Commitment Legislation Research Articles

Treatment During Civil Commitment for Sexual Offending Behaviors.

The first sex offender civil commitment legislation passed in Washington State in 1990. Since that time, 21 additional jurisdictions in the USA have passed similar statutes. Although considered controversial by some, the statutes have withstood legal scrutiny at the state and federal levels. These statutes have been found constitutional in large part because they offer treatment to those individuals detained under them. In the 25years since sex offender civil commitment became a reality, significant advances in sex offender assessment and treatment have shaped the landscape of the associated treatment programs. This article reviews current practice in programs that treat individuals detained under these laws and provides a framework in which these programs are delivered.

APA Board Approves Position Statement on Involuntary Outpatient Commitment

APA Board Approves Position Statement on Involuntary Outpatient Commitment

Obligatory dangerousness criteria in the involuntary commitment and treatment provisions of Australian mental health legislation

Objective Involuntary commitment and treatment (IC&T) of people affected by mental illness may have reference to considerations of dangerousness and/or need for care. While attempts have been made to classify mental health legislation according to whether IC&T has obligatory dangerousness criteria, there is no standardised procedure for making classification decisions. The aim of this study was to develop and trial a classification procedure and apply it to Australia's mental health legislation. Method We developed benchmarks for ‘need for care’ and ‘dangerousness’ and applied these benchmarks to classify the mental health legislation of Australia's 8 states and territories. Our focus was on civil commitment legislation rather than criminal commitment legislation. Results One state changed its legislation during the course of the study resulting in two classificatory exercises. In our initial classification, we were able to classify IC&T provisions in legislation from 6 of the 8 jurisdictions as being based on either ‘need for care’ or ‘dangerousness’. Two jurisdictions used a terminology that was outside the established benchmarks. In our second classification, we were also able to successfully classify IC&T provisions in 6 of the 8 jurisdictions. Of the 6 Acts that could be classified, all based IC&T on ‘need for care’ and none contained mandatory ‘dangerousness’ criteria. Conclusions The classification system developed for this study provided a transparent and probably reliable means of classifying 75% of Australia's mental health legislation. The inherent ambiguity of the terminology used in two jurisdictions means that further development of classification may not be possible until the meaning of the terms used has been addressed in case law. With respect to the 6 jurisdictions for which classification was possible, the findings suggest that Australia's mental health legislation relies on ‘need for care’ and not on ‘dangerousness’ as the guiding principle for IC&T.

Evaluation for Civil Commitment of Sex Offenders: A Survey of Experts

At this study's commencement, 17 states had enacted sex offender civil commitment legislation. Although each statute outlines broad criteria that must be met, civil commitment evaluators are given considerable latitude in how to conduct their assessment. Forty-one experts who conduct sex offender civil commitment evaluations were surveyed to identify the usual practice of these evaluators. A great deal of agreement exists across experts regarding the conduct of sex offender civil commitment evaluations. However, these patterns appear quite different from the usual practice outlined in other types of forensic evaluations. Experts in sex offender civil commitment endorsed documentation as the core method for evaluation. The majority of evaluators reported the assessment of paraphilias, substance abuse, other Axis I disorders, Axis II disorders, and psychopathy as essential to the evaluation. Virtually all survey respondents utilized actuarial risk assessment measures, primarily the Static-99, in assessing for risk of future sexual violence. Although several approaches to assessing volitional impairment were described, the majority of respondents reported that a history of sex offending combined with a personality disorder or a paraphilia established the necessary link between mental abnormality and risk of future sexual violence. An overwhelming majority of experts indicated that it was essential for evaluators to report their ultimate opinion as to whether criteria had been met for civil commitment. Future research regarding the use and incorporation of documentation should be conducted to determine whether the heavy reliance on documentation is unique to sex offender civil commitment evaluations, or whether it is commonly used in other forensic evaluations.

