Many countries have mental health laws governing involuntary commitment. Some, such as the United States, require a court hearing if the individual is hospitalized more than briefly. In most states, police officers and designated mental health professionals can require a brief commitment of an individual for psychiatric evaluation. If the individual is evaluated as needing further hospitalization, a court order must be obtained. Doctors, psychologists and/or psychiatrists present written reports to the court and in some cases testify before the judge. The person who is involuntarily hospitalized, in most U.S. jurisdictions, has access to counsel. A commitment is always time-limited and requires reevaluation at fixed intervals. It is also possible for a patient to challenge the commitment through habeas corpus. This was the case in a famous United States Supreme Court decision in 1975, O'Connor v. Donaldson, when Kenneth Donaldson, a patient committed to Florida State Hospital, 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.
Some individuals and groups have challenged involuntary commitment, particularly in countries that are part of the Anglo-American judicial tradition. There have also been allegations that at certain places and times the practice of involuntary commitment has been used for the suppression of dissent, or in a punitive way. There have been alternating trends towards the aboliton or substantial reduction of involuntary commitment via stricter standards for its imposition, and the greater use of involuntary commitment with more lax standards for its imposition.
In 1975, the United States Supreme Court ruled that involuntary hospitalization and/or treatment violates an individual's civil rights. 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 United States. In the United States the specifics of the relevant statutes vary from state to state. For example, in Florida, statistics show that 20 percent of the justifiable homicides committed by police in the United States occurred in Florida with the mentally ill being four times more likely to be the victim.
In most jurisdictions involuntary commitment is specifically directed at people claimed or found to be suffering from a mental illness which 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.") This decision requires a subjective opinion and is therefore open to error or abuse, both of which have been documented as occurring at different times in various places. There have been numerous official enquiries into such matters around the world and these have often led to legal and system reforms, but there have also been allegations that the requirements for involuntary commitment are "too lenient," with a consequential strengthening of such laws.
Involuntary commitment is used to some degree for each of the following headings although different jurisdictions have different criteria. Some allow involuntary commitment only if the person both appears to be suffering from a mental illness and that the effects of this produce a risk to themselves or others. Other jurisdictions have criteria that are broader.
This concern has found expression in the standards for involuntary commitment of a number of jurisdictions in the U.S. and other countries as the "danger to self or others" standard if someone has a "mental illness" or "mental disorder" (though sometimes explicit exceptions are made, as in Arizona law, in which "drug abuse, alcoholism or mental retardation" and "the declining mental abilities that directly accompany impending death" are specifically excepted), sometimes supplemented by the requirement that the danger be "imminent". However, it has come under criticism from two directions. Those who are concerned that the "danger to self or others" standard is too narrow and will not permit the commitment of those for whom it is necessary have occasionally advocated that it be replaced by the "gravely disabled" standard. There are others who are concerned that the "danger to self or others" standard is vague and not precisely defined, which could lead to abuse of involuntary commitment. However, some people find that the increasingly narrow definition of "danger to self or others" provided by statute and court rulings have to some degree mitigated these concerns.
Some of the same people who are concerned about the overbreadth of the "danger to self or others" standard are more concerned about the "gravely disabled" standard, as they find it broader still. The First District Court of Appeal in California, however, held in Conservatorship of Chambers (1977) (71 Cal.App.3d 277, 139 Cal.Rptr. 357), that the standard was not unconstitutional due to overbreadth or vagueness, and excluded commitment of people whose lifestyles were simply eccentric or unusual. In Wetherhorn v. Alaska Psychiatric Institute (2007), the Supreme Court of the State of Alaska found that a person could not be involuntarily committed under the statute unless his "level of incapacity [is] so substantial that the respondent is incapable of surviving safely in freedom." In In re Maricopa County, (Ariz. Ct. App. 1992, 840 P.2d 1042), the court held that "persistently or acutely disabled" was not an unconstitutionally vague standard.
The Michigan Mental Health Code provides that a person
may be subjected to involuntary commitment, a provision paralleled in the laws of many other jurisdictions. These types of provisions have been criticised 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 Oregon the standard that the allegedly mentally ill person
may be substituted for the danger to self or others standard.
