Civil Commitment

Historically, one of the most conflicted—indeed, contentious—issues facing criminal justice and mental health professionals is that of reducing ambiguity in civil commitment proceedings that restrict the freedom of individuals viewed as potentially violent, such as those with mental disorders, violent sex offenders, and juvenile delinquents. Center stage in this ever-changing dilemma is the debate surrounding the right of society to be safe from danger versus the potential loss of freedom faced by persons perceived, but not proved, to present an imminent threat of danger.

Though the exact wording differs depending on jurisdiction, all states have statutes defining requirements for civil commitment, which generally is the process by which an individual perceived as being a grave threat to self or others may be involuntarily admitted to a psychiatric hospital for treatment. Laws governing cases such as juvenile delinquents or sexually violent predators may also allow involuntary hospitalization for treatment purposes.

When justified, confinement without adjudication for a crime may not appear to be an especially perplexing dilemma, yet it persists as one of the most bewildering ethical problems mental health and legal professionals routinely face. Moreover, even though persons with mental illness generally are no more dangerous than persons without mental disorders, sensationalized media accounts of violent crimes committed by these individuals unnecessarily increase public anxiety. Heinous acts by mentally ill persons make news because they are rare. Yet, public fear has been heightened by media coverage of a possible mental or developmental disorder influencing incidents of mass killings, such as those involving Columbine High School, Virginia Tech, the Century movie theater in Aurora, Colorado, and an elementary school in Newtown, Connecticut.

There is vigorous debate as to whether mental health professionals are adequately trained to predict dangerousness, thereby jeopardizing an individual's right to be free from external restraint. More pointedly, the fundamental right to be left alone and not held captive without justification contains risk in instances in which the expertise of clinicians, lawyers, and judges rendering life-changing decisions in commitment hearings is not fully established.

The sweeping civil rights-driven legal change in the 1960s impacted civil commitment to the extent that thousands of persons with mental disorders previously admitted to psychiatric hospitals were abruptly freed, and treatment, when it occurred, often was provided in local jails or prisons that were poorly equipped to take on such a complex and demanding burden. Minimally, this suggests a couple of questions bearing close scrutiny:

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• How is behavior which may lead to civil commitment determined, and by whom?
• Are ethical strategies available that allow for intelligent, coherent articulations for achieving an equitable balance between the concerns of society to be protected from mentally unstable persons and those of benign individuals with mental disorders who conceivably could face involuntary hospitalization without just cause?