Evaluation for Civil Commitment of Sex Offenders: A Survey of Experts

At this study’s commencement, 17 states had enacted sex offender civil commitment legislation. Although each statute outlines broad criteria that must be met, civil commitment evaluators are given considerable latitude in how to conduct their assessment. Forty-one experts who conduct sex offender civil commitment evaluations were surveyed to identify the usual practice of these evaluators. A great deal of agreement exists across experts regarding the conduct of sex offender civil commitment evaluations. However, these patterns appear quite different from the usual practice outlined in other types of forensic evaluations. Experts in sex offender civil commitment endorsed documentation as the core method for evaluation. The majority of evaluators reported the assessment of paraphilias, substance abuse, other Axis I disorders, Axis II disorders, and psychopathy as essential to the evaluation. Virtually all survey respondents utilized actuarial risk assessment measures, primarily the Static-99, in assessing for risk of future sexual violence. Although several approaches to assessing volitional impairment were described, the majority of respondents reported that a history of sex offending combined with a personality disorder or a paraphilia established the necessary link between mental abnormality and risk of future sexual violence. An overwhelming majority of experts indicated that it was essential for evaluators to report their ultimate opinion as to whether criteria had been met for civil commitment. Future research regarding the use and incorporation of documentation should be conducted to determine whether the heavy reliance on documentation is unique to sex offender civil commitment evaluations, or whether it is commonly used in other forensic evaluations.

Judicial Review of the Meaning of "Mental Disorder"

New Zealand has recently experienced its first successful judicial review of a discharge decision made by a mental health review tribunal acting under the civil commitment legislation, the Mental Health (Compulsory Assessment and Treatment) Act 1992 (NZ). This article discusses the substantive issues in the litigation and the reviewing posture adopted by the courts. The litigation presents numerous issues central to the work of mental health review tribunals including the meaning of “mental disorder” for civil commitment and discharge purposes; the choice between legal and psychiatric readings of mental health legislation; the conflict between psychiatric ethics and community expectations; the right of the Crown to natural justice in tribunal proceedings; and the degree of deference to be shown by a reviewing court to a specialised tribunal.

Judicial Review of the Meaning of “Mental Disorder”

New Zealand has recently experienced its first successful judicial review of a discharge decision made by a mental health review tribunal acting under the civil commitment legislation, the Mental Health (Compulsory Assessment and Treatment) Act 1992 (NZ). This article discusses the substantive issues in the litigation and the reviewing posture adopted by the courts. The litigation presents numerous issues central to the work of mental health review tribunals including the meaning of “mental disorder” for civil commitment and discharge purposes; the choice between legal and psychiatric readings of mental health legislation; the conflict between psychiatric ethics and community expectations; the right of the Crown to natural justice in tribunal proceedings; and the degree of deference to be shown by a reviewing court to a specialised tribunal.

Characteristics of psychiatric inpatients detained under civil commitment legislation: A Canadian study

Characteristics of psychiatric inpatients detained under civil commitment legislation: A Canadian study

Criteria for involuntary hospitalisation.

The aim of this paper is to provide an overview of the ethical bases of compulsory commitment legislation. The ethical principles of beneficence and autonomy are examined and used to identify criteria for the commitment of mentally ill patients. Two aspects of beneficence, medical paternalism and social paternalism, are discussed. It is argued that social paternalism is insufficient ethically to warrant involuntary admission, and that the basis for compulsory hospitalisation is medical paternalism. The central role of autonomy in medical ethics suggests a patient should have a diminished capacity for autonomous decision-making and a potential to benefit from hospitalisation, as well as a risk of harm to self (including self-neglect) to warrant committal. In specific circumstances, the risk of harm to others may also justify committal. These ethical principles may be at odds with public attitudes.

The costs of enacting a sexual predator law.

This article describes the history of special sex offender commitment legislation in the United States during the 20th century. It reviews the enactment and demise of sexual psychopath laws from the late 1930s and the enactment of contemporary sexual predator laws. The article then examines in depth the direct and indirect costs of enacting and implementing a sexual predator law, drawing on the experience of both Washington and California. It demonstrates that these laws will be very expensive to implement, will generate at least 3 generations of litigation, and may not be a wise expenditure of scarce public resources.

