Skip to main content
Full access
Controversies in Psychiatric Services
Published Online: 20 August 2024

Involuntary Commitment: Opinions Regarding Patient Autonomy, Legal Parameters, and Behavioral Services Care Delivery

Publication: Psychiatric Services
The Controversies in Psychiatric Services column aims to highlight differing viewpoints on topics relevant to psychiatric services that have generated a debate or a divide in opinion. For this column, the editorial team chose to focus on the practice of involuntary commitment, asking authors to respond to the following statement:
With growing concern by local and state officials that individuals with mental disorders are underserved and lack access to hospital-based services, changes to involuntary commitment rules to enhance access to care are being assessed. Currently, there is controversy about criteria for involuntary commitment, authority to commit patients, and how both factors affect patient autonomy.
Clinical, legal, and ethical dilemmas regarding involuntary commitment in the delivery of mental health care services are addressed in three opinions. First, Zhong and Wasser argue that involuntary commitment in its current form does not preserve patient autonomy or provide an opportunity for recovery-oriented treatment. Worse, involuntary psychiatric hospitalizations and outpatient commitment practices are typically ineffective for many with an extensive history of prior commitment, resulting in repeated hospital admissions and poor community tenure. The authors propose decreasing the practice and focusing instead on palliative psychiatry and community-based supports, noting that liability laws also need to be updated to accommodate the new approach. Taking a contrary view, Sullivan et al. acknowledge that involuntary commitment is problematic, but they advocate for maintaining the practice to ensure that patients receive lifesaving treatments (as well as care that may benefit caregivers and the community as a whole). The authors note that involuntary treatment is ethically and clinically warranted for humanitarian reasons when it protects vulnerable individuals from harm. Finally, Minkoff describes the new laws in some states that authorize involuntary treatment for substance use disorders, which may be a catalyst for rethinking involuntary interventions in behavioral health. Specifically, the involuntary commitment process may be improved by a targeted approach that is supported by enhanced guidelines delineating criteria, settings, outcomes, and length of time for involuntary treatment.

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services

History

Published online: 20 August 2024

Keywords

  1. involuntary commitment
  2. law and psychiatry
  3. patient rights
  4. emergency psychiatry

Authors

Details

Matthew D. Erlich, M.D.

Notes

Matthew D. Erlich, M.D., Patrick Runnels, M.D., M.B.A., and Rachel M. Talley, M.D., are editors of this column. Dr. Erlich served as action editor for this exchange.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share