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Involuntary Commitment And Court-Ordered Treatment

After a great deal of study, the NAMI Board of Directors in 1995 approved a policy on involuntary commitment and court-ordered treatment. This policy was developed after a year of analysis with input from grassroots members around the country. The final text, approved by the board, is printed below.

In passing this policy, the board re-emphasized its belief that "the availability of effective, comprehensive, community-based systmes of care for persons suffering from brain disorders will diminish the need for involuntary commitment and court-ordered treatment." We also agree that court-ordered treatment should only be used as a "last resort." On the other hand, the board is cognizant of the fact "that there are certain individuals with brain disorders who at times, due to their illness, lack insight or judgment about their need for medical treatment." We believe the following policy does a good job of balancing an individual's civil rights with society's obligation to provide kind and compassionate care to those in need.

Policy On Involuntary Commitment And Court Ordered Treatment

Approved by NAMI Board of Directors on October 7,1995

The National Alliance for the Mentally Ill (NAMI) believes that all people should have the right to make their own decisions about medical treatment. However, NAMI is aware that there are certain individuals with brain disorders (also known as severe mental illnesses) such as schizophrenia and manic-depressive illness who, at times, due to their illness, lack insight or judgement about their need for medical treatment. NAMI is also aware that, in many states, laws and policies governing involuntary commitment and/or court-ordered treatment are inadequate.

NAMI, therefore, adopts the following policy:

    1.The availability of effective, comprehensive community-based systems of care for persons suffering from biological brain disorders will diminish the need for involuntary commitment and/or court-ordered treatment.

    2.Methods for facilitating communications about treatment preferences among individuals with biological brain disorders, family members, and treatment providers should be adopted and promoted in all states.

    3.Involuntary commitment and court-ordered treatment decisions must be made expeditiously and simultaneously in a single hearing so that individuals can receive treatment in a timely manner. The role of courts should be limited to review to ensure that procedures used in making these determinations comply with individual rights and due process requirements, and not to make medical decisions.

    4.Involuntary inpatient and outpatient commitment and court-ordered treatment should be used as a last resort and only when it is believed to be in the best interests of the individual in need. 5.States should adopt broader, more flexible standards that would provide for involuntary commitment and/or court-ordered treatment when an individual:

      (A).Is gravely disabled, which means that the person is substantially unable, except for reasons of indigence, to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety, or

      (B).Is likely to substantially deteriorate if not provided with timely treatment, or

      (C).Lacks capacity, which means that as a result of the brain disorder the person is unable to fully understand or lacks judgment to make an informed decision regarding his or her need for treatment, care or supervision.

    6.Current interpretations of laws that require proof of dangerousness often produce unsatisfactory outcomes because individuals are allowed to deteriorate needlessly before involuntary commitment and/or court-ordered treatment can be instituted. When the "dangerousness standard" is used, it must be interpreted more broadly than "imminently" and/or "provably" dangerous.

    7.State laws should also allow for consideration of past history in making determinations about involuntary commitment and/or court-ordered treatment, since past history is often a reliable way to anticipate the future course of illness.

    8.An independent administrative and/or judicial review must be guaranteed in all involuntary commitment and/or court-ordered treatment determinations. Individuals must be afforded access to appropriate representation knowledgeable about brain disorders and provided opportunities to submit evidence in opposition to involuntary commitment and/or court-ordered treatment.

    9.Responsibility for determining court-ordered treatment should always be vested with medical professionals, who, in conjunction with the individual, family, and other interested parties, must develop a plan for treatment.

    10.The legal standard for states to meet in order to justify emergency commitments for initial 24 to 72 hours should be "information and belief." For involuntary commitments beyond the initial period, the standard should be "clear and convincing evidence." Involuntary commitments and/or court-ordered treatment must be periodically subject to administrative or judicial review to ascertain whether circumstances justify the continuation of these orders.

    11.Court-ordered outpatient treatment should be considered as a less restrictive, more beneficial, and less costly treatment alternative to involuntary inpatient treatment.

    12.Efforts must be undertaken to better educate justice systems and law enforcement professionals about the relationship between severe brain disorders and the application of involuntary inpatient and outpatient commitment and court-ordered treatment.

    13.Private and public health insurance plans must cover the costs of involuntary inpatient and outpatient commitment and/or court-ordered treatment.

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