Starting in the 1960s, there has been a worldwide movement toward deinstitutionalization of patients from psychiatric hospitals into community care centers, and this has been matched with efforts at reform of involuntary commitment laws. (In the US from the 1970s onwards a relatively small number of ex-mental patients and former "consumers of psychiatric services" have promoted what they call "mad liberation," often calling for the abolition of involuntary commitment.)
In the US in the 1980s there was a return back to institutionalization and less stringent commitment laws. However, Michael L. Perlin has claimed that throughout this entire period psychiatrists have frequently and as a practice committed perjury during commitment hearings in order to make it more likely that a patient they believe would benefit from commitment will be committed. E. Fuller Torrey, a prominent proponent of involuntary commitment, has stated:
Torrey also quotes psychiatrist Paul Applebaum as saying when "confronted with psychotic persons who might well benefit from treatment and who would certainly suffer without it, mental health professionals and judges alike were reluctant to comply with the law," noting that in "'the dominance of the commonsense model, the laws are sometimes simply disregarded."4
The general trend worldwide remains one of closing large mental hospitals, increasing the integration of psychiatric treatment into general hospitals and of increasing community care at times using involuntary community treatment where in the past involuntary admission would have been used.
Involuntary commitment is governed by state law and procedures vary from state to state. Involuntary commitment is typically used against people diagnosed with, or alleged to have, a mental illness, particularly schizophrenia. In some jurisdictions, laws regarding the commitment of juveniles may vary, with what is the de facto involuntary commitment of a juvenile perhaps de jure defined as "voluntary" if his parents agree though s/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 Amendment through U. S. Supreme Court rulings beginning with Addington v. Texas 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.
An example of involuntary commitment procedures is the Baker Act used in Florida. Under this law, a person may be committed only if he or she presents a danger to himself 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 insuring 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 defender 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.
A small number of individuals in the United States 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 speech or writings of the person committed, saying that to deprive him of liberty based in whole or part on such speech and writings violates the First Amendment. 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 Amendment 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". This criticism has motivated the creation, in some jurisdictions, of a similar statutory privilege in this context. There have also been claims that conditions in, or "treatments" commonly performed in, mental hospitals to which individuals are involuntarily committed constitute torture, or are prohibited by the Convention Against Torture.
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.
In Germany, to do Involuntary commitment and Involuntary treatment to a person, there is a tendency more and more to use the Legal guardianship law instead of the Mental health law: The Legal Guardian decides that he/she must go into Mental Hospital and be treated against his/her will, and the police will carry out this decision.
This is easier for the police, the municipal offices or the persons who want that he/she against his/her will goes into psychiatry, because a person in psychiatry based on Mental health law has some rights, while a person under Legal guardianship de facto has not.
Lawyers in this country also have, according to "Werner Fuss Zentrum", the tendency to abuse the Legal guardianship law for other purposes .
Activities such as homosexuality and adultery can result in such imprisonment. In the People's Republic of China such facilities are used to imprison and "treat" dissidents. "Political harm to society" is legally a dangerous mental disorder and the authorities are instructed to arrest those who make anti-government speeches, write reactionary letters or express opinions on domestic and international affairs.
In the Soviet Union, psychiatric hospitals were often used as prisons in order to isolate political prisoners from the rest of society, discredit their ideas, and break them physically and mentally. The official explanation was that no sane person would declaim against Soviet government and communism.
In the UK sitcom Peep Show's third series, the second episode features a scene where, after sectioning their friend Merry, Jeremy, Super Hans and Mark unsuccessfully attempt to get each other sectioned.
² Spitzer, R.L. (1975). On pseudoscience in science, logic in remission, and psychiatric diagnosis: A critique of Rosenhan's "On being sane in insane places." Journal of Abnormal Psychology, 84, 442-452.
³ Perlin, M.L. (1993/1994). The ADA and Persons with Mental Disabilities: Can Sanist Attitudes Be Undone? Journal of Law and Health,, 8 JLHEALTH 15, 33-34.
4 Torrey, E. Fuller. (1997). Out of the Shadows: Confronting America's Mental Illness Crisis. New York: John Wiley and Sons.
Black Hands of Beijing: Lives of Defiance in China's Democracy Movement, by George Black and Robin Munro, New York: John Wiley & Sons, Inc., 1993.
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