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 hospital (inpatient) or in the community (outpatient).
Criteria for civil commitment are established by law, which varies between nations and, in the U.S., from state to state. Commitment proceedings often follow a period of emergency hospitalization during which an individual with acute psychiatric symptoms is confined for a relatively short duration (e.g. 72 hours) 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, the evaluation is presented in a formal court hearing where testimony and other evidence may also be submitted. The subject of the hearing typically is entitled to legal counsel and may challenge a commitment order through
habeas corpus is a writ, or legal action, through which a prisoner can be released from unlawful detention. The remedy can be sought by the prisoner or by another person coming to his aid. Habeas corpus originated in the English legal system, but it is now available in many nations...
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 "deinstitutionalization."
Purpose
In most jurisdictions, involuntary commitment is specifically applied to individuals found to be suffering from a
mental illnessA mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
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. (In some jurisdictions this is a distinct proceeding from being "found incompetent.")
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 criteria that are broader.
First aid
Training is gradually becoming available in
mental health first aidMental health first aid has been defined as "the help provided to a person developing a mental health problem or in a mental health crisis. The first aid is given until appropriate professional treatment is received or until the crisis resolves"....
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 (Canada, Finland, Hong Kong, Ireland, Singapore, Scotland, England, Wales, United States).
Mental health triageMental health triage is a clinical function conducted at point of entry to health services which aims to assess and categorize the urgency of mental health related problems...
may be used in an emergency room to evaluate the degree of risk and prioritize treatment.
Observation
Observation is sometimes used to determine if 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
A common reason given for involuntary commitment is to prevent danger to the individual or society. People with
suicidalSuicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
thoughts may act on these thoughts and harm or kill themselves. People with psychoses are occasionally driven by their
delusionA delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s or
hallucinationA hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s to harm themselves or others. People with certain types of
personality disorderPersonality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
s 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, "danger to self or others" standard has been broadened in recent years to include need-for-treatment criteria such as "gravely disabled."
In
ArizonaArizona ; is a state located in the southwestern region of the United States. It is also part of the western United States and the mountain west. The capital and largest city is Phoenix...
, the government can mandate in-patient treatment for anyone determined to be "persistently or acutely disabled." Virtually anyone who suspects that someone has mental problems and needs help could file an application to a state-licensed healthcare agency for a court-ordered evaluation.
In
ConnecticutConnecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
, someone can be committed only if he or she has "psychiatric disabilities and is dangerous to himself or herself or others or gravely disabled". "Gravely disabled" has usually been interpreted to mean that the person is unable on his own to obtain adequate food, shelter and clothing.
In
IowaIowa is a state located in the Midwestern United States, an area often referred to as the "American Heartland". It derives its name from the Ioway people, one of the many American Indian tribes that occupied the state at the time of European exploration. Iowa was a part of the French colony of New...
, any "interested person" may begin commitment proceedings by submitting a written statement to the court. If the court finds that the respondent is "seriously mentally impaired," he or she will be placed in a psychiatric hospital for further evaluation and possibly treatment. Further hearings are required at specific intervals for as long as the person is being involuntarily held.
The
MichiganMichigan is a U.S. state located in the Great Lakes Region of the United States of America. The name Michigan is the French form of the Ojibwa word mishigamaa, meaning "large water" or "large lake"....
Mental Health Code provides that a person "whose judgment is so impaired that he or she is unable to understand his or her need for treatment and whose continued behavior as the result of this mental illness can reasonably be expected, on the basis of competent clinical opinion, to result in significant physical harm to himself or herself or others" may be subjected to involuntary commitment, a provision paralleled in the laws of many other jurisdictions. These types of provisions have been criticized as a sort of "heads I win, tails you lose". Understanding one's "need for treatment" would cause one to agree to voluntary commitment, but the Bazelon Center has said that this "lack of insight" is "often no more than disagreement with the treating professional" and this disagreement might form part of the evidence to support one's involuntary commitment.
In
NevadaNevada is a state in the western, mountain west, and southwestern regions of the United States. With an area of and a population of about 2.7 million, it is the 7th-largest and 35th-most populous state. Over two-thirds of Nevada's people live in the Las Vegas metropolitan area, which contains its...
, prior to confining someone, the state must demonstrate that the person "is mentally ill and, because of that illness, is likely to harm himself or others if allowed his liberty."
In
OregonOregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...
, the standard that the allegedly mentally ill person "Peter [h]as been committed and hospitalized twice in the last three years, is showing symptoms or behavior similar to those that preceded and led to a prior hospitalization and, unless treated, will continue, to a reasonable medical probability, to deteriorate to become a danger to self or others or unable to provide for basic needs" may be substituted for the danger to self or others standard.
