Civil Commitment Statutes Research Articles

Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA.

Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A. Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics. While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment. Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.

Competency to Stand Trial, Civil Commitment, and Oregon State Hospital.

This article examines the explosive growth of individuals referred for competency to stand trial evaluation and restoration services in the state of Oregon and at Oregon State Hospital between the years 2000 and 2020. This paper also examines the links between competency to stand trial and civil commitment statutes. As yearly civil commitments rates have decreased in Oregon, competency to stand trial commitments to Oregon State Hospital have increased, suggesting an inverse relationship between these two important statutes. There is an overlap in the jurisdiction of these statutes, with both needing to function harmoniously for the civil and the criminal justice processes to each work for the benefit of the individuals involved in the criminal justice and mental health systems.

Development of civil commitment statutes (laws of involuntary detention and treatment) in Sri Lanka: a historical review

Civil commitment is the legal process through which a state can deprive individuals of their liberty based on mental illness. Legal statues of civil commitment are as old as the first therapeutic asylums of the Western world. The evolutions of these standards over the last two centuries reflect the changing landscape of psychiatry, the law and social attitudes towards people with mental illness. In Sri Lanka, the Mental Diseases Ordinance codifies the statuary standards of civil commitment. The current legislature dates back to the Lunacy Ordinance of 1873. The law as it stands was last amended in 1956. The historical development of the civil commitment standards of the current Mental Diseases Ordinance of Sri Lanka reflects similar developments that took place in English mental health law in the 19th and 20th Century. This article summarises the development of civil commitment standards from early 19 th century to modern times in Sri Lanka.

The Medical Incapacity Hold: A Policy on the Involuntary Medical Hospitalization of Patients Who Lack Decisional Capacity

Medically hospitalized patients who lack decisional capacity may request, demand, or attempt to leave the hospital despite grave risk to themselves. The treating physician in this scenario must determine how to safeguard such patients, including whether to attempt to keep them in the hospital. However, in many jurisdictions, there are no laws that address this matter directly. In this absence, psychiatrists are often called upon to issue an involuntary psychiatric hold (civil commitment) to keep the patient from leaving. Yet, civil commitment statutes were not intended for, and generally do not address, the needs of the medically ill patient without psychiatric illness. Civil commitment is permitted for patients who pose a danger to themselves or others, or who are gravely disabled, specifically as the result of a mental illness, and allows the transport of such individuals to facilities for psychiatric evaluation. It does not permit detention for medical illnesses nor the involuntary administration of medical treatments. Therefore, the establishment of hospital policies and procedures may be the most appropriate means of detaining medically hospitalized patients who lack capacity to understand the risks of leaving the hospital, in addition to mitigating the potential tort risk faced by the physician for acting in a manner that protects the patient. The purpose of this article is to identify the array of clinical and medical-legal concerns in these scenarios, and to describe the development of a "medical incapacity hold" policy as a means of addressing this unresolved issue.

Should sex traffickers be subject to sexually violent predator laws?

Purpose Protecting society from sex offenders has presented a challenge for state legislatures. Recent decades have seen a significant increase in sexually motivated crimes, especially sex trafficking. Effectively combatting sexual exploitation demands a range of legal strategies. As of 2012, 20 states have passed sexually violent predators (SVP) legislation. Human traffickers may exhibit the same deplorable characteristics as SVPs and should be subject to civil commitments. Traffickers are extremely skilled at exploiting their victim’s psychological pressure-points; knowing which cultural or personal experiences they can prey upon to extract compliance. The purpose of this paper is to discuss the overlapping predatory nature of sex traffickers and SVPs; the creation and purpose of sexual predator civil commitment statutes; and to dissect two cases which could give grounds for civil commitment. Design/methodology/approach Legal research and analysis. Findings Repeated human sex traffickers may suffer from an underlying mental illness which would render them a continued danger to society when released from jail. They should be evaluated and civility committed if medically appropriate. Practical implications A potential increase in civil commits. Social implications Keep society safe from repeat sexual predators. Originality/value The authors have vast experience in the field of human trafficking and this topic will be a pioneering initial discussion.

