laws (the involuntary confinement of sex offenders is typically addressed separately), with links to the statutes:

• Texas - Patient is entitled to a probable cause hearing within 72 hours of being detained. State presents a certificate of medical examination and a supporting affidavit, while the patient is granted an attorney.
• Illinois - Anyone who believes an individual needs immediate, involuntary hospitalization may present a petition to a mental health facility in the county where the patient resides. This petition must include a detailed statement, the name of the individual's spouse or guardian, and the petitioner's relationship to the patient.
• California - An authorized person (peace officer, mental health professional, etc.) must establish probable cause for involuntary commitment by proving that the patient is a danger to others, a danger to themselves, or is "gravely disabled as a result of the mental disorder."

A 2014 report by the Treatment Advocacy Center grades state civil commitment laws, with feedback about bed waits, delays in actual treatment (after initial confinement), enactment of AOT laws, and other factors.

Civil Commitment Proceedings

Proceedings for civil commitment of a mentally ill individual vary by state, but follow similar steps. Generally, the goal of the petitioner (the party seeking commitment) is to secure a court order requiring the patient to receive necessary treatment against their own wishes. If involuntary confinement pertains to a criminal matter, the petitioner most likely will be the district attorney; but mental health professionals, spouses, or other individuals also may file a petition.

Most states require a court order within two to three days of an emergency confinement and a hearing within a few weeks. The patient has a right to an attorney during the hearing and often will be appointed one.

Civil commitment will generally be upheld if the court agrees that the patient is a danger to themselves and/or the community, but patients may not be confined longer than is necessary for treatment and may be released after subsequent hearings.

Standards for Treatment and Confinement

Standards for involuntary treatment and confinement vary from state to state, although all patients are afforded protections under the federal Civil Rights of Institutionalized Persons Act of 1980 (CRIPA). While CRIPA doesn't establish new rights for institutionalized persons, it provides for the investigation of complaints regarding the rights of patients (both voluntarily and involuntarily institutionalized).

In Florida patients must be given notice of their rights in a care facility, including the right "to receive the least-restrictive, available treatment" possible. Also, Florida requires that the use of "restraints, seclusion, isolation," and other, more-extreme measures "may never be used for punishment, convenience of staff, or to compensate for inadequate staffing."

But even with such laws and procedures in place, there may be a lack of oversight and the complaints of mentally ill patients or their loved ones may not always be adequately investigated. Also, a lack of funding for state mental health facilities often results in overcrowded conditions and lackluster care.

Get Professional Legal Help With Your Involuntary Commitment Concerns

The state is within its rights to involuntarily commit you or a loved one to a mental health facility if it can prove that confinement is necessary, but it must follow due process. This means you (or a loved one) have the right to defend against such an action in court. If in doubt, reach out to a local health care law attorney for guidance.