Involuntary commitment

Involuntary commitment or civil commitment (also known informally as sectioning or being sectioned[1] in some jurisdictions, such as the United Kingdom)[2] is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is ordered by a court into treatment in a psychiatric hospital (inpatient) or in the community (outpatient).

For involuntary treatment in non-hospital settings, see involuntary treatment.

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. If civil commitment proceedings follow, then the evaluation is presented in a formal court hearing where testimony and other evidence may also be submitted. The subject of the hearing is typically entitled to legal counsel and may challenge a commitment order through habeas corpus.[3]

Historically, until the first third of the twentieth century or later in most jurisdictions, 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,[4] a trend known as "deinstitutionalisation".

Purpose

In 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 court-ordered treatment to individuals who meet statutory criteria for presenting a danger to self or others. Other jurisdictions have broader criteria.

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.

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 is psychotic or otherwise warrants commitment.

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

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".

Deinstitutionalization
Main article: Deinstitutionalisation

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. 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).

Before the 1960s deinstitutionalization there were earlier efforts to free psychiatric patients. Doctor Philippe Pinel (1745–1826) ordered the removal of chains from patients.[10]

In a study of 269 patients from Vermont State Hospital done by Courtenay M. Harding, Ph.D., and associates, about two-thirds of the ex-patients did well after deinstitutionalization.[11]

Around the world
Main article: Involuntary commitment internationally

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.[12] 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.

Politically motivated abuses
Main article: Political abuse of psychiatry

At certain places and times, the practice of involuntary commitment has been used for the suppression of dissent, or in a punitive way.

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.[13]

In 1927, after the execution of Sacco and Vanzetti in the United States, a demonstrator named Aurora D'Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a rally in support of the anarchists.[14]

See also

References
  1. "Being sectioned (in England and Wales)". Royal College of Psychiatrists. August 2013.
  2. "What does 'being sectioned' mean?". Rethink Mental Illness.
  3. 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.
  4. Hendin, Herbert (1996). Suicide in America. W. W. Norton. p. 214. ISBN 978-0-393-31368-0. OCLC 37916353.
  5. "About". Mental Health First Aid USA. National Council for Behavioral Health. 2013-10-10. Retrieved 2013-12-21.
  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. PMC 130043. 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. "View of The Evolution of Public Health and Current Challenges: A Review". ihrjournal.com. Retrieved 2018-12-19.
  11. 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.
  12. 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". United Nations. Retrieved 16 June 2016.
  13. 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.
  14. Temkin, Moshik (2009). The Sacco-Vanzetti Affair. New Haven, CT: Yale University Press. p. 316. ISBN 978-0-300-12484-2. OCLC 973121902.

Further reading
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