Involuntary commitment

Involuntary commitment or civil commitment (also known informally as sectioning or being sectioned[1] in some jurisdictions, such as the United Kingdom)[2] is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is ordered by a court into treatment in a psychiatric hospital (inpatient) or in the community (outpatient).

For involuntary treatment in non-hospital settings, see involuntary treatment.

Criteria for civil commitment are established by laws which vary between nations. 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, then the evaluation is presented in a formal court hearing where testimony and other evidence may also be submitted. The subject of the hearing is typically entitled to legal counsel and may challenge a commitment order through habeas corpus.[3]

Historically, until the mid-1960s in most jurisdictions in the United States, 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,[4] a trend known as "deinstitutionalisation".

Purpose

In most jurisdictions, involuntary commitment is applied to individuals believed to be experiencing a mental illness that impairs their ability to reason to such an extent that the agents of the law, state, or courts determine that decisions will be made for the individual under a legal framework. In some jurisdictions, this is a proceeding distinct from being found incompetent.

Involuntary commitment is used in some degree for each of the following 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 broader criteria.

First aid

Training is gradually becoming available in mental health first aid to equip community members such as teachers, school administrators, police officers, and medical workers with training in recognizing, and authority in managing, situations where involuntary evaluations of behavior are applicable under law.[5] The extension of first aid training to cover mental health problems and crises is a quite recent development.[6][7] A mental health first aid training course was developed in Australia in 2001 and has been found to improve assistance provided to persons with an alleged mental illness or 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, and the United States).[8] Mental health triage may be used in an emergency room to make a determination about potential risk and apply treatment protocols.

Observation

Observation is sometimes used to determine whether 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
See also: Obligatory Dangerousness Criterion

Austria, Belgium, Germany, Israel, the Netherlands, Northern Ireland, Russia, Taiwan, Ontario (Canada), and the United States have adopted commitment criteria based on the presumed danger of the defendant to self or to others.[9] People with suicidal thoughts may act on these impulses and harm or kill themselves. People with psychosis are occasionally driven by their delusions or hallucinations to harm themselves or others. People with certain types of personality disorders can occasionally present a danger to themselves or others.[10]

This concern has found expression in the standards for involuntary commitment in every US 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, the danger to self or others standard has been broadened in recent years to include need-for-treatment criteria such as "gravely disabled".[11]

Deinstitutionalization
Main article: Deinstitutionalisation

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 was typically 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 as instead being incarcerated or becoming homeless.[12] 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 take psychiatric medication while living outside the hospital (e.g. Laura's Law, Kendra's Law).[13][14]

Before the 1960s deinstitutionalization there were earlier efforts to free psychiatric patients. Doctor Philippe Pinel (1745–1826) ordered the removal of chains from patients.[15]

In a study of 269 patients from Vermont State Hospital done by Courtenay M. Harding, Ph.D., and associates, about two-thirds of the ex-patients did well after deinstitutionalization.[16]

Around the world
Main article: Involuntary commitment internationally

United Nations

United Nations General Assembly Resolution 46/119, "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.[17] 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.[18]

Wrongful involuntary commitment
Main article: Political abuse of psychiatry

Mental health professionals have, on occasion, wrongfully deemed individuals to have symptoms of a mental disorder, and thereby commit the individual for treatment in a psychiatric hospital. Claims of wrongful commitment are a common theme in the anti-psychiatry movement.[19][20][21]

In 1860, the case of Elizabeth Packard, who was wrongfully committed that year and filed a lawsuit and won thereafter, highlighted the issue of wrongful involuntary commitment.[22] In 1887, investigative journalist Nellie Bly went undercover at an asylum in New York City to expose the terrible conditions that mental patients at the time had to deal with. She published her findings and experiences as articles in New York World, and later made the articles into one book called Ten Days in a Mad-House.