In
UtahUtah is a state in the Western United States. It was the 45th state to join the Union, on January 4, 1896. Approximately 80% of Utah's 2,763,885 people live along the Wasatch Front, centering on Salt Lake City. This leaves vast expanses of the state nearly uninhabited, making the population the...
, the standard is that "the proposed patient has a mental illness which poses a substantial danger". "Substantial danger" means the person, by his or her behavior, due to mental illness: (a) is at serious risk to: (i) commit suicide, (ii) inflict serious bodily injury on himself or herself; or (iii) because of his or her actions or inaction, suffer serious bodily injury because he or she is incapable of providing the basic necessities of life, such as food, clothing, and shelter; (b) is at serious risk to cause or attempt to cause serious bodily injury; or (c) has inflicted or attempted to inflict serious bodily injury on another.
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 typically was 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 when outpatient services are not available or they choose not 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.
United Nations
United NationsThe United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
General Assembly (resolution 46/119 of 1991), "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.
Australia
In
AustraliaAustralia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, court hearings are not required for involuntary commitment. Mental health law is
constitutionallyThe Constitution of Australia is the supreme law under which the Australian Commonwealth Government operates. It consists of several documents. The most important is the Constitution of the Commonwealth of Australia...
under the state powers. Each state thus has different laws, many of which have been updated in recent years.
Referral for service
The usual requirement is that a police officer or a physician determine that a person requires a psychiatric examination, usually through a
psychiatric hospitalPsychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
. If the person is detained in the hospital, they usually must be seen by an authorized psychiatrist within a set period of time. In some states, after a further set period or at the request of the person or their representative, a tribunal hearing is held to determine whether the person should continue to be detained. In states where tribunals are not instituted, there is another form of appeal.
Some Australian states require that the person is a danger to the society or themselves; other states only require that the person be suffering from a mental illness that requires treatment. The Victorian Mental Health Act (1986) specifies in part that:
- "(1) A person may be admitted to and detained in an approved mental health service as an involuntary patient in accordance with the procedures specified in this Act only if—
- (a) the person appears to be mentally ill; and
- (b) the person's mental illness requires immediate treatment and that treatment can be obtained by admission to and detention in an approved mental health service; and
- (c) because of the person's mental illness, the person should be admitted and detained for treatment as an involuntary patient for his or her health or safety (whether to prevent a deterioration in the person's physical or mental condition or otherwise) or for the protection of members of the public; and
- (d) the person has refused or is unable to consent to the necessary treatment for the mental illness; and
- (e) the person cannot receive adequate treatment for the mental illness in a manner less restrictive of that person's freedom of decision and action.
There are additional qualifications and restrictions but the effect of these provisions is that people who are assessed by doctors as being in need of treatment may be admitted involuntarily without the need of demonstrating a risk of danger. This then overcomes the pressure described above to exaggerate issues of violence to obtain an admission.
Treatment
In general, once the person is under involuntary commitment, treatment may be instituted without further requirements. Some treatments such as
electroconvulsive therapyElectroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
(ECT) often require further procedures to comply with the law before they may be administered involuntarily.
Community treatment orders can be used in the first instance or after a period of admission to hospital as a voluntary or involuntary patient. With the trend towards deinstitutionalization this is becoming increasingly frequent and hospital admission is restricted to people with severe mental illnesses.
Germany
In Germany there is a growing tendency to use the law on legal guardianship, instead of
mental health lawMental health law is the area of the law that applies to persons with a diagnosis or possible diagnosis of mental illness, and to those involved in managing or treating such people.-Mental health law in general:...
, to justify involuntary commitment or treatment. The ward's
legal guardianA legal guardian is a person who has the legal authority to care for the personal and property interests of another person, called a ward. Usually, a person has the status of guardian because the ward is incapable of caring for his or her own interests due to infancy, incapacity, or disability...
decides that he/she must go into
mental hospitalMental hospital may refer to:*Psychiatric hospital*hospital in Nepal named Mental Hospital...
for treatment, and the police will act on this decision. This is simpler for the government and family members than the formal process for commitment under mental health laws.
In
German criminal lawStrafgesetzbuch is the German name for Penal Code and is abbreviated to StGB.- History :In Germany the Strafgesetzbuch goes back to the Penal Code of the German Empire passed in the year 1871 which was largely identical to the Penal Code of the North German Confederation.This Reichsstrafgesetzbuch ...
a person that was convicted of certain crimes can also be sentenced to be kept in preventive detention; see article on preventive detention.
Netherlands
In Dutch criminal law a
convictA convict is "a person found guilty of a crime and sentenced by a court" or "a person serving a sentence in prison", sometimes referred to in slang as simply a "con". Convicts are often called prisoners or inmates. Persons convicted and sentenced to non-custodial sentences often are not termed...
can be sentenced to involuntary psychiatric treatment in a special institute called a TBS-clinic.
