The Negotiation of Involuntary Civil Commitment

Abstract

Involuntary commitment to mental hospitals has been a topic of scholarly interest for the last twenty years. That interest has resulted in dozens of studies which have informed the legal reform of many state commitment statutes. In this paper we analyze the organizational context in which the decision to commit takes place. Relying on observations of the commitment process in an urban setting, we discuss the negotiating among the actors involved in the decision to commit. Our data suggest that formal disposition to involuntarily commit accounts for only a small percentage of those held at the hospital against their will. Court procedures and professional persuasion are used to coerce citizens into “voluntary” stays at the hospital in order to avoid court proceedings. We conclude with some thoughts about the meaning of commitment rates in light of these findings.

Perceived Dangerousness of Children With Mental Health Problems and Support for Coerced Treatment

“…For example, the National Research Council's analysis of eight cases of lethal school violence noted that "Serious mental health problems, including schizophrenia, clinical depression, and personality disorders, surfaced after the shootings for six of the eight boys" (3). Researchers also have maintained that an important risk factor for violence is untreated conduct disorder (4,5), as reflected in the high levels of untreated mental health problems among juvenile detainees (6)(7)(8). Finally, data on the decision to hospitalize children show a clear association with perceptions of dangerousness (9).…”

Civil commitment: A review of empirical research

“…Since over 80% of involuntary admissions do not reach court for civil commitment adjudication but are settled in this fashion, the researchers conclude that voluntary admissions function as a supplement to the coercive power of the state. Since public defenders do not question mental illness or the need for confinement, they also conclude that deference to psychiatry still occurs but it has moved out of the courtroom into hospital comdors (Lewis et al, 1984).…”

“…Since reform, however, no significant relations have been found between these variables and the voluntary or involuntary nature of mental patients' hospitalization (Nicholson, 1986), suggesting that one of the intentions of the reforms is being realized: voluntary treatment in preference to involuntary treatment, It appears that candidates who once would have been committed are now being voluntarily hospitalized. As later reviewed, studies in two states have described mental health and legal professionals working to obtain voluntary status for candidates (Decker, 1980(Decker, , 1981Gilboy and Schmidt, 1971;Lewis et al, 1984).…”