The Admissibility of Hearsay Evidence in New York State Sex Offender Civil Commitment Hearings After <i>State v. Floyd Y.</i>: Finding a Balance Between Promoting the General Welfare of Sexual Assault Victims and Providing Due Process of Law

In twenty states throughout the country, the government may petition for the civil commitment of detained sex offenders after they are released from prison. Although processes differ among the states, the government must generally show at a court proceeding that a detained sex offender both suffers from a mental abnormality and is dangerous and that this combination makes a detained sex offender likely to reoffend. At such court proceedings, both the government and the respondent will present evidence to either the court or the jury on these issues. As in most court proceedings, hearsay evidence is inadmissible at sex offender civil commitment hearings unless it meets sufficient indicia of reliability or fits within an established exception to the general rule against hearsay.On November 19, 2013, the New York State Court of Appeals determined that in sex offender civil commitment hearings, the best way to show that hearsay evidence regarding uncharged crimes and/or dropped charges meets sufficient indicia of reliability is to require live confrontation of the declarant. This Note argues, however, that neither the U.S. Constitution nor New York State's Civil Practice Law and Rules require live confrontation. In addition, live confrontation conflicts with the legislative intent of New York State's sex offender civil commitment statute and is detrimental to the psychological well-being of victims of sexual assault.

Law & Psychiatry: Gun Laws and Mental Illness: How Sensible Are the Current Restrictions?

This column describes federal and state laws to restrict access to firearms among people with mental illness. The contribution to public safety of these laws is likely to be small because only 3%-5% of violent acts are attributable to serious mental illness, and most do not involve guns. The categories of persons with mental illnesses targeted by the laws may not be at higher risk of violence than other subgroups in this population. The laws may deter people from seeking treatment for fear of losing the right to possess firearms and may reinforce stereotypes of persons with mental illnesses as dangerous.

Application of a Firearm Seizure Law Aimed at Dangerous Persons: Outcomes From the First Two Years

Application of a Firearm Seizure Law Aimed at Dangerous Persons: Outcomes From the First Two Years

Characteristics and Experiences of Adults With a Serious Mental Illness Who Were Involved in the Criminal Justice System

This study identified characteristics and experiences of arrestees and jail inmates with a serious mental illness that were associated with misdemeanor and felony arrests and additional days in jail. County and statewide criminal justice records and health and social service archival data sets were used to identify inmates with serious mental illness who were in the Pinellas County, Florida, jail between July 1, 2003, and June 30, 2004, and their health and social service contacts from July 1, 2002, to June 10, 2006. Criminal justice and mental health services were recorded longitudinally across 16 quarters, or 90-day periods. Generalized estimating equations for count data were used to describe the associations between individual characteristics and experiences and the risks of misdemeanor and felony arrests and additional days in jail. A total of 3,769 jail inmates (10.1% of all jail inmates) were diagnosed as having a serious mental illness. Participants experienced a mean+/-SD of .90+/-.60 arrest for every three quarters and 10.9+/-23.6 days in jail per quarter that they resided in the county. Being male, being homeless, not having outpatient mental health treatment, and having an involuntary psychiatric evaluation in the previous quarter were independently associated with significantly increased odds of misdemeanor arrests and additional days in jail. On the other hand, being black, being younger than 21 years, having a nonpsychotic diagnosis, and a co-occurring substance use disorder diagnosis were all independently associated with significantly increased odds of felony arrests, and with the exception of having a nonpsychotic diagnosis, they were also significantly associated with additional days in jail. Findings suggest that there are subgroups of individuals with a serious mental illness in the criminal justice system that may require different policy and programmatic responses.

