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The Criminal Justice System, 2nd Edition

Civil commitment

Definition: Civil commitment statutes allow the involuntary hospitalization and treatment of a person with mental illness who is dangerous to him- or herself (or others).

Criminal justice issue: Constitutional protections; courts; mental disorders

Significance: Involuntary civil commitment, like criminal incarceration, involves significant deprivation of liberty and raises due process concerns. Although there are some differences among states, civil commitment standards require objective evidence of both dangerousness and severe mental illness. Patients who are civilly committed must have access to high-quality treatment that includes meaningful community reentry services and support.

Freedom, liberty, and autonomy are cherished values in a free society, and loss of these values raises due process concerns. Civil commitment statutes allow the involuntary hospitalization and treatment of a person with mental illness who is a danger to him- or herself (or others). These statutes reflect two primary legal principles that date back to Aristotle: parens patriate (parent of the country) and police power. Parens patriate refers to the role of the state as a sovereign authority to intervene on behalf of citizens who are unable to care for themselves, whereas police power refers to the state assuming responsibility to maintain order and public safety. The core purpose of civil commitment is protecting the safety of the public and/or the person with mental illness. The state’s overarching interest in maintaining public safety, however, may come at the expense of restricting the liberties of certain individuals. Individuals may be hospitalized after conviction for a crime, either immediately or after conviction, in lieu of a prison sentence, or upon completion of a prison sentence. Involuntary civil commitment, like criminal incarceration, involves significant deprivation of liberty and raises due process concerns. Arguably, due process concerns are more implicated in civil commitment than criminal proceedings, given that civil commitment may continue for a lifetime. The circumstances under which a person can be involuntarily committed remain a complex legal and clinical issue.

Although there are some differences among states, civil commitment standards require objective evidence of both dangerousness and severe mental illness. In a landmark case, O’Connor v. Donaldson, the U.S. Supreme Court articulated that the state cannot confine a nondangerous mentally ill person against his will who is capable of surviving safely in the community. The patient in this case, Kenneth Donaldson, while visiting his parents had claimed that someone was putting poison in his food. He had a history of mental illness and hospitalization. His father fearing that his son was having another episode petitioned a commitment hearing. Mr. Donaldson was diagnosed with paranoid delusions and admitted to a state hospital where he was held for nearly fifteen years. Throughout the hospitalization, he never posed a danger to himself or others, nor was he ever suicidal or suspected of injuring himself. However, he was confined in a locked room with sixty beds and his treatment was custodial at best. He did not receive meaningful treatment for the illness that he was being held for. He repeatedly requested release to friends who agreed to care for him but his pleas were dismissed. Courts held that involuntary commitment by virtue indicated that the person was incompetent to make meaningful decisions. His continued confinement was justified under the pretext of suffering from paranoid delusions and refusing treatment, which mainly consisted of medication and electroshocks. This case was significant in setting standards to protect the due process and the rights of civilly committed individuals.

The decision on O’Connor v. Donaldson established the basis that mental illness, in and of itself, was not enough to keep a person civilly committed indefinitely. A finding of danger to oneself or others was needed to meet the due process requirement. What constitutes dangerous behavior, however, remains an abstract construct that is hard to define and measure. Mental health and legal experts define and assess dangerousness differently from each other and within their own professions. Another major limitation on the assessment of dangerousness was that early assessments of violence and dangerousness, often based on unsubstantiated beliefs of individual psychiatrists and psychologists, were found to be inaccurate, leading to some researchers likening such predictions to “flipping a coin.” This was especially evident when their opinion was grounded in unstructured interviews, intuition, and professional discretion. Prominent researchers saw the need to increase predictive accuracy of dangerousness, leading the prediction of future dangerousness to shift toward evidence-based risk assessment; this has advanced the field considerably. To date, mental health experts with competent knowledge of risk assessment, rely on empirically validated risk factors to estimate the likelihood of recidivism and use objective instruments that are designed for specific settings, populations, and types of violence.

After O’Connor v. Donaldson, another issue that the courts had to address was whether proof of dangerousness alone was sufficient for continued commitment. Could an individual deemed dangerous as a result of mental illness and criminality be kept against his will? Interpreted broadly, would this include contract killers, gang members, drug dealers, and other dangerous offenders whose criminal behaviors are motived by pursuit of personal goals? In Foucha v. Louisiana, another seminal case on civil commitment, the Supreme Court ruled that dangerousness alone, without the presence of a serious and severe mental illness, was not enough to support civil commitment. In 1984, Mr. Foucha was charged with aggravated burglary and a firearm offense. The trial court found that at the time of committing the above offenses, he was unable to distinguish right from wrong and was thus insane. He was committed to a state hospital until such time that his sanity was restored. Four years later, he was found to have regained his sanity but still considered dangerous. His continued dangerousness, however, was attributed to the presence of antisocial personality disorder (a condition that was comorbid, but arguably independent of the condition that had impaired his ability to distinguish right from wrong). Although antisocial personality disorder is a codified Diagnostic and Statistical Manual of Mental Disorders (DSM) mental illness, the Supreme Court ruled that antisocial personality disorder was not a severe mental illness to support continued commitment. Since Foucha v. Louisiana, the connection between mental illness and dangerousness has generated considerable debate and there are conflicting opinions on this issue.

