Balancing The Argument Against Civil Commitment Laws
While surfing the web I read an article about the “uncivil” nature of civil commitment laws. Civil commitment is the legal process by which an individual with a severe mental illness can be involuntarily committed to a hospital for treatment. It gives families hope if their loved one doesn’t think they need help. Arguments against this action dates back to the mid-1950s when civil rights attorneys fought to reduce inpatient care. The detrimental consequences of this argument is noticeable in the increase in homelessness, victimization, crime, incarceration, and suicide.
Enhanced civil commitment laws aim for stabilization. But promoters of civil rights standards aim to influence families to believe independence will be reduced with civil commitment. The opposite is actually the truth.
Civil commitment laws provide greater autonomy for the individual with a severe or untreated mental illness. By offering treatment that controls or balances symptoms that reduce independence, hospitalization is a safe haven. The incivility is not present in civil commitment laws, but is present when vulnerable individuals are left homeless, incarcerated, murdered, or perpetrators of crime.
Recent stories of failing commitment laws across the nation have been shared with families continuing to ask for reform. Rarely do we hear outcry against better commitment laws. This is proof the need for change is great.
There are 3 steps the system should implement to help the untreated and severely ill in our communities:
- Reform civil commitment laws and enforce/redefine Assisted Outpatient Treatment (AOT):
- Current civil commitment laws prevent timely treatment by requiring “dangerousness” or lethality to be present
- AOT offers the option of court-ordered outpatient or inpatient treatment including medication
- Better laws should ensure that hospital staff are properly supervised/trained to prevent patient abuse and poor treatment
- Increase age of consent for treatment:
- Youths (14-16) have legal authority to make treatment decisions. Many 14-16yr olds are not mature enough to make appropriate decisions on most things in life (sexual integrity, peer influence, substance abuse, etc.), much less mental health care.
- Provide education for families and caregivers:
- Families should be given access to free online classes regarding mental health or supplied with free resources at an initial assessment. Families are often in the dark and could benefit from readily available resources.
Most anti-inpatient care supporters attempt to site various resources that state there are no concrete studies to support the success rate of AOT or better civil commitment laws. Not true. In fact, a similar program to AOT, known as the Program of Assertive Community Treatment (PACT) Model, is implemented in 6 states: DE, FL, MT, NJ, RI, TX, and District Of Columbia. The program is:
- Empirically supported
- Provides the severely mentally ill or untreated with treatment within the home or community 24/7
- Comprehensive, provides local treatment, and individualized
The argument against civil commitment law is more of a legal debate based on preference and support of the 1st Amendment, rather than a debate of moral ethics, needs, and facts. We have to find a compromise. Supporters of current civil commitment laws are often individuals who do not believe they are ill or are civil rights attorneys.
The majority of our society involves the severely mentally ill or untreated who are not getting services because of poorly enforced or lax civil commitment laws. When are we going to wake up and change this?
I look forward to you sharing your thoughts,
All the best
Frontline: (2005). Deinstitutionalization: A psychiatric “Titanic.” Retrieved March 5, 2013, from http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.
MentalIllNessPolicy.org. (1999). Deinstitutionalization. Retrieved March 5, 2013, from http://mentalillnesspolicy.org/imd/deinstitutionalization-flory.html.
New Hampshire Public Radio. The continuing challenge of deinstitutionalization. Retrieved March 4, 2013, from http://info.nhpr.org/node/11022.
NAMI. (n.d.). Assertive Community Treatment (ACT). PACT: Program of Assertive Community Treatment. Retrieved March 5, 2013, from http://www.nami.org/Template.cfm?Section=ACT-TA_Center&template=/ContentManagement/ContentDisplay.cfm&ContentID=132547.
Hill, T. (2013). Balancing The Argument Against Civil Commitment Laws. Psych Central. Retrieved on July 4, 2015, from http://blogs.psychcentral.com/caregivers/2013/03/balancing-the-argument-against-civil-commitment-laws/