Changing Trends in Mental Health Legislation: Anatomy of Reforming a Civil Commitment Law

In this article, we discuss changing trends of mental health legislation in the United States using a case study of the process of reforming the civil commitment law in New Jersey. That state's new commitment law, commonly called the "screening law," was enacted after a thirteen-year legislative process. Changes in the orientation of the proposed legislation and the dynamics of the process of reforming the commitment law in the state exemplify changing national trends in civil commitment legislation. We consider how the proposed legislation shifted in emphasis from a strong civil libertarian orientation to a social service approach. We assess the role of various interest groups, their negotiations, and the compromises that emerged. Our analysis of the process shows that changes in the social and political environment were the decisive factors that stimulated the process of reforming the civil commitment laws. Many of these changes occurred outside the mental health system and could be neither anticipated nor controlled by the various parties. Our examination of the process and the final outcome of this legislation reveals how organizations and interest groups, in their efforts to adapt to changing conditions, shaped the legislative outcome according to their interests.

Historical Development of Legal Protection for the Rights of Mentally Ill Persons in France

The authors trace the development of legal protection of the rights of mentally ill persons to the experiences of Gabriel-Honoré de Riqueti, the Count of Mirabeau, who was imprisoned without due process more than 200 years ago. Influenced by the ideas of the leaders of the American Revolution, he later became a representative to the French Republic's National Assembly and played a pivotal role in defining human rights, including the rights of mentally ill persons, in France. He advocated involvement of judicial authorities in any decision to confine a citizen, even in the case of mental disorder. French civil commitment legislation of 1838 established the authority of physicians and civil officials in commitment decisions, but limited judicial involvement to review after commitment. A new 1990 law limits judicial involvement to review after commitment, but extends the rights of hospitalized patients in many areas.

The constitutionality of involuntary civil commitment of opiate addicts.

This paper deals with the constitutionality of involuntary treatment of opiate addicts. Although the first laws permitting involuntary treatment of opiate addicts were enacted in the second half of the nineteenth century, addicts were not committed in large numbers until California and New York enacted new civil commitment legislation in the 1960s. Inevitably, the courts were called upon to decide if involuntary treatment was constitutional. Both the California and New York courts decided that it was. These decisions were heavily influenced by statements made by the United States Supreme Court in Robinson v. California. The Robinson case did not actually involve the constitutionality of involuntary treatment; it involved the question of whether it was constitutional for a state to make addiction a crime. Nevertheless, the Supreme Court declared (in a dictum) that a state might establish a program of compulsory treatment for opiate addicts either to discourage violation of its criminal laws against narcotic trafficking or to safeguard the general health or welfare of its inhabitants. Presumably because the Robinson case did not involve the constitutionality of involuntary treatment of opiate addicts, the Supreme Court did not go into that question as deeply as it might have. The California and New York courts, in turn, relied too much on this dictum and did not delve deeply into the question. The New York courts did a better job than the California courts, but their work too was not as good as it should have been.

Mental Illness Assumptions in Civil Commitment Proceedings

Under reformed commitment legislation, mental illness alone is insufficient grounds for mental hospitalization. Nonetheless, judges of involuntary commitment hearings operate under the working assumption that persons sought to be committed are mentally ill, and this assumption shapes all other aspects of their evaluations. This article treats the mental illness assumption as an experiental reality and explores the ways in which the assumption influences judges' assessments of candidate patients' courtroom demeanor, testimony, and behavior. It examines the assumption's effect on judges' evaluations of the tenability of these persons' proposed community living arrangements and suggests that contemporary commitment practices tend to enforce a sort of “community custody” upon those persons who avoid commitment.

Rights of mentally retarded persons in New Zealand and the United States: A comparison

With a different form of government, New Zealand’s approach to legal rights for mentally retarded persons remains different from that of the United States. In New Zealand, the political arenas are smaller and primarily involve the parliament, some national agencies, and the local government hospital boards. With a federal system of government, the United States is influenced by more political factors. New Zealand’s more limited political arena accounts for the very prominent role of the New Zealand Society for the Intellectually Handicapped which is partially funded by the national government. However, the legislative approach in New Zealand remains long and arduous. Legislative changes currently being sought include adult guardianship, education rights, separate commitment legislation from the Mental Health Act, and employment rights. The judicial arena has proved a quicker route for establishing rights in the U.S.

Civil commitment trends in Ontario: the effect of legislation on clinical practice.

