Commitment

COMMITMENT

Proceedings directing the confinement of a mentally ill or incompetent person for treatment.

Pursuant to statutory and case law, due process protections are afforded to persons who have been involuntarily committed, including periodic judicial review. Commitment has often raised difficult issues of balancing the civil liberties of the person who is subject to commitment against other competing interests, including the rights of society to be protected from individuals who might prove dangerous as a result of their mental illness or incompetence, and the community's interest in ensuring that these individuals receive proper treatment.

Each state has its own detailed statutory scheme providing for the involuntary commitment of individuals who might be mentally ill or incompetent. These statutes usually contain language defining the types of mental illnesses and conditions covered by the law, as well as certain conditions that are excluded from coverage—generally mental retardation, epilepsy, developmental disabilities, and drug or alcohol addiction. In addition, most state commitment statutes set forth specific criteria or standards that link these conditions to justifications for involuntary commitment.

Most jurisdictions have at least one criterion that is based on a person's dangerousness to himself or herself, or others. Some states require that other criteria that are closely related to dangerousness be met, such as the presence of a grave disability or an inability to provide for one's basic human needs, or that some medical or psychological treatment is essential to the person's welfare. Since the 1980s, some states have moved significantly away from a strict dangerousness standard for involuntary commitment. In Arizona, for example, a person who is "persistently or acutely disabled" because of mental illness may be subject to commitment (Ariz. Rev. Stat. Ann. § 36-540 (A) [1995]), and in Delaware, an individual who cannot make "responsible decisions" about inpatient care and treatment may be committed (Del. Code Ann. tit. 16, § 5001 [1995]). An even broader standard has been enacted in Iowa, where the law provides that a person may be committed if he or she is likely to inflict serious emotional injury on family or others who "lack reasonable opportunity" to avoid contact with that person (Iowa Code Ann. § 229.1 [West 1995]).

In most jurisdictions, commitment requires a showing that inpatient hospitalization is the least restrictive treatment alternative for the person, in addition to a showing of dangerousness. This requirement is based on the principle, established by the U.S. Supreme Court, that even though a government purpose might be legitimate and substantial, the purpose "cannot be pursued by means that broadly stifle fundamental personal liberties when the end can be more narrowly achieved" (Shelton v. Tucker, 364 U.S. 479, 81 S. Ct. 247, 5 L. Ed. 2d 231 [1960]). As a result, most states, through either statutes or case law, recognize a patient's right to be treated in the least restrictive setting.

Despite the difficult legal issues relating to the restriction of liberty that results from involuntary treatment, the U.S. Supreme Court has considered the constitutionality of civil commitment on relatively few occasions. In 1975, in perhaps its most significant decision on the issue, the Court held that a state "cannot constitutionally confine … a non-dangerous individual who is capable of surviving safely in freedom

by himself or with the help of willing and responsible family members or friends" (O'Connor v. Donaldson, 422 U.S. 563, 95 S. Ct. 2486, 45 L. Ed. 2d 396). The Court further stated that a "mere finding" of mental illness "cannot justify a state's locking a person up against his will and keeping him indefinitely in simple custodial confinement." Although the Court appeared to establish the right of a nondangerous individual not to be involuntarily committed, it left unresolved the issue of whether a mentally ill person has a constitutional right to treatment.

In a later decision, Zinermon v. Burch, 494 U.S. 113, 110 S. Ct. 975, 108 L. Ed. 2d 100 (1990), the Court further addressed dangerousness as a justification for civil commitment. It stated that involuntary commitment procedures "guard against the confinement of a person who, though mentally ill, is harmless and can live safely outside an institution." Confinement of such a person would be unconstitutional, the Court held.

The involuntary commitment of individuals who previously have been convicted of a crime has presented an entirely new set of constitutional considerations. The most significant issue has concerned whether a prisoner, following completion of her or his sentence, may be committed to a psychiatric facility without receiving the same due process protections afforded to other individuals who are subjected to civil commitment.

