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Civil Commitment

Civil commitment is the legal process under which individuals with mental illness may be subjected to involuntary hospitalization. This entry discusses the impact and consequences of commitment, the justifications for the resulting intrusion on liberty, the statutory criteria for commitment, and the constitutional requirements that underlie them. It examines the requirement that candidates for commitment must be mentally ill or disordered and the psychiatric conditions that will qualify. It then considers the requirement of functional impairment imposed by these statutes and the Constitution, including incompetency in the case of parens patriae criteria and volitional impairment in the case of police power criteria. It also discusses the kinds of danger that may satisfy police power criteria, the degree of imminence of such danger that is required, and the methods used by clinical evaluators in predicting dangerousness. It then considers the medical appropriateness and least restrictive alternative requirements for commitment. It concludes by discussing the procedural due process hearing requirements for commitment.

The Impact and Consequences of Civil Commitment

In the past 50 years, the use of civil commitment has been reduced. The census of public mental hospitals in 1955 was around 550,000. The policy of deinstitutionalization, the shift of the locus of care from the hospital to the community, and the tightening of civil commitment criteria have reduced our reliance on involuntary hospitalization. Only about 55,000 patients are now hospitalized on any particular day. However, patients once spent long periods and sometimes an entire lifetime in the hospital, whereas most patients today are discharged after 30 days or less, and many within as few as 5 days. For many patients, civil commitment has become a revolving door, whereby they experience several periods of hospitalization each year. Civil commitment thus continues to affect a large number of patients, even if the duration of hospitalization has been dramatically reduced.

Civil commitment results in a massive curtailment of liberty. It intrudes on the fundamental interest in being free of external restraint. Patients are subjected to detailed regulation of their every activity, and they are forced to submit to various forms of intrusive treatment, including psychotropic medication, which may cause severe and unwanted side effects that are lasting. Involuntary hospitalization also imposes a severe stigma, which produces continued social and occupational disabilities long after discharge. As a result, the criteria for involuntary hospitalization have been limited, and the procedural protections required before it may be imposed have been expanded.

Justifications for Civil Commitment

There are two justifications for civil commitment. The first is the government's police power interest in protecting the community from those who are predicted to be dangerous as a result of their mental illness. The second is the parens patriae interest in protecting the best interests of those whose illness deprives them of the ability to make rational decisions on their own behalf concerning their need for hospitalization and treatment. The Fifth and Fourteenth Amendment due process clauses place substantive and procedural limitations on governmental deprivations of liberty. At a minimum, such deprivations may not be arbitrary or purposeless. Because the liberty interest in being free of external restraint is a fundamental constitutional right, an exceedingly heavy burden of justification is placed on the government. To satisfy constitutional requirements, civil commitment thus must be justified as being necessary to accomplish one or more compelling governmental interests. The state's police power and parens patriae power interests are both compelling and in appropriate cases, therefore, will justify commitment. These two justifications are reflected in typical civil commitment statutory criteria. The individual will be entitled to a hearing at which the state must demonstrate satisfaction of the criteria and show that there is no less intrusive alternative method of achieving the government's interests in protecting the individual or the community. Then, commitment may be authorized for a limited time period.

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