The rationale for and history of civil commitment legislation in Ontario are reviewed. The civil commitment rate in Ontario from 1926 to 1980 for provincial psychiatric hospitals, and from 1974 to 1980 for all psychiatric inpatient facilities was analyzed to detect variation in the rate over time and with relevant legislation. The findings indicate that mental health legislation has had little effect on commitment practices in Ontario. In addition, the variation in the commitment rate over the period reviewed cannot be ascribed to inconsistent application by physicians. The other variables affecting the rate are discussed in this context. The need for more descriptive studies of the major determinants of the commitment rate is emphasized.

Mental commitment legislation: Impact on length of stay

Mental commitment legislation: Impact on length of stay

The Survivor: An Anatomy of Life in the Death Camps

Back to table of contents Previous article Next article ArticleNo AccessThe Survivor: An Anatomy of Life in the Death CampsPAUL CHODOFFPAUL CHODOFFSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.133.11.1357AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "The Survivor: An Anatomy of Life in the Death Camps." American Journal of Psychiatry, 133(11), p. 1357 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byJournal of Korean Neuropsychiatric Association, Vol. 51, No. 3Nashim: A Journal of Jewish Women's Studies & Gender Issues, No. 13Ethics and Aging: Confronting Abuse and Self-Neglect24 October 2008 | Journal of Elder Abuse & Neglect, Vol. 11, No. 2The Ethics of Tailoring the Patient's ChartJames Dwyer, Ph.D., and Anthony Shih, M.D.1 October 1998 | Psychiatric Services, Vol. 49, No. 10Perspectives on Effective Advocacy for Homeless Mentally Ill PersonsH. Richard Lamb1 April 2006 | Psychiatric Services, Vol. 43, No. 12Shaken, but alive: organizational behavior in the wake of catastrophic events17 August 2016 | Industrial Crisis Quarterly, Vol. 5, No. 4Psychiatric Commitment of the Elderly2 September 2016 | Journal of Geriatric Psychiatry and Neurology, Vol. 2, No. 3Behavioral Sciences & the Law, Vol. 6, No. 1An experimental analysis of the civil commitment recommendations of psychologists and psychiatristsBehavioral Sciences & the Law, Vol. 6, No. 1Nordisk Psykiatrisk Tidsskrift, Vol. 41, No. 4Rights, wrongs, and the dilemma of coerced community treatment1 April 2006 | American Journal of Psychiatry, Vol. 143, No. 10Psychiatric Quarterly, Vol. 58, No. 2New England Journal of Medicine, Vol. 315, No. 18Attitude change concerning right to refuse treatment: the impact of experience1 April 2006 | American Journal of Psychiatry, Vol. 142, No. 11Ethical Conflicts in Psychiatry: The Soviet Union Vs. the U.SPaul Chodoff1 April 2006 | Psychiatric Services, Vol. 36, No. 9Involuntary hospitalization of the mentally ill as a moral issue1 April 2006 | American Journal of Psychiatry, Vol. 141, No. 3Are lawyers enemies of psychiatrists? A survey of civil commitment counsel and judges1 April 2006 | American Journal of Psychiatry, Vol. 140, No. 3New Directions for Mental Health Services, Vol. 1983, No. 17The Boston State Hospital case: a conflict of civil liberties and true liberalism1 April 2006 | American Journal of Psychiatry, Vol. 139, No. 2The Morality of Involuntary HospitalizationExplaining the increased arrest rate among mental patients: a cautionary note1 April 2006 | American Journal of Psychiatry, Vol. 137, No. 12Law and Human Behavior, Vol. 3, No. 3The process of criminal commitment for pretrial psychiatric examination: an evaluation1 April 2006 | American Journal of Psychiatry, Vol. 135, No. 1Psychiatric Quarterly, Vol. 50, No. 3Mental commitment legislation: Impact on length of stayThe journal of mental health administration, Vol. 6, No. 1Physical violence in the concept of dangerousness: a case report1 April 2006 | American Journal of Psychiatry, Vol. 134, No. 2 Volume 133Issue 11 November 1976Pages 1357-1357 Metrics PDF download History Published online 1 April 2006 Published in print 1 November 1976

Care of the chronically mentally ill--a national disgrace.

