Outpatient and Civil Commitment
Involuntary admission to a psychiatric hospital, or “civil commitment,” is an extraordinary measure; a court orders a person to be confined in a hospital without consent and against his or her will. The Bazelon Center’s early work won legal protections that are now widespread in state civil commitment laws, for instance, that involuntary admissions must be justified by exceptional circumstances such as danger to self or others, that involuntary admissions are time-limited and subject to periodic court review, and that people involuntarily hospitalized have a right to treatment to secure their early release.
Most often, the crisis that results in civil commitment does not arise instantaneously. Before the crisis, the individual had mounting problems, for which the mental health system offered little or no help, and the involuntary admission could have been avoided by early and effective interventions. For this reason, the Bazelon Center advocates for mental health systems to view involuntary admissions as failures of community services, to identify interventions that could have averted the crisis, and to put those interventions in place. Often, needed reforms–for example, better coordination among police and mental health agencies–can be accomplished at little or no cost. All involuntary admissions should be examined with the goal of preventing crises that culminate in hospitalization.
Outpatient commitment is another involuntary form of treatment. A court orders a person to comply with a specific treatment plan, usually requiring the person to take medication and sometimes directing where the person lives and how his or her day is spent. Many outpatient commitment laws were enacted in the wake of tragedies portrayed as being brought on by individuals with untreated mental illnesses who resisted services. In fact, however, the individuals usually had tried to get help without success.
The Bazelon Center opposes outpatient commitment. There is no evidence that it improves public safety. Moreover, the evidence is strong that building a responsive mental health system with services like mobile crisis teams, assertive community treatment teams (ACT), and supported housing, is the best strategy for ensuring that people receive needed treatment. When people are dangerous due to mental illnesses, they should be hospitalized. When safety is not an issue, treatment should be voluntary, because this approach holds the best promise for long-term engagement in treatment. Failure to engage people with serious mental illnesses is a service problem; not a legal problem. Outpatient commitment is not a quick-fix that can overcome the inadequacies of under-resourced and under-performing mental health systems. Coercion, even with judicial sanction, is not a substitute for quality services.