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Involuntary Commitment

Involuntary commitment, civil commitment, involuntary hospitalization or involuntary hospitalisation (Commonwealth English; see spelling differences), (also known informally as sectioning or being sectioned in some jurisdictions, such as the United Kingdom ) is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily. This treatment may involve the administration of psychoactive drugs, including involuntary administration. In many jurisdictions, people diagnosed with mental health disorders can also be forced to undergo treatment while in the community; this is sometimes referred to as outpatient commitment and shares legal processes with commitment. 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. Civil commitment procedures may take place in a court or only involve physicians. If commitment does not involve a court there is normally an appeal process that does involve the judiciary in some capacity, though potentially through a specialist court.[lower-alpha 1] 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, a trend known as "deinstitutionalisation". In many currents, individuals can voluntarily admit themselves to a mental health hospital and may have more rights than those who are involuntarily committed. This practice is referred to as voluntary commitment. In the United States, an indefinite form of commitment is applied to people convicted of some sexual offences.

mental health disorders mental health outpatient commitment

1. Purpose

For 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 involuntary treatment to individuals who meet statutory criteria for presenting a danger to self or others. Other jurisdictions have broader criteria. The legal process by which commitment takes place varies between jurisdictions. Some jurisdictions have a formal court hearing where testimony and other evidence may also be submitted where subject of the hearing is typically entitled to legal counsel and may challenge a commitment order through habeas corpus.[1] Other jurisdictions have delegated these power to physicians,[2] though may provide an appeal process that involves the judiciary but may also involve physicians.[3] For example in the UK a mental health tribunal consists of a judge, a medical member, and a lay representative.[4]

1.1. 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.

1.2. 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 should be committed.

1.3. Containment of Danger

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. Research has found that those who suffer from schizophrenia are between 3.4 and 7.4 times more likely to engage in violent behaviour than members of the general public. [10] However, because other confounding factors such as childhood adversity and poverty are correlated with both schizophrenia and violence it can be difficult to determine whether this effect is due to schizophrenia or other factors. In an attempt to avoid these confounding factors, researchers have tried comparing the rates of violence amongst people diagnosed with schizophrenia to their siblings in a similar manner to twin studies. In these studies people with schizophrenia are found to be between 1.3 and 1.8 times more likely to engage in violent behaviour.[10]

People with certain types of personality disorders can occasionally present a danger to themselves or others.[11]

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".[12]

2. Deinstitutionalization

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.[13] 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).[14][15]

Before the 1960s deinstitutionalization there were earlier efforts to free psychiatric patients. Philippe Pinel (1745–1826) ordered the removal of chains from patients.[16]

In a study of 269 patients from Vermont State Hospital done by Courtenay M. Harding and associates, about two-thirds of the ex-patients did well after deinstitutionalization.[17]

3. Around the World

3.1. 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.[18] 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.[19]

4. Wrongful Involuntary Commitment

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.[20][21][22]

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.[23] 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.[24] 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.[25][26] 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.[27][28] Decades later in the 1990s, several of the orphans sued Quebec and the Catholic Church for the abuse and wrongdoing.[29] 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.[30][31]

Patients are able to sue if they believe that they have been wrongfully committed.[32][33][34] In one instance, Junius Wilson, an African American man, was committed to Cherry Hospital in Goldsboro, North Carolina in 1925 for an alleged crime without a trial or conviction. He was castrated. He continued to be held at Cherry Hospital for the next 67 years of his life. It turned out he was deaf rather than mentally ill.[35][36][37]

In many American states[38] sex offenders who have completed a period of incarceration can be civilly committed to a mental institution based on a finding of dangerousness due to a mental disorder.[39] Although the United States Supreme Court determined that this practice does not constitute double jeopardy,[40] organizations such as the American Psychiatric Association (APA) strongly oppose the practice.[41] The Task Force on Sexually Dangerous Offenders, a component of APA's Council on Psychiatry and Law, reported that "in the opinion of the task force, sexual predator commitment laws represent a serious assault on the integrity of psychiatry, particularly with regard to defining mental illness and the clinical conditions for compulsory treatment. Moreover, by bending civil commitment to serve essentially non-medical purposes, statutes threaten to undermine the legitimacy of the medical model of commitment."[42][43]