In the first half of the twentieth century there were a few high-profile cases of wrongful commitment based on racism or punishment for political dissenters. In the former Soviet Union, psychiatric hospitals were used as prisons to isolate political prisoners from the rest of society. British playwright Tom Stoppard wrote Every Good Boy Deserves Favour about the relationship between a patient and his doctor in one of these hospitals. Stoppard was inspired by a meeting with a Russian exile.[23] In 1927, after the execution of Sacco and Vanzetti in the United States, demonstrator Aurora D'Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a rally in support of the anarchists.[24][25] Throughout the 1940s and 1950s in Canada, 20,000 Canadian children, called the Duplessis orphans, were wrongfully certified as being mentally ill and as a result were wrongfully committed to psychiatric institutions where they were forced to take psychiatric medication that they did not need, and were abused. They were named after Maurice Duplessis, the premier of Quebec at the time, who deliberately committed these children to in order to misappropriate additional subsidies from the federal government.[26][27] Decades later in the 1990s, several of the orphans sued Quebec and the Catholic Church for the abuse and wrongdoing.[28] In 1958, black pastor and activist Clennon Washington King Jr. tried enrolling at the University of Mississippi, which at the time was white, for summer classes; the local police secretly arrested and involuntarily committed him to a mental hospital for 12 days.[29][30]

Patients are able to sue if they believe that they have been wrongfully committed.[31][32][33]

