Involuntary commitment: Encyclopedia II - Involuntary commitment - Purposes of involuntary commitment

Involuntary commitment - Purposes of involuntary commitment

Involuntary commitment has been used for a variety of purposes over the years and in different jurisdictions. There has been considerable debate about these purposes and this has been a factor in leading to the various laws. A number of individuals and groups remain strongly opposed to either all these laws, some of these laws, or some aspects of their application.

In most jurisdictions involuntary commitment is specifically directed at people claimed or found to be suffering from a mental illness which impairs their reasoning ability to such an extent that the laws state or courts find that decisions must or should be made for them under a legal framework. This decision requires a subjective opinion and is therefore open to error or abuse, both of which have been documented as occurring at different times in various places. There have been numerous official enquiries into such matters around the world and these have often led to legal and system reforms.

Involuntary commitment is used to some degree for each of the following headings although different jurisdictions have different criteria. Some allow involuntary commitment only if the person both appears to be suffering from a mental illness and that the effects of this produce a risk to themselves or others. Other jurisdictions have much broader criteria.

Involuntary commitment - Observation

Observation is sometimes used to determine if a person warrants involuntary commitment. It is not always clear on a relatively brief examination whether a person is psychotic or otherwise warrants commitment and so sometimes people are admitted for a period to observe their behavior. This period of observation can be helpful in determining the actual diagnosis but can tend to produce an expectation of disease which can alter the perceptions and behavior of the staff. Rosenhan's classic paper, "On being sane in insane places",¹ demonstrated a variety of problems. In this study a number of volunteers mimicked illnesses to obtain admission to hospital and then subsequently behaved normally. The staff continued to perceive that they were exhibiting signs of the illness diagnosed on admission and treated them as such. This paper has since been criticised by Spitzer² who argued that given the initial symptoms presented that the mindset of the staff was not only understandable but that it did not invalidate an ability to diagnose conditions as Rosenhan had claimed. Rosenhan's experiment remains a cautionary tale that informs the teaching of trainee psychiatrists.

Involuntary commitment - Containment of danger

A common reason given for involuntary commitment is to prevent danger to the individual or society. People with suicidal thoughts may act on these thoughts and harm or kill themselves. People with psychoses are occasionally driven by their delusions or hallucinations to harm themselves or others. People with personality disorders are occasionally violent.

This concern has found expression in the standards for involuntary commitment of a number of jurisdictions in the U.S. and other countries as the "danger to self or others" standard if someone has a "mental illness" or "mental disorder" (though sometimes explicit exceptions are made, as in Arizona law, in which "drug abuse, alcoholism or mental retardation" and "[t]he declining mental abilities that directly accompany impending death" are specifically excepted), [1] sometimes supplemented by the requirement that the danger be "imminent". However, it has come under criticism from two directions. Those who are concerned that the "danger to self or others" standard is too narrow and will not permit the commitment of those for whom it is necessary have occasionally advocated that it be replaced by the "gravely disabled" standard. There are others who are concerned that the "danger to self or others" standard is vague and not precisely defined, which could lead to abuse of involuntary commitment. However, some people find that the increasingly narrow definition of "danger to self or others" provided by statute and court rulings have to some degree mitigated these concerns.

Some of the same people who are concerned about the overbreadth of the "danger to self or others" standard are more concerned about the "gravely disabled" standard, as they find it broader still. The First District Court of Appeal in California, however, held in Conservatorship of Chambers (1977) 71 Cal.App.3d 277, 139 Cal.Rptr. 357, that the standard was not unconstitutional due to overbreadth or vagueness, and excluded commitment of people whose lifestyles were simply eccentric or unusual. In In re Maricopa County, 840 P.2d 1042, (Ariz. Ct. App. 1992), the court held that "persistently or acutely disabled" was not an unconstitutionally vague standard.

The Michigan Mental Health Code provides that a person

may be subjected to involuntary commitment, a provision paralleled in the laws of many other jurisdictions. These types of provisions have been criticised as a sort of "heads I win, tails you lose," as if the person admits that he needs inpatient treatment, he will be voluntarily hospitalised, but if he denies that he needs treatment, this will form part of the evidence supporting his involuntary hospitalisation.

In Oregon the standard that the allegedly mentally ill person

may be substituted for the danger to self or others standard.

Involuntary commitment - Treatment of illness

Many psychiatric disorders are treated with therapies such as antipsychotics, antidepressants or, more rarely, electroconvulsive therapy also known as electroshock. Many studies have shown the effectiveness of these treatments in their ability to produce a reduction in symptoms and signs of psychiatric disorders.^{[citation needed]} These studies have been used in some jurisdictions as reasons to allow involuntary commitment solely on the basis of the person having a treatable psychiatric disorder. In those jurisdictions where danger is required for commitment, involuntary treatment is still usually allowed. Other studies have shown that psychiatric treatment is less effective than no treatment at all.^{[citation needed]}

Adapted from the Wikipedia article "Purposes of involuntary commitment", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki