Seeing a loved one struggle with the damaging influence of substance use and other mental health disorders can be frustrating and confusing. Often, people hope to encourage a positive change, but they feel helpless.
Though the situation is complex, there are options one may employ to connect their friend or family member to the type of help they need. In some cases, pursuing an involuntary mental health commitment or an involuntary civil commitment could be the decision that changes a loved one’s life forever.
What Is Involuntary Commitment?
An involuntary commitment is a legal intervention where a judge orders a person to be confined in a psychiatric hospital. The involuntary commitment process is set in motion by a serious mental disorder or troublesome mental health symptoms.
The purpose of involuntary commitment is two-fold:
- To protect a person with a mental illness from behaviors that could threaten their life or well-being
- To protect others from a person with a severe mental illness
A person with intense mental health symptoms may not see the dangers associated with their thoughts or actions because the illness is disrupting their judgment and perception. These people will not see a need for mental health services and likely refuse attempts to encourage treatment.
An involuntary commitment is a way for a person to force another individual into professional treatment so they can receive the care and attention they need. Without involuntary commitment, a person experiencing severe mental health symptoms could cause significant harm to self or others.
Although inpatient hospitalization is usually associated with commitments, most states have involuntary outpatient commitments as well. In an outpatient commitment, a judge orders the individual to attend outpatient mental health treatment to address their symptoms.
Criteria for Having Someone Committed
The reasons for involuntary commitment have shifted over the last 50 years. Previously, a judge could commit someone based a need for treatment, which resulted in many people being held for years or decades in institutions. Now, the standard is based on a person’s level of dangerousness. Generally, the criteria for having someone committed involves:
- The person having a mental health disorder, including substance use disorders
- The person poses a serious risk to him or herself
- The person poses a serious risk to others
- The person is too disabled to adequately care for their daily needs
Most states adopted these guidelines, with a few exceptions. For example, Delaware only focuses on a person’s inability to make responsible choices, and Iowa only needs evidence that shows the person could cause an emotional injury to another individual.
These criteria aim to commit people who need mental health services but cannot make the choice to receive treatment independently. Some people appropriate for involuntary commitment include:
- Someone with severe depression and suicidal thoughts, intent or plans
- A person violently aggressive due to a manic episode or psychosis
- An older person with dementia who is not caring for their needs
Who Can Initiate the Process?
In most cases, anyone can begin the commitment process by calling 911 or alerting authorities to the situation. It is important to remember that the policies and procedures vary at the state or county level. For example, in Pennsylvania, a doctor or police officer may initiate commitment without prior authorization. All other individuals must involve a mental health delegate to complete the commitment.
When a friend, family member or other concerned person encourages a commitment, they are called a petitioner. The petitioner works with family, crisis professionals, law enforcement, doctors and judges to ensure the process is completed.
How Long Does It Last?
The involuntary commitment length of stay also varies by state. For example, in Pennsylvania, hospital staff cannot keep people admitted under an involuntary commitment for more than 120 hours. Lengths are predetermined by each state and set to a minimum to keep from infringing on the rights of the person being committed. They’re also standardized, and hospital staff can propose extended stays based on the needs of the individual.
Mental Health Commitment Laws by State
There is tremendous variability regarding involuntary commitment laws by state. Different states vary by:
- The grounds for commitment
- The commitment process
- The duration of stay
- The option for outpatient commitment
Substance use disorders add another layer into the equation. These conditions are technically mental health conditions, but at times, law enforcement, medical personnel and mental health experts treat the disorders differently.
States with Involuntary Commitment Laws for Substance Abuse Disorder Only
One state has involuntary commitment for substance abuse disorders only. If someone is intoxicated or endangering themselves and others due to substance use, excluding alcohol use, concerned people could ask for involuntary substance abuse treatment. Currently, Vermont is the only state that permits this level of commitment.
