Voluntary Vs. Involuntary Psychiatric Treatment

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 occurs in all states, but the standards vary from state to state.

  • In eight states, the sole grounds for civil commitment is “dangerousness” – a requirement that an individual with severe mental illness must demonstrate an immediate, physical danger to self or others before a court can intervene and order treatment.
  •  In the remaining 42 states, laws permit intervention based on additional criteria that are broader than “dangerousness to self or others.” The specifics vary but generally include a second standard, referred to as “grave disability,” which typically focuses on the person’s inability to meet his or her basic survival need.
  • In 26 of those states, there is a third provision under which a court can intervene in a mental health crisis – what the Treatment Advocacy Center calls the “need-for-treatment” standard. Need-for-treatment standards are particularly relevant for individuals who lack insight into their illness (the syndrome known as “anosognosia”) because they focus the court’s attention on needless personal suffering, from which the person is incapable of seeking relief. Need-for-treatment standards typically include qualification for care based on at least one of the following conditions:
    – the person’s inability to provide for needed psychiatric care,
    – the person’s inability to make an informed medical decision,
    – the person’s need for intervention to prevent further psychiatric or emotional deterioration.

The Treatment Advocacy Center’s efforts to eliminate barriers to treatment for severe mental illness include:

  • Advocating for a broader civil commitment standard than mere “dangerousness” in the eight states with only that standard
  • Advocating for more comprehensive civil commitment standards in the 24 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

–the Treatment Advocacy Center


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