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Varied State Laws and How it Complicates Involuntary Civil Commitment

What is involuntary civil commitment? Involuntary civil commitment is the admission of an individual into a mental health facility, or providing them treatment against their will, if they are an immediate risk or danger to themselves or those around them. A person could face this situation because of:

  • Mental illness
  • Developmental disability
  • Substance use disorder

The Ethics of Civil Commitment

The act of involuntary commitment of an individual creates real ethical challenges, especially because informed consent is a cornerstone of medical practice. Those who oppose this process are concerned with the limitation of liberties for the individual being committed and undermining their personal autonomy. They believe that a court-ordered commitment to treatment must have a strong justification. The process of forced treatment and the overall experience could also leave the individual stigmatized, traumatized, and less receptive to treatment in the future. 

A report from the Substance Abuse and Mental Health Services Administration provides guidance on policies and practices to ensure ethical boundaries are maintained.  

Differences in State Laws and Standards

A 2020 report found that state laws vary widely, and “no two states take the same approach” with civil commitment. Tennessee, for example, requires a multistep process to ensure the need for commitment:

  • Emergency detention 
  • First Certificate of Need
  • Second Certificate of Need and Admission
  • Probable cause hearing and commitment
  • Non-emergency judicial commitment

Here’s a graphical view of the process followed in North Carolina.

States with the best grades were, Minnesota, Wisconsin, Michigan, West Virginia, North Dakota, Vermont, Arkansas, Hawaii, Louisiana, and Wyoming. 

States with the poorest performance grade were, Montana, Tennessee, Rhode Island, District of Columbia, Connecticut, Massachusetts, Delaware, and Maryland.

The map below provides an overview of performance of all 50 states and D.C. 

national psychiatric treatment scorecard from the Treatment Advocacy Center

Whether an individual receives timely and appropriate treatment for an acute or chronic psychiatric condition will depend on the state they are in. The report found that:

  • Most states allow an emergency psychiatric hold of at least 72 hours for evaluation and crisis care
  • Very few states require danger to self or danger to others as an imminent qualifier for hospitalization
  • Majority of states allow intervention if a person is unable to meet basic needs (food, clothing, or shelter) due to a mental illness
  • 47 states’ laws authorize civil commitment on an outpatient basis.

Overall, the report concluded that many state policies are long overdue for an update. Additionally, several state laws create barriers for mental health treatment, often because of vague and confusing procedures. 

Surabhi Dangi-Garimella, Ph.D. is a biologist who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.

Surabhi Dangi Garamella

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