  1. 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." 
  2. Rains, Luke Sheridan; Zenina, Tatiana; Dias, Marisa Casanova; Jones, Rebecca; Jeffreys, Stephen; Branthonne-Foster, Stella; Lloyd-Evans, Brynmor; Johnson, Sonia (2019-05-01). "Variations in patterns of involuntary hospitalisation and in legal frameworks: an international comparative study". The Lancet Psychiatry 6 (5): 403–417. doi:10.1016/S2215-0366(19)30090-2. ISSN 2215-0366. PMID 30954479. PMC 6475657. Retrieved 2020-08-23. 
  3. For a discussion of the role of physicians in mental health tribunals and its effects see [7]
  4. "The chair of each Mental Health Tribunal is a legal member who is known as a tribunal judge. There are usually three tribunal members at a hearing, one legal member, one medical member, and one other member, as defined above. Any three or more such members, constituted in this manner, may exercise the jurisdiction of a Mental Health Tribunal" [8] :99
  5. "About". National Council for Behavioral Health. 2013-10-10. 
  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. 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. Fazel, Seena; Gulati, Gautam; Linsell, Louise; Geddes, John R.; Grann, Martin (2009-08-11). McGrath, John. ed. "Schizophrenia and Violence: Systematic Review and Meta-Analysis". PLOS Medicine (Public Library of Science (PLoS)) 6 (8): e1000120. doi:10.1371/journal.pmed.1000120. ISSN 1549-1676. PMID 19668362.
  11. Sansone, Randy A.; Sansone, Lori (March 9, 2012). "Borderline Personality and Externalized Aggression". Innovations in Clinical Neuroscience 9 (3): 23–26. PMID 22567607.
  12. STATE STANDARDS FOR CIVIL COMMITMENT. Arlington, Virginia: Treatment Advocacy Center. 2018. 
  13. Dear, Micheal J.; Wolch, Jennifer R. (1987). Landscapes of Despair: From Deinstitutionalization to Homelessness. Princeton, NJ: Princeton Legacy Library. ISBN 9781400858965. 
  14. "Kendra's Law: Results from New York's First Ten Years with Assisted Outpatient Treatment". 
  15. A Guide to Laura's Law: California's Law for Assisted Outpatient Treatment. The California Treatment Advocacy Coalition & The Treatment Advocacy Center. 2009. 
  16. "View of The Evolution of Public Health and Current Challenges: A Review". 
  17. 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.
  18. 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". 
  19. "Mental Health and Development". 
  20. "UNC study: Mental illness by itself does not predict future violent behavior". UNC Health Care. February 2, 2009. 
  21. 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. PMID 20711302.
  22. Henry A. Nasrallah (December 2011). "The antipsychiatry movement: Who and why". 
  23. Testa, Megan; West, Sara G. (October 2010). "Civil Commitment in the United States". Psychiatry (Edgmont) 7 (10): 30–40. ISSN 1550-5952. PMID 22778709.
  24. 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.
  25. Temkin, Moshik (2009). The Sacco-Vanzetti Affair. New Haven, CT: Yale University Press. p. 316. ISBN 978-0-300-12484-2. OCLC 973121902. 
  26. Moshik, Temkin (2009). The Sacco-Vanzetti Affair. Yale University Press Publishers. p. 316. ISBN 978-0-300-12484-2. 
  27. "Duplessis orphans seek proof of medical experiments". Jun 18, 2004. 
  28. Hahn, Christine (May 22, 2003). "The Worst of Times: How Psychiatry Used Quebec's Orphans as Guinea Pigs". 
  29. Farnsworth, Clyde H. (1993-05-21). "Orphans of the 1950's, Telling of Abuse, Sue Quebec" (in en-US). The New York Times. ISSN 0362-4331. 
  30. 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. Retrieved July 14, 2020. 
  31. "Negro Pastor Pronounced Sane; Demands Mississippi Apologize". UPI. Sarasota Journal 20 June 1958: 3.,1936782
  32. "Detaining patients against wishes carries legal risks -" (in en). 2010-08-11. 
  33. Orlando, James (Jan 24, 2013). "Involuntary Civil Commitment and Patients' Rights". 
  34. "Can an involuntary commitment be false imprisonment if it is not malpractice? : Thompson O'neil Law". 
  36. Wright, Gary (June 24, 1993). "Now 95, deaf man was castrated, locked up for decades". 
  37. "Deaf Man To Be Released After 67 Years In Psychiatric Hospital". Nov 10, 1992. 
  38. Hamilton-Smith, Guy (2018-11-16). "The Endless Punishment of Civil Commitment" (in en-US). 
  39. Signorelli, Nina (2020-07-09). "A Backdoor Around Double Jeopardy" (in en-US). 
  40. Kansas v. Hendricks, 521 U.S. 346, 361 (1997) ("The thrust of Hendricks’ argument is that the Act establishes criminal proceedings; hence confinement under it necessarily constitutes punishment. He contends that where, as here, newly enacted 'punishment' is predicated upon past conduct for which he has already been convicted and forced to serve a prison sentence, the Constitution's Double Jeopardy and Ex Post Facto Clauses are violated. We are unpersuaded by Hendricks’ argument that Kansas has established criminal proceedings.").
  41. "APA Opposes Civil Commitment of Sex Offenders After Prison" (in en-US). 2019-11-08. 
  42. Template:Bluebook website
  43. "Assessing the Real Risk of Sexually Violent Predators: Doctor Padilla's Dangerous Data, Tamara Rice Lave and Franklin E. Zimring, 2018 | Prison Legal News". 
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