TBSThe acronym TBS may refer to:In broadcasting:*Tokyo Broadcasting System, a TV station in Tokyo, Japan*TBS Radio & Communications, the flagship radio station of the Japan Radio Network *TBS , a US cable television channel...
is an
abbreviationAn abbreviation is a shortened form of a word or phrase. Usually, but not always, it consists of a letter or group of letters taken from the word or phrase...
for "Ter Beschikkingstelling," literally meaning "being placed at disposal." Legally, such a sentence is not regarded as punishment like a
prisonA prison is a place in which people are physically confined and, usually, deprived of a range of personal freedoms. Imprisonment or incarceration is a legal penalty that may be imposed by the state for the commission of a crime...
sentence, but as a special measure. In the
NetherlandsThe Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
, it is common practice to sentence criminals to a combination of a normal prison term and TBS. The convict will then be placed in a TBS-clinic after serving time in prison (usually two-thirds of the original prison sentence, although this practice is under discussion).
According to Dutch law, meeting three conditions is required for a convict to be sentenced to TBS. These conditions are:
- the crime committed must have been directly related to a psychiatric disorder,
- recidivism
Recidivism is the act of a person repeating an undesirable behavior after they have either experienced negative consequences of that behavior, or have been treated or trained to extinguish that behavior...
must be likely, and
- the convict can not, or only partially, be held accountable for the crime.
To determine if these conditions are met, the suspect is observed in a forensic psychiatric detention center, the Pieter Baan Centre. Neither the prosecution or the defense can effectively challenge the Pieter Baan Centre's report, since it is the only institution that can conduct such investigations. Fatal mistakes have occurred, for instance, when a child molester regarded by the Pieter Baan Center as "not dangerous" killed a child upon release. The conclusions in the centre's report are not binding, the judge can decide to ignore, or only partially accept them.
Every convict detained in a TBS-clinic may get temporary leave, after serving a certain time or after some progress in treatment. This is regarded as an essential part of treatment, as the convict will be gradually re-entering society this way. At first the convict will be escorted by a therapist, and will be allowed outside the clinic for only a few hours. After evaluation, time and freedom of movement will be expanded until the convict can move freely outside the clinic without escort (usually for one day at a time). At that time, the convict will find work or follow an education. Generally, the convict is released after being in this situation for one or two years without incident.
The time to be served in TBS can be indefinite, and it may be used as a form of
preventive detentionPreventive detention is an imprisonment that is not imposed as the punishment for a crime, but in order to prevent a person from committing a crime, if that person is deemed likely to commit a crime....
. Evaluation by the court will occur every one or two years. During these evaluations the court determines if any progress is made in treatment of the convict, and if it will be safe to release the convict into society. In general, the court will follow conclusions made by the TBS-clinic.
Average time served in a TBS-clinic by a convict is slightly over eight years.
Dutch TBS-clinics
In the
NetherlandsThe Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
there are currently 12 institutions regarded as TBS-clinics:
- AMC de Meren/Arkin, Amsterdam
Amsterdam is the largest city and the capital of the Netherlands. The current position of Amsterdam as capital city of the Kingdom of the Netherlands is governed by the constitution of August 24, 1815 and its successors. Amsterdam has a population of 783,364 within city limits, an urban population...
- Dr. Henri van der Hoevenstichting, Utrecht
Utrecht city and municipality is the capital and most populous city of the Dutch province of Utrecht. It is located in the eastern corner of the Randstad conurbation, and is the fourth largest city of the Netherlands with a population of 312,634 on 1 Jan 2011.Utrecht's ancient city centre features...
- Dr. S. van Mesdagkliniek, Groningen
- Hoeve Boschoord, Boschoord
- FPC Veldzicht, Balkbrug
- Pompestichting, Nijmegen
- Oostvaarderskliniek, Almere
Almere is a planned city and municipality in the province of Flevoland, the Netherlands, bordering Lelystad and Zeewolde. The municipality of Almere comprises the districts Almere Stad, Almere Haven, Almere Buiten, Almere Hout, Almere Poort and Almere Pampus .Almere is the youngest city in the...
- De Kijvelanden/FPC Tweelanden, Poortugaal
- FPC Oldenkotte, Rekken
- FPC De Rooyse Wissel, Venray
- GGz Drenthe
Drenthe is a province of the Netherlands, located in the north-east of the country. The capital city is Assen. It is bordered by Overijssel to the south, Friesland to the west, Groningen to the north, and Germany to the east.-History:Drenthe, unlike many other parts of the Netherlands, has been a...