Sex-Offender Commitment Law Ruled Unconstitutional

Sex-Offender Commitment Law Ruled Unconstitutional

Civil Commitment: A Therapeutic Jurisprudence Model

Back to table of contents Previous article Next article Book ReviewFull AccessCivil Commitment: A Therapeutic Jurisprudence ModelJohn Petrila J.D., LL.M.John Petrila J.D., LL.M.Search for more papers by this authorPublished Online:1 Apr 2007https://doi.org/10.1176/ps.2007.58.4.572aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Few topics in mental health are more controversial than involuntary civil commitment. Forty years ago, most state commitment laws relied on a medical model. However, litigation arguing that such statutes were too sweeping in their reach resulted in the eventual adoption of more legalistic commitment laws. As community care lagged behind need, civil commitment statutes were decried as overly legalistic, and states again began adopting more medically oriented commitment criteria, extending the reach of commitment laws to outpatient settings. As a result, the debate regarding civil commitment has reached a conceptual and intellectual impasse, with proponents of more medical or more legalistic approaches rehearsing arguments that vary little from those first raised 40 years ago. Bruce Winick, in his excellent new book Civil Commitment , offers a potential path away from this impasse. Winick, a professor at the University of Miami's School of Law, is one of the nation's leading mental health law scholars. With David Wexler, he is the cofounder of "therapeutic jurisprudence," which Winick defines as "an interdisciplinary approach to legal scholarship and law reform that sees the law itself as a therapeutic agent. … Therapeutic jurisprudence calls for the study of [the law's impact] with the tools of the behavioral sciences so that we can better understand law and how it applies and can reshape it to minimize its anti-therapeutic effects and maximize its therapeutic potential."Therapeutic jurisprudence has gained increasing influence over the last decade. For example, it is the philosophic foundation for the hundreds of drug courts and mental health courts that have emerged since the early 1990s. In this book, Winick uses therapeutic jurisprudence in a generally successful effort to determine which aspects of civil commitment law and practice have therapeutic or antitherapeutic consequences. He does this in 11 concise but thorough chapters by applying social sciences research on coercion, capacity, and choice to each element of civil commitment law. The result is a balanced, nonideological reframing of the topic. For example, Winick is respectful of individual liberty, arguing that research shows that treatment adherence is most likely when the individual's participation is voluntary and informed. He also asserts that the legal process required before a person is committed should be honored, because if a person is given a voice, "patients will respond more effectively to hospitalization."At the same time, he proposes relaxing legal standards when their rigid application might impede access to care. For example, he believes that individuals who voluntarily seek care should be considered competent in the absence of very compelling evidence to the contrary. In his view, to apply a competency standard too rigidly could result in denial of care or in civil commitment rather than voluntary admission to care, with antitherapeutic consequences. Anyone involved with civil commitment will find this book useful and thought provoking, particularly given continuing controversy regarding civil commitment and the use of coercion. It is becoming increasingly apparent that individuals in community care are subject to myriad types of leverage, including coercion, that are all designed to gain treatment adherence ( 1 ). Winick insists that one of the most important questions we can ask about legal rules and legal processes is whether they have a therapeutic or antitherapeutic impact. In doing so, he illustrates how the debate about civil commitment and coercion might be reframed in a way that permits proponents of both the legalistic and the medical models of commitment to begin talking to each other rather than past each other. Dr. Petrila is affiliated with the Florida Mental Health Institute, University of South Florida, Tampa.Reference1. Monahan J, Redlich AD, Swanson J, et al: Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services 56:37–44, 2005Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 58Issue 4 April, 2007Pages 572-573PSYCHIATRIC SERVICES April 2007 Volume 58 Number 4 Metrics PDF download History Published online 1 April 2007 Published in print 1 April 2007