The high court addressed the issue in Jones v. United States, 463 U.S. 354, 103 S. Ct. 3043, 77 L. Ed. 2d 694 (1983). In Jones, the defendant was acquitted of a crime by reason of insanity, but was confined to a psychiatric hospital for longer than his sentence would have been, had he been convicted. Michael Jones challenged the constitutionality of his commitment. A 5–4 majority of the U.S. Supreme Court affirmed the commitment. The Court reasoned that punishment of an insanity acquittee is inappropriate, and thus the length of the criminal sentence that would have been imposed, had the patient been found sane, was not relevant. Instead, the Court held, the duration of the commitment should depend on the patient's recovery. Thus, if the patient's condition warrants further treatment, the commitment could continue, regardless of the length of the sentence that otherwise would have been imposed.

The commitment of individuals who have been convicted of sex-related crimes has sparked even more intense debate. Courts in many states have had to address difficult questions involving so-called sexual predators: Should these individuals be allowed to re-enter society after they have served their prison terms? May a state detain them indefinitely without violating their constitutional rights?

These questions went before the U.S. Supreme Court in Kansas v. Hendricks, 521 U.S. 346, 117 S. Ct. 2072, 138 L. Ed. 2d 501 (1997). In that case, the Court reviewed the constitutionality of the Kansas Sexually Violent Predator Act, which establishes procedures for the civil commitment of persons who, due to a mental abnormality or a personality disorder, are likely to engage in predatory acts of sexual violence. Kan. Stat. §§ 59-29a01 et seq. Kansas invoked the act in committing an inmate who had a long history of sexually molesting children, and who was scheduled for release from prison shortly after the act became law.

In a 5-4 decision written by Associate Justice clarence thomas, the Court rejected arguments that someone can be confined to a mental institution only if the person has been diagnosed with a mental illness. The Court also rejected arguments that the Kansas law violated the double jeopardy provision of the fifth amendment to the U.S. Constitution, even though, under the law, persons who are first imprisoned for a sex crime may be institutionalized again when their criminal sentence has been served, based on some of the same evidence that had been used to convict them. The Kansas law created a civil commitment procedure that would result in confinement in a mental hospital, the Court said, and the protection against double jeopardy is only triggered by subsequent criminal punishments and prosecutions.

The U.S. Supreme Court's decision was hailed by Kansas and the 38 other states that had urged the justices to uphold the law. However, defense lawyers, civil libertarians, and mental health professionals warned that the decision might allow states to lock up convicts who are not truly dangerous to society. In effect, said several mental health experts, the ruling misuses mental hospitals for punishment purposes, singling out one category of violent criminal for unlimited incarceration without the safeguards afforded to criminal defendants in the bill of rights. Dissenting justices echoed these sentiments in Hendricks, writing that while they agreed in principle with idea that states may confine sexual predators who are deemed to be mentally abnormal, in this case it appeared that Kansas had not tried to treat the mental problems of the convict whose case was before the court. As a result, they wrote, his institutionalization functioned more like a punishment, and therefore it was unconstitutional.

Although 19 states now have laws authorizing civil commitment for sexual predators, courts in many of those states have been highly circumspect in applying them. For example, the Iowa Supreme Court ruled that the state could not commit a prisoner, who was serving a criminal sentence for operating a motor vehicle without the owner's consent, as a sexually violent predator, even though the prisoner had been convicted for sexually violent offenses in the past. In re Detention of Gonzales, 658 N.W.2d 103 (Iowa 2003). The prisoner was not confined for a sexually violent offense at the time that state filed its petition for commitment. Further, the state failed to prove, or even to allege, a recent overt act that met the statutory definition for being a sexual predator. The Iowa Supreme Court reasoned that it would not be just or reasonable "to allow the state to reach back in time, seize on a sexually violent offense for which a defendant was discharged, and couple this with a present confinement for a totally different offense—or, perhaps, a trivial one—and use the Sexually Violent Predator Act to confine the person."

further readings

Haycock, Joel, et al. 1994. "Mediating the Gap: Thinking about Alternatives to the Current Practice of Civil Commitment." New England Journal on Criminal and Civil Confinement 20.

Parry, John. 1994. "Involuntary Civil Commitment in the Nineties: A Constitutional Perspective." Mental and Physical Disability Law Reporter 18.

Miller, Robert D. 1987. Involuntary Civil Commitment of the Mentally Ill in the Post-Reform Era. Springfield, Ill.: Thomas.

Winick, Bruce J. 1999. "Therapeutic Jurisprudence and the Civil Commitment Hearing." The Journal of Contemporary Legal Issues 10.

cross-references

Patients' Rights.