In the new legal thriller Michael Clayton, Michael must silence his colleague Arthur Edens, who plans to sabotage a big case. At wit’s end, Michael wonders if he can send Arthur to an insane asylum against his will. Last Thursday, TV shrink Dr. Phil said that Britney Spears may be a suicide risk who needs “to be involuntarily committed.” Under what circumstances can you force a loved one, suspicious officemate, or eccentric celebrity into the nuthouse?
Imminent danger. Laws vary somewhat from state to state, but all commitment statutes uphold a basic principle: If an individual is mentally ill and he poses an immediate, substantial threat of physical harm to himself or to others, then it’s permissible to detain him for involuntary psychiatric care. New York, where Michael Clayton takes place, condones the forced hospitalization of any person with a mental illness who “attempts at suicide or serious bodily harm” or who manifests “homicidal or other violent behavior.”
Many states also permit involuntary commitment in cases of grave disability. In California—where Britney Spears resides—this applies to those whose mental illness limits their access to food and shelter. Arizona’s standards are somewhat lower. In that state, lawmakers have deemed that forced hospitalization is appropriate if an individual’s condition is deteriorating, and he can’t make an informed decision as to whether treatment is desirable.
To prevent wrongful detainment, all states require some sort of multistep review process. Here’s how it works: Generally, either a family member or a health-care professional must petition a local judge. In some states, anyone—a co-worker, neighbor, or just a concerned observer—can serve as petitioner. If the judge finds reasonable grounds for a psychiatric examination, he’ll order local law enforcement to haul the alleged loon to a mental ward. Next, at least two physicians evaluate the subject’s condition and decide whether to proceed with a request for extended commitment. In the event of such a request, there’s a full hearing.
How did these laws come about? Commitment statutes were once lax and arbitrary; essentially, anyone suffering from a mental illness could be forced into treatment, regardless of imminent danger. As a result, in 1955 there were more than 500,000 people in state mental wards—or 339 for every 100,000 Americans. (By way of contrast, there were only 59,400 psychiatric inmates as of December 2000—or 22 per 100,000.) This state of affairs led both liberals and libertarians to call for reform. Liberals argued that the civil rights of the mentally ill were being curtailed, and libertarians wanted to downsize state-owned hospitals by shifting the burden of responsibility onto community centers. Luckily, the deinstitutionalization movement coincided with the development of anti-psychotic medication, which can help schizophrenics and manic depressives lead independent lives. By the early 1970s, state legislatures began enacting more stringent commitment laws based on a “danger” standard.
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Explainer thanks Richard Bonnie of the University of Virginia and Jon Stanley of the Treatment Advocacy Center.