Civil Commitment: A Therapeutic Jurisprudence Model

Back to table of contents Previous article Next article Book ReviewFull AccessCivil Commitment: A Therapeutic Jurisprudence ModelJohn Petrila J.D., LL.M.John Petrila J.D., LL.M.Search for more papers by this authorPublished Online:1 Apr 2007https://doi.org/10.1176/ps.2007.58.4.572aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Few topics in mental health are more controversial than involuntary civil commitment. Forty years ago, most state commitment laws relied on a medical model. However, litigation arguing that such statutes were too sweeping in their reach resulted in the eventual adoption of more legalistic commitment laws. As community care lagged behind need, civil commitment statutes were decried as overly legalistic, and states again began adopting more medically oriented commitment criteria, extending the reach of commitment laws to outpatient settings. As a result, the debate regarding civil commitment has reached a conceptual and intellectual impasse, with proponents of more medical or more legalistic approaches rehearsing arguments that vary little from those first raised 40 years ago. Bruce Winick, in his excellent new book Civil Commitment , offers a potential path away from this impasse. Winick, a professor at the University of Miami's School of Law, is one of the nation's leading mental health law scholars. With David Wexler, he is the cofounder of "therapeutic jurisprudence," which Winick defines as "an interdisciplinary approach to legal scholarship and law reform that sees the law itself as a therapeutic agent. … Therapeutic jurisprudence calls for the study of [the law's impact] with the tools of the behavioral sciences so that we can better understand law and how it applies and can reshape it to minimize its anti-therapeutic effects and maximize its therapeutic potential."Therapeutic jurisprudence has gained increasing influence over the last decade. For example, it is the philosophic foundation for the hundreds of drug courts and mental health courts that have emerged since the early 1990s. In this book, Winick uses therapeutic jurisprudence in a generally successful effort to determine which aspects of civil commitment law and practice have therapeutic or antitherapeutic consequences. He does this in 11 concise but thorough chapters by applying social sciences research on coercion, capacity, and choice to each element of civil commitment law. The result is a balanced, nonideological reframing of the topic. For example, Winick is respectful of individual liberty, arguing that research shows that treatment adherence is most likely when the individual's participation is voluntary and informed. He also asserts that the legal process required before a person is committed should be honored, because if a person is given a voice, "patients will respond more effectively to hospitalization."At the same time, he proposes relaxing legal standards when their rigid application might impede access to care. For example, he believes that individuals who voluntarily seek care should be considered competent in the absence of very compelling evidence to the contrary. In his view, to apply a competency standard too rigidly could result in denial of care or in civil commitment rather than voluntary admission to care, with antitherapeutic consequences. Anyone involved with civil commitment will find this book useful and thought provoking, particularly given continuing controversy regarding civil commitment and the use of coercion. It is becoming increasingly apparent that individuals in community care are subject to myriad types of leverage, including coercion, that are all designed to gain treatment adherence ( 1 ). Winick insists that one of the most important questions we can ask about legal rules and legal processes is whether they have a therapeutic or antitherapeutic impact. In doing so, he illustrates how the debate about civil commitment and coercion might be reframed in a way that permits proponents of both the legalistic and the medical models of commitment to begin talking to each other rather than past each other. Dr. Petrila is affiliated with the Florida Mental Health Institute, University of South Florida, Tampa.Reference1. Monahan J, Redlich AD, Swanson J, et al: Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services 56:37–44, 2005Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 58Issue 4 April, 2007Pages 572-573PSYCHIATRIC SERVICES April 2007 Volume 58 Number 4 Metrics PDF download History Published online 1 April 2007 Published in print 1 April 2007

Toward a Twenty-First Century Civil Commitment Statute: A Legal, Medical, and Policy Analysis of Preventive Outpatient Treatment

This law review Note explores current Preventive Outpatient Treatment statutes, also known as Assisted Outpatient Treatment statutes. The Note focuses primarily on Kendra's Law of New York and Laura's Law of California but also discusses similar statutes and bills in other states.

Imminent Suicide: The Illusion of Short‐Term Prediction

The concept of imminent suicide is examined. A search of National Electronic Library for Mental Health, the Cochrane Library, PubMed, OVID and MD Consult databases was conducted using the terms "suicide, imminent." The term imminent frequently appears in the mental health literature, finding common usage among clinicians. It is also a legal term of art embedded in civil commitment statutes; duty to warn and protect statutes and case law, usually under the rubric of dangerousness; and in seclusion and restraint policies. Managed care admission protocols may contain imminence criteria for patients at risk for suicide before approving insurance benefits, yet no suicide risk factors exist for the short-term prediction of suicide.

Governor Bypasses Legislature, Orders Commitments

Governor Bypasses Legislature, Orders Commitments

U.S. involuntary mental health commitment statutes: requirements for persons perceived to be a potential harm to self.