, AssenAssen is a municipality and a city in the north eastern Netherlands, capital of the province of Drenthe. It received city rights in 1809. Assen's main claim to fame is the TT Circuit Assen the motorcycle racing circuit, where on the last Saturday in June the Dutch TT is run...
- GGz Eindhoven/De Woenselse Poort, Eindhoven
These institutions combined currently are holding about 1840 convicts.
By the end of the 20th century, it was concluded that some convicts could not be treated and therefore could not be safely released into society. For these convicts, TBS-clinics formed special wards, called "long-stay wards". Transfer to such a ward means that the convict will no longer be actively treated, but merely detained. This is regarded as more cost-effective. In general, the convicts in these wards will be incarcerated for the rest of their lives, although their detention is eligible for regular review by the court.
Controversy
Since the latter half of the 1990s considerable controversy has grown among
DutchThe Dutch people are an ethnic group native to the Netherlands. They share a common culture and speak the Dutch language. Dutch people and their descendants are found in migrant communities worldwide, notably in Suriname, Chile, Brazil, Canada, Australia, South Africa, New Zealand, and the United...
societyA society, or a human society, is a group of people related to each other through persistent relations, or a large social grouping sharing the same geographical or virtual territory, subject to the same political authority and dominant cultural expectations...
, about the TBS-system. This controversy has two main reasons. The first reason is the media increasingly reported cases of convicts committing crimes while still in, or after, treatment in a TBS-clinic.
Some examples of these cases are:
- During 1992, a truck driver was convicted for raping and murdering three young children. Eight years earlier he was released from a TBS-clinic after being treated for child molestation.
- A convict, about to be released from a TBS-clinic, murdered the owner of a garage in 1996 while under the influence of drugs.
- An ex-convict, treated in a TBS-clinic, murdered two women in 1994 and 1997.
- A convict, still treated by a TBS-clinic, randomly killed a man in the city of Groningen in 1999.
- Between 2000 and 2004, an ex-convict tortured several animals and killed a homeless man. He had been treated in a TBS-clinic.
- In 2002 an ex-convict was sentenced for triple murder
Murder is the unlawful killing, with malice aforethought, of another human being, and generally this state of mind distinguishes murder from other forms of unlawful homicide...
. He also was released earlier.
- In 2005 a convict escaped his escort during leave. He was arrested several days later after killing a man.
Political and social commotion increased, and debate started about the effectiveness of the TBS-system and if convicts should be granted leave from TBS-clinics. Especially right-wing politicians pleaded the TBS-system should be discarded altogether. Numerous articles in newspapers, magazines, television and radio programs and a revealing book written by an ex-convict (which for the first time openly questioned the effectiveness of the TBS-system) boosted discussion. Prior to that, any problems had been mostly denied by TBS-clinics themselves.
The center of attention became a highly renowned TBS-clinic, Dr. S. Van Mesdagkliniek in the city of
Groningen. Events that took place there, by the end of the 1990s and the first years of the 21st century, initiated the second reason for controversy. Concern rose about signs of unprofessional behavior by staff working in TBS-clinics, and the Dr. S. Van Mesdagkliniek proved to be among the most infamous for these problems. This TBS-clinic has been plagued with unprofessional and even criminal acts by its staff since 1999. During that year, the Dr. S. Van Mesdagkliniek came under investigation by Dutch police after rumors about female staffmembers committing sexual offenses against convicts. Five such cases were discovered during the investigation, and also numerous cases of
drug-abuseA substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
, smuggling and trading of
contrabandThe word contraband, reported in English since 1529, from Medieval French contrebande "a smuggling," denotes any item which, relating to its nature, is illegal to be possessed or sold....
such as: alcohol, mobile phones, pornographic material and hard drugs. It became apparent that staff members did not have the required education, had not been informed about rules and regulations, disregarded legal procedures, gave
false testimoniesPerjury, also known as forswearing, is the willful act of swearing a false oath or affirmation to tell the truth, whether spoken or in writing, concerning matters material to a judicial proceeding. That is, the witness falsely promises to tell the truth about matters which affect the outcome of the...
, tampered with evidence, uttered false accusations against convicts, and intimidated colleagues. At least one
psychiatristA psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
, employed as such by the Dr. S. Van Mesdagkliniek, proved to be not qualified, and treatment of convicts was in many cases simply non-existent. These problems had been known for long by the management, but were always kept hidden. After public outcry about this situation, management was replaced and all of the nine (at the time) TBS-clinics in the
NetherlandsThe Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
were subjected to investigation. Six of them proved to be below the required legal standards. However, problems for the expensive Dutch TBS-system did not end there. In spite of many measures taken by the government, convicts still were released without proper treatment. As a consequence, numerous crimes were committed by convicts that were regarded as treated by TBS-clinics. Also, sexual offenses against convicts by staff members and
smugglingSmuggling is the clandestine transportation of goods or persons, such as out of a building, into a prison, or across an international border, in violation of applicable laws or other regulations.There are various motivations to smuggle...
of contraband did not cease in several TBS-clinics. In 2006, the Dutch government formed a committee to investigate the TBS-system. Some, however not the worst, problems were recognized and measures were proclaimed. One of the known actual results is that fewer convicts escape during temporary release.