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See also

References
  1. "Being sectioned (in England and Wales)". Royal College of Psychiatrists. August 2013.
  2. "What does 'being sectioned' mean?". Rethink Mental Illness.
  3. Texas Young Lawyers Association (January 2008). "Committed To Healing: Involuntary Commitment Procedures" (PDF). Austin, TX: State Bar of Texas. p. 2. The law provides a process known as Involuntary Commitment. Involuntary commitment is the use of legal means to commit a person to a mental hospital or psychiatric ward against their will or over their protests.
  4. Hendin, Herbert (1996). Suicide in America. W. W. Norton. p. 214. ISBN 978-0-393-31368-0. OCLC 37916353.
  5. "About". Mental Health First Aid USA. National Council for Behavioral Health. 2013-10-10. Retrieved 2013-12-21.
  6. Kitchener, Betty A.; Jorm, Anthony F. (1 October 2002). "Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behaviour". BMC Psychiatry. 2: 10. doi:10.1186/1471-244X-2-10. PMC 130043. PMID 12359045.
  7. Kitchener, Betty; Jorm, Anthony; Kelly, Claire (2010). Mental Health First Aid Manual (2nd ed.). Parkville, Victoria: ORYGEN Youth Health Resource Centre. ISBN 978-0-9805541-3-7. OCLC 608074743.
  8. Kitchener, Betty A.; Jorm, Anthony F. (February 2008). "Mental health first aid: an international program for early intervention". Early Intervention in Psychiatry. 2 (1): 55–61. doi:10.1111/j.1751-7893.2007.00056.x. PMID 21352133.
  9. Appelbaum, Paul S. (June 1997). "Almost a Revolution: An International Perspective on the Law of Involuntary Commitment". Journal of the American Academy of Psychiatry and the Law. 25 (2): 135–147. PMID 9213286.
  10. Sansone, Randy A.; Sansone, Lori (March 9, 2012). "Borderline Personality and Externalized Aggression". Innovations in Clinical Neuroscience. 9.
  11. STATE STANDARDS FOR CIVIL COMMITMENT. Arlington, Virigina: Treatment Advocacy Center. 2018.
  12. Dear, Micheal J.; Wolch, Jennifer R. (1987). Landscapes of Despair: From Deinstitutionalization to Homelessness. Princeton, NJ: Princeton Legacy Library.
  13. "Kendra's Law: Results from New York's First Ten Years with Assisted Outpatient Treatment". Treatment Advocacy Center. Retrieved August 2, 2020.
  14. A Guide to Laura’s Law: California’s Law for Assisted Outpatient Treatment (PDF). The California Treatment Advocacy Coalition & The Treatment Advocacy Center. 2009.
  15. "View of The Evolution of Public Health and Current Challenges: A Review". ihrjournal.com. Retrieved 2018-12-19.
  16. Harding, C.M.; Brooks, G.W.; Ashikaga, T.; Strauss, J.S.; Breier, A. (June 1987). "The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later". American Journal of Psychiatry. 144 (6): 718–26. doi:10.1176/ajp.144.6.718. PMID 3591991.
  17. UN General Assembly (17 December 1991). "A/RES/46/119: Principles for the protection of persons with mental illness and the improvement of mental health care". United Nations. Retrieved 16 June 2016.
  18. "Mental Health and Development". United Nations. Retrieved August 2, 2020.
  19. "UNC study: Mental illness by itself does not predict future violent behavior". UNC Health Care. February 2, 2009. Archived from the original on April 14, 2009. Retrieved July 2, 2009.
  20. Desai, Nimesh G. (2005). "Antipsychiatry: Meeting the challenge". Indian Journal of Psychiatry. 47 (4): 185–187. doi:10.4103/0019-5545.43048. ISSN 0019-5545. PMC 2921130. PMID 20711302. Archived from the original on June 26, 2019. Retrieved July 13, 2020.
  21. Henry A. Nasrallah (December 2011). "The antipsychiatry movement: Who and why" (PDF). Current Psychiatry. Archived from the original (PDF) on 2015-02-07. Retrieved 2013-08-14.
  22. Testa, Megan; West, Sara G. (October 2010). "Civil Commitment in the United States". Psychiatry (Edgmont). 7 (10): 30–40. ISSN 1550-5952. PMC 3392176. PMID 22778709. Archived from the original on June 7, 2020. Retrieved July 13, 2020.
  23. Caute, David (2005). The dancer defects: The struggle for cultural supremacy during the Cold War. Oxford: Oxford University Press. p. 359. ISBN 978-0-19-927883-1. OCLC 434472173.
  24. Temkin, Moshik (2009). The Sacco-Vanzetti Affair. New Haven, CT: Yale University Press. p. 316. ISBN 978-0-300-12484-2. OCLC 973121902.
  25. Moshik, Temkin (2009). The Sacco-Vanzetti Affair. Yale University Press Publishers. p. 316. ISBN 978-0-300-12484-2.
  26. "Duplessis orphans seek proof of medical experiments". Canadian Broadcasting Corporation. Jun 18, 2004. Archived from the original on January 28, 2018.
  27. Hahn, Christine (May 22, 2003). "The Worst of Times: How Psychiatry Used Quebec's Orphans as Guinea Pigs". Freedom. Retrieved 2020-07-14.
  28. Farnsworth, Clyde H. (1993-05-21). "Orphans of the 1950's, Telling of Abuse, Sue Quebec". The New York Times. ISSN 0362-4331. Archived from the original on November 23, 2018. Retrieved 2020-07-14.
  29. Tucker, William H. (2002). The Funding of Scientific Racism: Wickliffe Draper and the Pioneer Fund. University of Illinois Press. p. 119. ISBN 978-0-252-02762-8. Archived from the original on May 6, 2020. Retrieved July 14, 2020.
  30. "Negro Pastor Pronounced Sane; Demands Mississippi Apologize". UPI. Sarasota Journal 20 June 1958: 3.
  31. "Detaining patients against wishes carries legal risks - amednews.com". American Medical News. 2010-08-11. Archived from the original on August 29, 2018. Retrieved 2020-07-13.
  32. Orlando, James (Jan 24, 2013). "Involuntary Civil Commitment and Patients' Rights". Connecticut General Assembly. Archived from the original on March 20, 2015.
  33. "Can an involuntary commitment be false imprisonment if it is not malpractice? : Thompson O'neil Law". Thompson & O'Neil Law. Archived from the original on December 20, 2019. Retrieved 2020-07-13.

Further reading
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