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 commit-
ment of individuals who might be mentally ill or
incompetent. These statutes usually contain lan-
guage 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, develop-
mental disabilities, and drug or alcohol addic-
tion. 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 dan-
gerousness 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 dan-
gerousness standard for involuntary commit-
ment. 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 pro-
vides that a person may be committed if he or
she is likely to inflict serious emotional injury on
family or others who “lack reasonable opportu-
nity” 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 per-
son, 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 legiti-
mate and substantial, the purpose “cannot be
pursued by means that broadly stifle fundamen-
tal 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 invol-
untary treatment, the U.S. Supreme Court has
considered the constitutionality of civil commit-
ment on relatively few occasions. In 1975, in
perhaps its most significant decision on the
issue, the Court held that a state “cannot consti-
tutionally confine . . . a non-dangerous individ-
ual who is capable of surviving safely in freedom
by himself or with the help of willing and
responsible family members or friends” (O’Con-
nor 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 unre-
solved 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 constitu-
tional considerations. The most significant issue
has concerned whether a prisoner, following
completion of her or his sentence, may be com-
mitted 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.