Controversy regarding the, often praised, Dutch TBS-system does not cease to exist. In 2005, a staff member working in the Dr. S. Van Mesdagkliniek was caught while smuggling liquor to convicts suffering from alcohol-related problems. In 2007, a female staff member committed sexual offenses against a convict, and had smuggled contraband. She was sentenced to three months in prison in 2009. That same year, investigation proved convicts still had ample access to illicit drugs and four inmates from the Dr. S. Van Mesdagkliniek were arrested for possession of
child pornographyChild pornography refers to images or films and, in some cases, writings depicting sexually explicit activities involving a child...
. Many crimes committed by released convicts treated in TBS-clinics, escape statistics because they occurred in other countries, or because they differ from the
crimeCrime is the breach of rules or laws for which some governing authority can ultimately prescribe a conviction...
the convict was originally convicted for (many convicts released from TBS-clinics find their way in illegal drug trade and related crimes). Because there seems to be no acceptable alternative available, political support for the much plagued TBS-system remains, in spite of controversy.
United Kingdom
In the
United KingdomThe United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, the process known in the
United StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
as involuntary commitment is informally known as "sectioning", after the various sections of the
Mental Health Act 1983The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom which applies to people in England and Wales. It covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters...
(covering England and Wales), the Mental Health (Northern Ireland) Order 1986 and the
Mental Health (Care and Treatment) (Scotland) Act 2003The Mental Health Act 2003, which came into effect on 5 October 2005, enables medical professionals to detain and treat people against their will on grounds of mental disorder, with the Mental Health Tribunal for Scotland and the Mental Welfare Commission for Scotland providing safeguards against...
that provide its legal basis.
In England and Wales,
Approved Mental Health ProfessionalThe role of approved social worker, or ASW, has now been replaced by that of approved mental health professional, or AMHP, in England and Wales....
s have a lead role in coordinating Mental Health Act assessments, which they conduct in cooperation with usually two medical practitioners. Under the Mental Health Act, detention is determined by utility and purpose. Mentally ill individuals may be detained under Section 2 for a period of assessment lasting up to 28 days or Section 3 for a period of treatment lasting up to 6 months. Patients already on a ward may be detained under section 5(2) for up to 72 hours for the purposes of allowing an assessment to take place for section 2 or 3. Separate sections deal with mentally ill criminal offenders. In all cases detention needs to be justified on the basis that the person has a mental disorder and poses a risk of harm to their own health, safety, or the safety of others.
Under the amended
Mental Health Act 2007The Mental Act 2007 is an Act of the Parliament of the United Kingdom. It amends the Mental Health Act 1983 and the Mental Capacity Act 2005. It applies to people in England and Wales. Most of the Act was implemented on 3 November 2008....
, which came into force in November 2008, to be detained under Section 3 for treatment, appropriate treatment must be available in the place of detention. Supervised Community Treatment orders means people can be discharged to the community on a conditional basis, remaining liable to recall to hospital if they break the conditions of the community treatment order.
United States
Involuntary commitment is governed by state law and procedures vary from state to state. In some
jurisdictionJurisdiction is the practical authority granted to a formally constituted legal body or to a political leader to deal with and make pronouncements on legal matters and, by implication, to administer justice within a defined area of responsibility...
s, laws regarding the commitment of
juvenileIn law, a minor is a person under a certain age — the age of majority — which legally demarcates childhood from adulthood; the age depends upon jurisdiction and application, but is typically 18...
s may vary, with what is the
de facto involuntary commitment of a juvenile perhaps
de jureDe jure is an expression that means "concerning law", as contrasted with de facto, which means "concerning fact".De jure = 'Legally', De facto = 'In fact'....
defined as "voluntary" if his parents agree, though he may still have a right to protest and attempt to get released. However, there is a body of case law governing the civil commitment of individuals under the
Fourteenth AmendmentThe Fourteenth Amendment to the United States Constitution was adopted on July 9, 1868, as one of the Reconstruction Amendments.Its Citizenship Clause provides a broad definition of citizenship that overruled the Dred Scott v...
through U.S. Supreme Court rulings beginning with
Addington v. TexasAddington v. Texas , , is a U.S. Supreme Court landmark case that set the standard for involuntary commitment for treatment by raising the burden of proof required to commit persons for psychiatric treatment from the usual civil burden of proof of "preponderance of the evidence" to "clear and...
in 1979 which set the bar for involuntary commitment for treatment by raising the burden of proof required to commit persons from the usual civil burden of proof of "preponderance of the evidence" to the higher standard of "clear and convincing" evidence.