Overrepresentation of people with mental illness in the criminal justice system has led some states to enact laws and policies to distinguish between civil vs. forensic commitments. In California, for example, patients who are admitted from criminal courts for a crime linked to their mental illness are referred to as forensic patients, whereas patients admitted from civil courts who are a danger to themselves or others are referred to as civil commitment patients. Among the most prominent differences between forensic vs. civil commitment are that forensic commitments do not require a recent overt act, occur after an offender has served his term of incarceration, and may include personality disorders. This distinction between forensic vs. civil patients has brought greater awareness to the commitment process, treatment needs and planning, discharge, and supervision of these patients. One major emphasis has been recognizing the unique needs of these populations, and balancing rehabilitative goals with meaningful forensic outcomes. Another interest is the right to treatment in the least restrictive setting that is consistent with risk level and clinical needs. Finally, patients who are civilly committed must have access to high-quality treatment that includes meaningful community reentry services and support.

Allen Azizian and Charles Broderick

Further Reading

1 

Dolan, M., and M. Doyle. “Violence Risk Prediction.” The British Journal of Psychiatry 177, no. 4 (2000): 303-11.

2 

Ennis, B. J., and T. R. Litwack. “Psychiatry and the Presumption of Expertise: Flipping Coins in the Courtroom.” California Law Review 62, no. 3 (1974): 693-752.

3 

Fazel, S., J. P. Singh, H. Doll, and M. Grann. “Use of Risk Assessment Instruments to Predict Violence and Antisocial Behaviour in 73 Samples Involving 24,827 People: Systematic Review and Meta-analysis.” BMJ: British Medical Journal 345, no. 7868 (2012): 1-12.

4 

Foucha v. Louisana, 504 U.S. 71 (1992).

5 

Gendreau, P., C. Goggin, and M. Law. “Predicting Prison Misconduct.” Criminal Justice & Behavior 24 (1997): 414-31. doi:10.1177/0093854897024004002.

6 

Grove, W. M., D. H. Zald, B. S. Lebow, B. E. Snitz, and C. Nelson. “Clinical versus Mechanical Prediction: A Meta-Analysis.” Psychological Assessment 12, no. 1 (2000): 19.

7 

Hart, S. D., and C. Logan. “Formulation of Violence Risk Using Evidence-Based Assessments: The Structured Professional Judgment Approach.” In Forensic Case Formulation. Edited by P. Sturmey and M. McMurran. Chichester, UK: John Wiley & Sons, Ltd. doi:10.1002/9781119977018.ch4.

8 

Meyer, R. G., and C. M. Weaver. Law and Mental Health: A Case-based Approach. New York: Guilford Press, 2006.

9 

Monahan, J. The Clinical Prediction of Violent Behavior. Northvale, N.J.: Jason Aronson, 1995.

10 

Monahan, J., and H. J. Steadman. “Toward a Rejuvenation of Risk Assessment Research.” Violence and Mental Disorder: Developments in Risk Assessment (1994): 1-17.

11 

O’Connor v. Donaldson, 422 U.S. 563 (1975).

See also Mental illness; Prison and jail systems; Psychopathy; Punishment; Rehabilitation; Solitary confinement; Criminal law; Criminal justice system; Competency to stand trial; Community-based corrections.

Citation Types

Type
Format
MLA 9th
"Civil Commitment." The Criminal Justice System, 2nd Edition, edited by Hooper Michael K., Salem Press, 2017. Salem Online, online.salempress.com/articleDetails.do?articleName=CJ2E_0359.
APA 7th
Civil commitment. The Criminal Justice System, 2nd Edition, In H. Michael K. (Ed.), Salem Press, 2017. Salem Online, online.salempress.com/articleDetails.do?articleName=CJ2E_0359.
CMOS 17th
"Civil Commitment." The Criminal Justice System, 2nd Edition, Edited by Hooper Michael K.. Salem Press, 2017. Salem Online, online.salempress.com/articleDetails.do?articleName=CJ2E_0359.