Rights Under Involuntary Commitment: Correcting Misperceptions

Natalie Frank, Ph.D.

Inaccurate beliefs that commitment equals imprisonment and the inability to refuse treatment are addressed and valid sources cited replacing biased opinions.

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Credit Geoffrey Dromard Australian News Community (CC BY 4.0)

Many individuals in this country still view involuntary commitment in ways that parallel “One Flew Over The Cuckoos Nest.” While historically, inpatient commitment meant being placed in a facility under deplorable conditions with no real treatment offered this hasn’t been the case in the U.S. for some time, though illegal abuse of this ruling does on occasion occur. This article provides the history behind such questions and the current laws for those committed based on Supreme Court Findings debunking opinions and myths presented as fact.

Historical Precedents

In the landmark case of O’Conner v. Donaldson (1975), the supreme court determined it unlawful to involuntarily commit an individual who posed no imminent danger to himself or others. Subsequent to that ruling many other rulings have established laws protecting the rights of the mentally ill including Rennie v. Klein (1979) which established a committed individual has the right to refuse medication unless he is involved in an emergency situation, in the absence of a court order and the same year Rogers v. Okin upheld this ruling and added that such patients can also refuse other treatment as well.

Current Laws and Alternative Options

Although currently all but four U.S. states permit some form of involuntary treatment for short periods but only in the case of emergency situations which have been deemed unmanageable with any other procedure. In addition, laws related to this allowance require that the lowest level of treatment believed to resolve the emergency be used (Washington et al.).

Most states have also moved away from inpatient commitment to “assisted outpatient commitment” where an individual involuntarily committed can live outside a hospital, though sometimes under strict guidelines such as attending mandatory psychiatric appointments and agreeing to take medication if believed beneficial by the treatment team. All but 8 States currently allow for assisted outpatient commitment.

False Arguments Made By Alleged “Advocacy” Groups

While intending to safeguard the human rights of the mentally ill, Advocacy Groups and Anti-Psychiatry Groups often use scare tactics to establish the right of mentally ill people to refuse inpatient hospitalization. They give voice to myths such as involuntary commitment equaling criminal imprisonment, when committed patients are often imprisoned indefinitely, forced treatment including medication and ECT is frequently employed and that when “imprisoned” in such hospitals staff “force brain-damaging drugs and other brain-damaging treatments such as Electroshock upon them over their desperate, but hopeless objections” (Gottstein, 2002).

Despite what may be good intentions, these arguments against involuntary commitment simply don’t hold up as there is absolutely no evidence that the courts are prejudiced against individuals with unacceptable behavior or mental problems such that they commit practically everyone they are called on to adjudicate.

In addition, the reliability and validity of diagnosing mental illnesses is excellent for many disorders based on kappa coefficients (percentage of agreement that occurred above and beyond that expected by chance), including, but not limited to, Schizophrenic Disorders, Anxiety Disorders, Mood Disorders, and Substance use Disorders (e.g. Oltmanns & Emery, 2004; Pierucci-Lagha et. al. 2007), and gambling addictions (Stinchfield, 2003).

Admittedly reliability is poorer for other diagnostic categories, primarily the Personality Disorders, due in large part to their comorbidity with Axis I disorders and other Axis II disorders. This overlap of symptoms however is in the process of being re-conceptualized in the upcoming version of the DSM, the primary diagnostic system for psychiatric disorders in the U.S. and many other countries which is based on a strong research foundation (e.g. Oltmanns & Emery, 2004).

Regardless, however, calling into question the reliability of diagnoses is nothing but smoke and mirrors having nothing to do with civil commitment as a mental diagnosis is unnecessary nor is the ability to predict dangerousness for an individual to be involuntarily committed. The law in all 50 states requires that an individual be considered a harm to themselves based on their own statements or harm to others based on a threat made against a named victim. In the majority of states, an individual can also be hospitalized based on the inability to provide the basics necessary for survival. (e.g. Testa & West, 2010).

Note: The laws regarding individuals involuntarily committed due to having committed a felony crime in regards to involuntary medication as related to the ability to stand trial, help in their own defense, or be executed despite not being on the medications at the time the crime was committed are somewhat different and vary more widely by state.

Truth Separated From Fiction

In summary, the laws allowing an individual to be involuntarily committed in all states require the criteria of dangerousness, meaning there must be adequate support for the probability they are a danger to themselves or others either from their own statements or testimony during a commitment hearing. If committed they can only be held for observation for a limited amount of time (anywhere from 24- 48 hours depending on the state) at which time they must be released if the treating psychiatrist gathers no supporting evidence.

Furthermore, the experience of those placed in a psychiatric hospital does not resemble imprisonment. Nor can their right to refuse medication or treatment be taken away unless it is considered an emergency situation defined as one. This could cause potential harm to the patient, other residents or staff and the lowest dose of medication necessary to control the emergency must be used.

Individuals with mental illnesses must be treated in the least restrictive environment appropriate and many almost all states now have an assisted outpatient commitment option though under this condition patients may be required to attend psychiatric appointments and agree to take medications as deemed necessary by the treatment team. Supposed advocacy groups for the rights of mentally ill patients, often use scare techniques which are inaccurate and entirely unfounded to attempt to prove the necessity of new laws instituted to prevent further involuntary commitment until the “deplorable and dangerous” conditions of psychiatric hospitals. However, these claims are false and individuals should be vary when seeing such reports, checking the sources to ascertain if they are reputable.

Sources

  • The Law Project for Psychiatric Rights, Psychiatric Myths. Retrieved, September 3, 2020.
  • Oltmanns, T. F., & Emery, R., (2004). Classification and Assessment of Abnormal Behavior in Abnormal Psychology, 4th ed., Pearson Prentice Hall; Upper Saddle River N.J. (pp. 112–114).
  • Pierucci-Lagha, A., Gelernter, J., Chan, G., Arias, A., Cubells, J. F., Farrer, L., & Kranzler, H. R., (2007). Reliability of DSM-IV Diagnostic Criteria Using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Drug and Alcohol Dependence, 91: 81–90.
  • Psychiatry: Force of Law. PsychRights. Retrieved September 3, 2020.
  • Pubmed. Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Retrieved September 3, 2011.
  • Stinchfield, R., (2003). Reliability, Validity, and Classification Accuracy of a Measure of DSM-IV Diagnostic Criteria for Pathological Gambling. American Journal of Psychiatry 160:180–182.
  • Testa, M., & West, S.G., (2010). Civil Commitment in the United States. Innovations in Clinical Neuroscience, 7: 30–40.
  • “Washington et al., Petitioners v. Walter Harper.” Retrieved September 3, 2020.

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