In 1975, the U.S. Supreme Court ruled that involuntary hospitalization and/or treatment violates an individual's
civil rightsCivil and political rights are a class of rights that protect individuals' freedom from unwarranted infringement by governments and private organizations, and ensure one's ability to participate in the civil and political life of the state without discrimination or repression.Civil rights include...
in
O'Connor v. Donaldson. This ruling forced individual states to change their statutes. For example, the individual must be exhibiting behavior that is a danger to himself or others in order to be held, the hold must be for evaluation only and a court order must be received for more than very short term treatment or hospitalization (typically no longer than 72 hours). This ruling has severely limited involuntary treatment and hospitalization in the U.S. In the U.S. the specifics of the relevant statutes vary from state to state.
This was the case in a famous United States Supreme Court decision in 1975,
O'Connor v. DonaldsonO'Connor v. Donaldson, 422 U.S. 563 , was a landmark decision in mental health law. The United States Supreme Court ruled that a state cannot constitutionally confine, without more, a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing...
, when Kenneth Donaldson, a patient committed to
Florida State HospitalFlorida State Hospital is a hospital and mental institution in Chattahoochee, Florida. Established in 1876, it was until 1947 Florida's only state mental institution. It currently has a capacity of 1,042 patients...
, sued the hospital and staff for confining him for 15 years against his will. The decision means that it is unconstitutional to commit for treatment a person who is not imminently a danger to himself or others and is capable to a minimal degree of surviving on his own.
An example of involuntary commitment procedures is the Baker Act used in
FloridaFlorida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
. Under this law, a person may be committed only if they present a danger to themselves or others. A police officer, doctor, nurse or licensed mental health professional may initiate an involuntary examination that lasts for up to 72 hours. Within this time, two psychiatrists may ask a judge to extend the commitment and order involuntary treatment. The Baker Act also requires that all commitment orders be reviewed every six months in addition to ensuring certain rights to the committed including the right to contact outsiders. Also, a person under an involuntary commitment order has a right to counsel and a right to have the state provide a
public defenderThe term public defender is primarily used to refer to a criminal defense lawyer appointed to represent people charged with a crime but who cannot afford to hire an attorney in the United States and Brazil. The term is also applied to some ombudsman offices, for example in Jamaica, and is one way...
if they cannot afford a lawyer. While the Florida law allows police to initiate the examination, it is the recommendations of two psychiatrists that guide the decisions of the court.
In the 1990s, involuntary commitment laws were extended under various state laws commonly recognized under the umbrella term SVP laws to hold some convicted
sex offenderA sex offender is a person who has committed a sex crime. What constitutes a sex crime differs by culture and by legal jurisdiction. Most jurisdictions compile their laws into sections such as traffic, assault, sexual, etc. The majority of convicted sex offenders have convictions for crimes of a...
s in psychiatric facilities after their prison terms were completed. (This is generally referred to as "civil commitment," not "involuntary commitment," since involuntary commitment can be criminal or civil). This matter has been the subject of a number of cases before the Supreme Court, most notably
Kansas v. HendricksKansas v. Hendricks is a case in which U.S. Supreme Court set forth procedures for the indefinite civil commitment of prisoners convicted of a sex offense whom the state deems dangerous due to a mental abnormality.-Fact of case:...
and
United States v. ComstockUnited States v. Comstock, 560 U.S. ___ was a decision by the Supreme Court of the United States, which ruled that the federal government has authority under the Necessary and Proper Clause to require the civil commitment of individuals already in Federal custody...
in regard to the
Adam Walsh Child Protection and Safety ActThe Adam Walsh Child Protection and Safety Act is a federal statute that was signed into law by U.S. President George W. Bush on July 27, 2006. The Walsh Act organizes sex offenders into three tiers and mandates that Tier 3 offenders update their whereabouts every three months with lifetime...
, which does not require a conviction on sex offences, but only that the person be in federal custody and be deemed a "sexually dangerous person".
Controversy about liberty
The impact of involuntary commitment on the right of self-determination has been a cause of concern. Critics of involuntary commitment have advocated that "the due process protections... provided to criminal defendants" be extended to them. The
Libertarian PartyThe Libertarian Party is the third largest and fastest growing political party in the United States. The political platform of the Libertarian Party reflects its brand of libertarianism, favoring minimally regulated, laissez-faire markets, strong civil liberties, minimally regulated migration...
opposes the practice in its platform.