States with Involuntary Commitment Laws for Alcoholism Only
Montana and Rhode Island are currently the only states that allow involuntary commitment for alcoholism. These states are different from others because they do not allow involuntary commitment for addiction to substances like opioids, stimulants and hallucinogens and instead focus only on alcohol use disorders.
States with Involuntary Commitment Laws for Both Substance Use Disorder and Alcoholism
The majority of states sanction involuntary drug and alcohol treatment. The states are:
- District of Columbia
- North Carolina
- North Dakota
- South Carolina
- South Dakota
- West Virginia
How to Get Help for a Loved One in Crisis
Getting help for a loved one in crisis may be simple or quite complex depending on the situation and their symptoms. There is a high burden of proof needed to show someone needs involuntary treatment.
If someone is exceptionally suicidal or homicidal, the need is clear, but if someone is using large amounts of alcohol or other drugs, there must be compelling evidence to justify hospitalization. A person worried about a friend or loved one should always consider commitment.
In most cases, the process can begin with a call to 911 or a local mental health or crisis response team. From there, professionals will ask questions to determine the best course of action based on the law and the person’s treatment needs.
Florida has passed legislation to increase access to involuntary treatment through The Baker Act and The Marchman Act.
The Baker Act
The Baker Act allows law enforcement, mental health professionals or medical professionals to request a voluntary or involuntary commitment of an individual who is at risk of serious injury to self or others. This law allows for the individual to be involuntarily held for up to 72 hours and may be initiated by mental health professionals, doctors, law enforcement officials and judges.
The Marchman Act
The Marchman Act allows friends and family to get help for a loved one who is using substances, and the substance use will likely harm their well-being without treatment. This involuntary treatment period can last 60 days, though 90-day extensions are available if deemed necessary.
Involuntary Treatment Outcomes
Many people believe addiction treatment must be voluntary to produce the desired results, but this might not always be true. The National Institute on Drug Abuse reports mandated treatment can be effective. People who are required to attend mental health or substance use treatment have higher attendance rates and longer tenures in treatment. These two aspects result in positive treatment outcomes. Studies of people pressured into treatment show results that are similar or better than those who attend voluntarily.
Of course, no one wishes for their loved one to need emergency psychiatric treatment, but it is comforting to know helpful options exist. If your loved one lives with co-occurring substance use and mental health disorder and is willing to attend treatment to avoid commitment, consider reaching out to The Recovery Village. The Recovery Village is a professional substance use treatment center specializing in addiction and co-occurring mental health conditions.
Broward Behavioral Health Coalition. “Baker Act and Marchman Act.” Accessed May 17, 2019. Erie County Pennsylvania. “Voluntary and Involuntary Commitment of Persons During a Mental Crisis.” Accessed May 17, 2019. National Institute on Drug Abuse. “Principles for Drug Addiction Treatment: A Research-Based Guide (Third Edition).” January 2018. Accessed May 17, 2019. Testa, Megan, West, Sara G. “Civil Commitment in the United States.” Psychiatry, October 2010. Accessed May 17, 2019. Vimont, Celia. “Many States Allow Involuntary Commitment for Addiction Treatment.” Partnership for Drug-Free Kids, September 14, 2016. Accessed May 17, 2019.
Broward Behavioral Health Coalition. “Baker Act and Marchman Act.” Accessed May 17, 2019.
Erie County Pennsylvania. “Voluntary and Involuntary Commitment of Persons During a Mental Crisis.” Accessed May 17, 2019.
National Institute on Drug Abuse. “Principles for Drug Addiction Treatment: A Research-Based Guide (Third Edition).” January 2018. Accessed May 17, 2019.
Testa, Megan, West, Sara G. “Civil Commitment in the United States.” Psychiatry, October 2010. Accessed May 17, 2019.
Vimont, Celia. “Many States Allow Involuntary Commitment for Addiction Treatment.” Partnership for Drug-Free Kids, September 14, 2016. Accessed May 17, 2019.