The civil commitment statutes of all 50 states and the District of Columbia were reviewed to determine: (1) What is required for a person who is believed to be at serious and imminent risk of self-harm to be eligible for involuntary hospitalization; and (2) Whether an attempt to involuntarily hospitalize was required or was merely an option when the requirements found in number 1 were met. The analysis revealed that nearly 85% of the jurisdictions require dangerousness to self to be the result of a mental illness, and only two jurisdictions mandate attempts at involuntary commitment if a person is deemed to be an imminent harm to self. These results have implications for practice with individuals who are suicidal.

A Mischaracterization

Back to table of contents Previous article Next article LetterFull AccessA MischaracterizationLinda S. Grossman, Ph.D., and Christopher G. Fichtner, M.D.Linda S. GrossmanSearch for more papers by this author, Ph.D., and Christopher G. FichtnerSearch for more papers by this author, M.D.Published Online:1 Jun 1999https://doi.org/10.1176/ps.50.6.836AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We thank Dr. Zonana for calling attention to our incomplete representation of his statement that "from the public viewpoint, only a relapse rate of zero is acceptable." As we inferred, such a view might lead to the conclusion that the only solution for sex offenders would be indefinite confinement, with or without treatment. Zonana makes no such recommendation. Rather, he acknowledges the growing evidence of treatability for some sex offenders. He develops several lines of argument against the civil commitment statutes, one of which involves his representation of the public viewpoint. Since our review of the treatment research literature yielded evidence that treatment makes a difference, we meant to point out that treatment would be expected to have some beneficial impact whether it is prison based or in the context of civil commitment.This evidence of some beneficial impact leaves unanswered important questions of differential responsiveness of subpopulations of sex offenders and of where treatment should be provided (prisons, mental hospitals, "hybrid" institutions, or outpatient settings). We noted evidence that treatment in institutional settings and an extensive criminal record are in general associated with poorer outcome. We also mentioned several concerns of mental health professionals and public administrators, including risks associated with mixing populations and the drain on mental health services resources. Reid (1) has pointed out that questions of treatability, where such patients are housed, and what resources are available for their care are conceptually separable.We believe the main policy implication of our article is that, given the prospect of effective treatments and the major uncertainties surrounding verification of just how effective these treatments may be, new treatment programs cannot be responsibly developed without clinical research components.

An examination of California's civil commitment laws and national future trends.

California's civil commitment statute serves as a model for many other states. A move to update the California law may set national precedent.

Police Officer Attitudes and Use of Discretion in Situations Involving the Mentally Ill: The Need to Narrow the Focus

Research to date has very effectively highlighted the fact that the mentally ill are vulnerable to systematic criminalization. The reasons cited for this range from decreasing mental health resources, to restrictive civil commitment statutes, to increased numbers of mentally ill citizens in the community as a result of deinstitutionalization. However, the research has also shown that the presence of a criminalization phenomenon is not yet generalizable. The prevailing research emphasizes a macro-level approach, using either archival data or large groups of police-citizen contacts without regard for factors intrinsic to the police-citizen exchange. This article examined two such variables (police-citizen contact type and police officer type) to illustrate the need to narrow the focus in the research. We contend that our emphasis moves the criminalization debate forward and helps provide a more comprehensive understanding of the interaction between the police and the mentally ill. Further, we submit that by controlling for these two variables, research findings will more likely be generalizable and replicable.

Civil commitment of the anorexic patient

Involuntary commitment appears to be an infrequently used intervention with anorexic patients, in part because of clinicians’ uncertainty about its applicability to this population. In contrast to overtly suicidal patients, anorexic patients typically fail to express an intent to harm themselves, although their actions may result in severe harm. Examination of the language of civil commitment statutes, however, suggests that when the behavior of anorexic patients endangers their lives, they will usually be committable under grave disability standards. This appears to comport with the practices of experts in the treatment of anorexia, and with practices in other countries as well. Involuntary commitment should be used as an approach of last resort, when patients decline voluntary hospitalization and their physical safety is at risk. Moreover, civil commitment should probably also be limited to circumstances in which therapeutic gain is likely from hospitalization. Many severely ill anorexic patients will lack competence to make treatment decisions on their own behalf, allowing involuntary feeding and other procedures to take place, if necessary. Civil commitment is a tool that can legitimately be used in emergent situations with anorexic patients.