Law and Practice
Law and Practice
Civil commitment is the involuntary commitment of an individual into an inpatient treatment facility for the safety of him/herself or others (Greenley, n.d.; Testa & West, 2010). This process can force an individual to submit to psychiatric care because of the inherent risk the pose to them. In a civil commitment situation, a person is deemed to be unable to make a reasoned and well-informed decision about their own welfare. This is not unlike insanity pleas which some states allow in criminal defense. Similar to those cases, and despite what a person says about themselves and their own well-being, a court, psychiatric and psychological specialists, and advocates for both the state and the individual can determine that individual is incompetent (Testa & West). This is not a matter that is taken lightly in any American court, and requires assessment by mental health professionals trained to recognize and accurately diagnose people who pose a risk to themselves or someone else (Greenley). Civil commitment justification is not limited to mental health diagnoses. Civil commitments may be made for people with developmental disabilities and who are unable to understand their situation or they may have a substance abuse dependence that prevents them from being able to make sound judgements about their own best interests. According to Greenley, if the individual is unable to understand the risks and benefits of a particular treatment and make a reasoned judgement about it, they may be a candidate for a civil commitment.
Either an adult or a child can be placed in treatment under civil commitment. There are, however, three basic criteria. The person in question has to have been evaluated by a professional and the “individual must be:
“1. Mentally ill, drug or alcohol dependent or developmentally disabled; and
“2. A proper subject for treatment; and
“3. Dangerous.” (Greenley, n.d., p. 355).
If all three of these criteria are not met, then the person cannot be determined to be in such dire straits as to have their inherent rights of individual freedom removed. Even if an individual is found to have met each of the three outlined criteria, their placement must be one of least restriction (Greenley). In other words, a patient cannot be place in an inpatient facility for the convenience of the court or the public, when an outpatient facility would meet the patient’s needs while still protecting the individual(s) deemed to be at risk of harm due to the patient’s behavior (Greenley).
Under federal law, and subsequently state laws as well, it is inappropriate to civilly commit an individual for treatment if they are not, in fact, treatable. According to judicial review through appeal “a court may order commitment only if it concludes that the treatment techniques [psychological, educational, social, chemical, medical or somatic techniques designed to bring about rehabilitation] are likely to improve or control the symptoms of the mental disability,” (Greenley, n.d., p. 355). If the patient’s symptoms cannot be controlled or at least improved to allow higher level functioning for the patient in question, then the only care the court can require is custodial care to foster the patient’s safety.
A key to civil commitment is the patient’s level of danger to self or others. There are different tests of dangerousness and different states provide for different administrations and different requirements to be considered a dangerous person.
First the individual is evaluated to determine if he is a danger to himself. If it is determined that the individual poses a likely threat of harm to himself, i.e., is suicidal and likely to carry out a plan, then the individual is likely to meet criteria for civil commitment (Greenley, n.d.; Testa & West, 2010). This determination can be made by showing the patient has either made threats with a plan and means or active attempts to harm himself (Greenley).
A second independent criterion for civil commitment lies in the risk one poses towards other people. If an individual poses a serious threat to harm another person they may be civilly committed. Such a decision may be made based on “proof of recent violent or homicidal behaviorwhich reasonably put others in fear” (Greenley, p. 356). Here, courts, advocates and mental health professionals must contend with the term “reasonable” (Greenley, p. 356) and determine how and when the term applies to such a degree that an individual’s unalienable rights are violated.
Impaired judgement is another consideration of civil commitment. If an individual’s judgement is such that they are likely to put themselves or another person(s) in danger due to their inability to identify risk or avoid negligence, this person may be appropriate for commitment. However, the definition of impaired judgement cannot be based on a single event, but must be established as a pattern of behavior over a period of time (Greenley, n.d.). The final test, similar to the previous, is the inability to satisfy basic needs. Persons meeting this criterion may be unable to secure and maintain food, shelter, etc. Their failure to do so must be shown to cause risk of significant injury or possible death (Greenley).
As with any power over the welfare of others, it is imperative that advocates remain in place to monitor for misuse of power (Testa & West, 2010). It is important that civil commitment be carefully monitored so that only those patients who are in need of treatment are addressed. Civil commitment cannot be used as a means for alternative incarceration of people who do not meet criminal standards but would be more convenient to a social system if they were placed outside its bounds (Testa & West.).
References
Greenley, D. (n.d.). Civil commitment and voluntary treatment. Rights and Reality II, pp. 351- 362.
Testa, M. & West, S. (2010). Civil commitment in the United States. Psychiatry, 7 (10), pp. 30-40.