Thomas SzaszThomas Stephen Szasz is a psychiatrist and academic. Since 1990 he has been Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York. He is a well-known social critic of the moral and scientific foundations of psychiatry, and of the social...
and the
anti-psychiatry movementAnti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
has also been prominent in challenging involuntary commitment.
A small number of individuals in the U.S. have opposed involuntary commitment in those cases in which the diagnosis forming the justification for the involuntary commitment rests, or the individuals say it rests, on the
speechInterpersonal communication is usually defined by communication scholars in numerous ways, usually describing participants who are dependent upon one another. It...
or
writingWriting is the representation of language in a textual medium through the use of a set of signs or symbols . It is distinguished from illustration, such as cave drawing and painting, and non-symbolic preservation of language via non-textual media, such as magnetic tape audio.Writing most likely...
s of the person committed, saying that to deprive him of liberty based in whole or part on such speech and writings violates the
First AmendmentThe First Amendment to the United States Constitution is part of the Bill of Rights. The amendment prohibits the making of any law respecting an establishment of religion, impeding the free exercise of religion, abridging the freedom of speech, infringing on the freedom of the press, interfering...
. Other individuals have opposed involuntary commitment on the bases that they claim (despite the amendment generally being held to apply only to criminal cases) it violates the
Fifth AmendmentThe Fifth Amendment to the United States Constitution, which is part of the Bill of Rights, protects against abuse of government authority in a legal procedure. Its guarantees stem from English common law which traces back to the Magna Carta in 1215...
in a number of ways, particularly its privilege against self-incrimination, as the psychiatrically examined individual may not be free to remain silent, and such silence may actually be used as "proof" of his "mental illness".
Although patients involuntarily committed theoretically have a legal right to refuse treatment, refusal to take medications or participate in other treatments is noted by hospital staff. Court reviews usually are heavily weighted toward the hospital staff, with the patient input during such hearings minimal. In
Kansas v. Hendricks, the US Supreme Court found that civil commitment is constitutional regardless of whether any treatment is provided.
Alternatives
Accompanying deinstitutionalization was the development of laws expanding the power of courts to
order people to take psychiatric medication on an outpatient basisInvoluntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...
. Though the practice had occasionally occurred earlier,
outpatient commitmentOutpatient commitment refers to mental health law that allows the compulsory, community-based treatment of individuals with mental illness.In the United States the term "assisted outpatient treatment" or "AOT" is often used and refers to a process whereby a judge orders a qualifying person with...
was used for many people who would otherwise have been involuntarily committed. The court orders often specified that a person who violated the court order and refused to take the medication would be subject to involuntary commitment.
Involuntary commitment is distinguished from
conservatorshipConservatorship is a legal concept in the United States of America, where an entity or organization is subjected to the legal control of an external entity or organization, known as a conservator. Conservatorship is established either by court order or via a statutory or regulatory authority...
and guardianship. The intent of conservatorship or guardianship is to protect those not mentally able to handle their affairs from the effects of their bad decisions, particularly with respect to financial dealings. For example, a conservatorship might be used to take control of the finances of a person with
dementiaDementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, so that the person's assets and income are used to meet his basic needs, e.g., by paying rent and utility bills.
Advance psychiatric directives may have a bearing on involuntary commitment.
District of Columbia
In the District of Columbia any police officer, physician, or mental health professional can request to have you evaluated at
St. Elizabeths HospitalSt. Elizabeths Hospital is a psychiatric hospital operated by the District of Columbia Department of Mental Health. It was the first large-scale, federally-run psychiatric hospital in the United States. Housing several thousand patients at its peak, St. Elizabeths had a fully functioning...
, where the physician on duty can hold the patient for up to 48 hours. A family member or concerned citizen can also petition the Department of Mental Health, but the claim will be evaluated prior to the police acting upon it. In order to be held further, a request must be filed with the Department of Mental Health. However, this only can keep the patient involuntary admitted for up to seven days. For further commitment, the patient is evaluated by a mental health court, part of family court, for which the public defender assists the patient. This can result in the patient being held up to one year at which point the patient returns to mental health court.
This is different for someone first admitted to
St. Elizabeths HospitalSt. Elizabeths Hospital is a psychiatric hospital operated by the District of Columbia Department of Mental Health. It was the first large-scale, federally-run psychiatric hospital in the United States. Housing several thousand patients at its peak, St. Elizabeths had a fully functioning...
due to criminal charges. If found to not ever become competent for trial, they will be evaluated via a Jackson hearing for possible continued commitment to protect the public. If they have been found not guilty by reason of insanity, their dangerousness is evaluated at a Bolton Hearing.
