Voluntary treatment for any medical condition is always desirable. However, the nature of severe mental illness is that it attacks the brain - the very organ central to the capacity for making a choice. As a result, every state has established civil commitment laws and standards to empower the court to order individuals with untreated severe mental illness into treatment.
Civil commitment is a legal mechanism in which a court orders treatment for an individual with severe mental illness who meets pre-established criteria. Civil commitment occurs in all states, but the standards and procedures for it vary from state to state.
- In a few states, the sole grounds for civil commitment is “dangerousness” – the requirement that an individual with severe mental illness is an immediate, physical danger to self or others before a court can intervene and order treatment. In Maryland, dangerousness is a requirement for inpatient commitment. In New York it is required for court-ordered inpatient treatment, but broader criteria are provided for assisted outpatient treatment (AOT).
- In the remaining states, laws permit intervention based on additional criteria that go beyond "dangerousness to self or others." The specifics of these alternative criteria vary considerably, but most include a second standard sometimes known as the "gravely disabled" standard. Gravely disabled laws typically focus on the person's inability to independently meet his or her basic survival needs, e.g., food, clothing and/or shelter. Examples of states with gravely disabled provisions are California and Connecticut.
- In roughly half states, the additional criteria for court intervention include a third provision the Treatment Advocacy Center terms a “need-for-treatment” standard. Need-for-treatment standards are particularly relevant for individuals who lack insight into their illness (a symptom of the brain condition known as “anosognosia”) because they focus the court’s attention on needless personal suffering and/or deterioration, from which the person is incapable of seeking relief without assistance. Need-for-treatment standards typically include qualification for court-ordered intervention based on one or more of the following conditions:
- the person’s inability to seek needed psychiatric care,
- the person’s inability to make an informed medical decision, and/or
- the person’s need for intervention to prevent further physical, psychiatric or emotional deterioration.
The Treatment Advocacy Center’s efforts to eliminate barriers to treatment for severe mental illness include:
- Advocating for broader civil commitment standards than mere “dangerousness” in states where it is the sole standard
- Advocating for more comprehensive civil commitment standards in the states where the need for treatment is not considered in civil commitment proceedings
- Advocating nationwide for active use of the civil commitment laws and standards already in place to provide timely intervention that prevents or reduces the consequences of non-treatment for severe mental illness
If someone you know is in psychiatric crisis, knowing the civil commitment standards in your state can be critical to getting timely intervention. Essential information on emergency hospitalization and court-ordered inpatient or outpatient treatment is linked from our Civil Commitment Laws and Standards page. The information may also be accessed from your smartphone. Open this link on your smartphone for mobile psychiatric emergency information.