Civil Commitment and Mental Health Law: Rights, Criteria, and Controversies

1. Chapter 16 Mental Health and the Law

2. Civil Commitment • Before 1969, in the United States, the need for treatment was sufficient cause to hospitalize people against their will. Such involuntary hospitalization is called civil commitment. • Since 1969, the need for treatment alone is no longer sufficient legal cause for civil commitment in most states.

3. Procedurally, most states now mandate that persons being considered for involuntary commitment have the right to a public hearing, the right to counsel, the right to call and confront witnesses, the right to appeal decisions, and the right to be placed in the least restrictive treatment setting. • In practice, judges typically defer to the judgment of mental health professionals about a person’s mental illness and meeting of the criteria for commitment.

4. Involuntary Commitment and Civil Rights • People who have been committed to a mental institution often feel that they have given up all their civil rights. • But numerous court cases over the years have established that these people retain most of the civil rights, and have certain additional rights due to their committed status: • Right to treatment • Right to refuse treatment

5. Criteria for Involuntary Commitment • Grave disability • Dangerousness to self* • Dangerousness to others* • *In many states the danger posed must be imminent

6. Violence and People with Mental Disorders

7. Prevalence of Involuntary Commitment

8. Patients’ Rights • Right to Treatment • Right to Refuse Treatment • Informed Consent

9. Competence to Stand Trial • People who do not have an understanding of what is happening to them in a courtroom and who cannot participate in their own defense are said to be incompetent to stand trial. • Defense attorneys suspect impaired competence in their clients in up to 10% of cases. • Psychologists help determine competence.

10. Critical Judgments that Mental-Health Professionals Are Asked to Make About People Accused of Crimes • Whether they are competent to stand trial • Whether they were sane at the time that the crimes were committed

11. Insanity Defense • Insanity • A legal term rather than a psychological or medical term • Defined in various ways • All definitions reflect the fundamental doctrine that people cannot be held fully responsible for their acts if they were so mentally incapacitated at the time of the acts that they could not conform to the rules of society

12. Insanity Defense, continued • Controversial: While the lay public often thinks of the insanity defense as a means by which guilty people “get off,” the insanity defense is used much less often than the public tends to think. • Fewer than 1 in 100 defendants in felony cases file insanity pleas, and of these only 26% result in acquittal.

14. Insanity Defense Rules