Maryland
In Maryland any person may request, via a Emergency Evaluation form, that another individual be evaluated against their will by an emergency room physician for involuntary admission. If the judge concurs, he will direct the police to escort the individual to the hospital. A licensed physician, psychologist, social worker, or nurse practitioner who has examined the patient or a police officer may bring a potential patient to the emergency room for forced evaluation without approval from a judge. The patient may be kept in the hospital for up to thirty hours. If by then two physicians, or one physician and one psychologist then decide that the patient meets the Maryland criteria for an involuntary psychiatric admission, then he or she may be kept inpatient involuntarily for up to ten days. During this time an administrative law judge determines if criteria for longer civil commitment are met:
- a person has a mental illness;
- a person needs inpatient care or treatment;
- a person presents a danger to themselves or to others;
- a person are unable or unwilling to be admitted voluntarily;
- there is no available, less restrictive form of care or treatment to meet the person's needs.
Virginia
As of 2008 Virginia was one of only five states requiring imminent danger in order to involuntarily commit someone. But after the Virginia Tech Massacre, there was significant political consensus to strengthen the protections for society and allow more leniency in determining that an individual needed to be committed against their will.
- the person has a mental illness and there is a substantial likelihood that, as a result of mental illness, the person will, in the near future, (1) cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting, or threatening harm and other relevant information, if any
- the person has a mental illness and there is a substantial likelihood that, as a result of mental illness, the person will, in the near future, (2) suffer serious harm due to his lack of capacity to protect himself from harm or to provide for his basic human needs
"Imminent danger" was found to have too much variability throughout Virginia due to vagueness. The new standard is more specific in that substantial likelihood is more clear. However, in order to not limit potential detainee's freedoms too much it is characterized by the time limit of near future. "Recent acts" is legally established to require more than a mere recitation of past events.
Politically motivated abuses
At certain places and times, the practice of involuntary commitment has been used for the
suppression of dissentSuppression of dissent occurs when an individual or group which is more powerful than another tries to directly or indirectly censor, persecute or otherwise oppress the other party, rather than engage with and constructively respond to or accommodate the other party's arguments or viewpoint...
, or in a punitive way.
In the former
Soviet UnionThe Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
, psychiatric hospitals were used as prisons in order to isolate
political prisonerAccording to the Longman Dictionary of Contemporary English, a political prisoner is ‘someone who is in prison because they have opposed or criticized the government of their own country’....
s from the rest of society. The official explanation was that no
saneSanity refers to the soundness, rationality and healthiness of the human mind, as opposed to insanity. A person is sane if they are rational...
person would declaim against Soviet government and
CommunismCommunism is a social, political and economic ideology that aims at the establishment of a classless, moneyless, revolutionary and stateless socialist society structured upon common ownership of the means of production...
. British playwright
Tom StoppardSir Tom Stoppard OM, CBE, FRSL is a British playwright, knighted in 1997. He has written prolifically for TV, radio, film and stage, finding prominence with plays such as Arcadia, The Coast of Utopia, Every Good Boy Deserves Favour, Professional Foul, The Real Thing, and Rosencrantz and...
wrote
Every Good Boy Deserves Favour about the relationship between a patient and his doctor in one of these hospitals.
The government of the United States employed involuntary commitment against a political dissenter once. In 1927 after the execution of
Sacco and VanzettiFerdinando Nicola Sacco and Bartolomeo Vanzetti were anarchists who were convicted of murdering two men during a 1920 armed robbery in South Braintree, Massachusetts, 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 (Involuntary psychiatric hold)
Section 5150 is a section of the California Welfare and Institutions Code which allows a qualified officer or clinician to involuntarily confine a person deemed to have a mental disorder that makes them a danger to him or her self, and/or others and/or gravely disabled...
- Baker Act
- Criminal justice
Criminal Justice is the system of practices and institutions of governments directed at upholding social control, deterring and mitigating crime, or sanctioning those who violate laws with criminal penalties and rehabilitation efforts...
- John Hunt
John Hunt , an Irish citizen, is a writer, artist and an involuntarily detained psychiatric patient. The conditions of Hunt's detention have been the subject of a sustained campaign by his former partner and mother of his child Gráinne Humphrys...
- Involuntary treatment
Involuntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...
- Medical law
Medical law is the branch of law which concerns the prerogatives and responsibilities of medical professionals and the rights of the patient. It should not be confused with medical jurisprudence, which is a branch of medicine, rather than a branch of law....
- Rosenhan experiment
The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973. It was published in the journal Science under the title "On being sane in insane places." The study is considered an important and influential criticism of...
- Ulysses contract
- Voluntary commitment
Voluntary commitment is the act or practice of a person being admitted to a psychiatric hospital, or other mental health facility, voluntarily, and without the process of involuntary commitment...
External links