Outpatient Commitment, Involuntary

Outpatient Civil Commitment Defined

Civil commitment is a form of compulsory treatment. Every state has a civil commitment statute that permits the involuntary hospitalization of an individual if certain conditions (generally a mental illness with behavioral consequences, most typically dangerousness to self or others) are found to exist. Many states have broadened the application of involuntary civil commitment statutes to permit individuals to be committed to treatment in outpatient settings.

Because outpatient civil commitment, like inpatient civil commitment, involves some deprivation of individual liberty, state statutes must specify the criteria that will be applied before someone can be ordered into outpatient care. There are three general types of outpatient commitment. The first is a form of “conditional release” used in some circumstances when an individual is going to be discharged from inpatient psychiatric care. The individual must agree on discharge to comply with one or more conditions, including the receipt of treatment in the community. A second type of outpatient commitment statute (most common among the states) uses the same criteria for both inpatient and outpatient commitment but permits a judge to order outpatient treatment as an alternative to inpatient treatment if the judge finds that the person meets the criteria for civil commitment. In the third type of outpatient commitment statute, there are separate statutory provisions for outpatient commitment, and the criteria differ from those used for inpatient commitment.

Criteria for Outpatient Commitment

While most states use the same criteria for inpatient and outpatient commitment, since the mid-1990s there has been more emphasis on the creation of discrete and separate criteria for outpatient commitment. These statutes, best exemplified by those found in New York and North Carolina, use many or all of the following criteria in defining those individuals who may be involuntarily ordered into outpatient treatment:

• The person is 18 years of age or older.
• He or she suffers from a mental illness.
• The individual is unlikely to survive safely in the community without supervision.
• He or she has a history of lack of adherence to treatment for mental illness.
• As a result, within a defined period in the past (usually 36 or 48 months), he or she has been hospitalized or jailed or has engaged in dangerous conduct (including threats).
• The individual refuses treatment or lacks the capacity to accept treatment voluntarily.
• In light of the person's history and condition, the person requires treatment to prevent a relapse or deterioration that could result in harm to the person or others.

A primary difference between criteria such as these and more typical involuntary commitment criteria is that these criteria are preventive in nature, permitting intervention in anticipation of the person's relapse or deterioration. In contrast, most civil commitment statutes permit intervention only after the occurrence of specified behavior, typically defined as being dangerous to either self or others, or an inability to meet basic needs.

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