Back to table of contents Previous article Next article ArticleNo AccessCare of the Chronically Mentally Ill—A National DisgraceROBERT REICHROBERT REICHSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.130.8.911AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Care of the Chronically Mentally Ill—A National Disgrace." American Journal of Psychiatry, 130(8), pp. 911–912 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byAustralian Economic History Review, Vol. 49, No. 2Australian Journal of Public Administration, Vol. 68, No. 4Australia's National Mental Health Strategy and Deinstitutionalization: Some Empirical Results17 November 2016 | Australian & New Zealand Journal of Psychiatry, Vol. 39, No. 11-12Deinstitutionalization: Avoiding the Disasters of the PastJohn A. Talbott, M.D.1 October 2004 | Psychiatric Services, Vol. 55, No. 10Care of the Chronically Mentally Ill—Still a National DisgraceJohn A. Talbott, M.D.1 October 2004 | Psychiatric Services, Vol. 55, No. 10SSRN Electronic JournalReduction of Length of Stay in an Acute Care Psychiatric Unit1 February 1996 | The Canadian Journal of Psychiatry, Vol. 41, No. 1International Journal of Group Psychotherapy, Vol. 46, No. 2Social Science & Medicine, Vol. 40, No. 5Social Indicators Research, Vol. 33, No. 1-3Culture, Medicine and Psychiatry, Vol. 16, No. 2Community Mental Health Journal, Vol. 26, No. 5Nordisk Psykiatrisk Tidsskrift, Vol. 44, No. 5The Journal of Primary Prevention, Vol. 10, No. 2New Directions for Mental Health Services, Vol. 1988, No. 37Feasibility of Discharge of Chronic Psychiatric Patients26 June 2016 | Australian & New Zealand Journal of Psychiatry, Vol. 18, No. 4New Directions for Mental Health Services, Vol. 1982, No. 14Community Mental Health Journal, Vol. 18, No. 1American Journal of Orthopsychiatry, Vol. 52, No. 3Patient-Selection Bias for the Case Conference? An Inquiry into Psychiatric Education Inequity12 April 2018 | Academic Psychiatry, Vol. 5, No. 3Community Mental Health Journal, Vol. 17, No. 2Psychiatric Quarterly, Vol. 53, No. 3American Journal of Orthopsychiatry, Vol. 50, No. 1American Journal of Orthopsychiatry, Vol. 50, No. 1Deinstitutionalization: Avoiding the Disasters of the PastJohn A. Talbott1 April 2006 | Psychiatric Services, Vol. 30, No. 9Emergency Psychiatric Care in Municipal HospitalsPsychiatric Annals, Vol. 9, No. 5The Professional Geographer, Vol. 31, No. 3The State Mental Hospital: A Local Health Department's RoleAmerican Journal of Public Health, Vol. 69, No. 1Psychiatric Quarterly, Vol. 50, No. 3Comprehensive Psychiatry, Vol. 19, No. 6Mental commitment legislation: Impact on length of stayThe journal of mental health administration, Vol. 6, No. 1DEFINING THE FUNCTIONS OF HOSPITAL PSYCHIATRY: IMPLICATIONS FOR TRAININGE. Mansell Pattison1 April 2006 | Psychiatric Services, Vol. 27, No. 6Crime and violence among mental patients1 April 2006 | American Journal of Psychiatry, Vol. 133, No. 2Phasing out State Hospitals — A Psychiatric DilemmaNew England Journal of Medicine, Vol. 294, No. 5Policy Sciences, Vol. 7, No. 1Social Psychiatry, Vol. 11, No. 1Social Psychiatry, Vol. 11, No. 3Community Mental Health Journal, Vol. 12, No. 2Community Mental Health Journal, Vol. 12, No. 1Social Consequences of Policy Toward Mental IllnessScience, Vol. 188, No. 4195THE EXODUS OF LONG—STAY PSYCHIATRIC PATIENTS1 June 1975 | Medical Journal of Australia, Vol. 1, No. 26THE PRACTICAL LIMITS OF PATIENTS' RIGHTSPsychiatric Annals, Vol. 5, No. 4The Psychiatric Quarterly, Vol. 48, No. 3Antipode, Vol. 6, No. 3Transactions of the New York Academy of Sciences, Vol. 36, No. 7 Series IIThe Lancet, Vol. 302, No. 7842 Volume 130Issue 8 August 1973Pages 911-912 Metrics PDF download History Published online 1 April 2006 Published in print 1 August 1973