Involuntary Outpatient
Commitment
Legislation: State
Perspectives
Virginia House of Delegate's
Health, Welfare and Institutions Committee
July 30, 2007
Sarah Steverman, MSW
Policy Associate
National Conference of State Legislatures
Common Characteristics of
Involuntary Treatment Statutes
Most have a “grave disability” provision.
Most states permit outpatient commitment.
The standards for inpatient and outpatient
commitment differ.
Some states require outpatient treatment to be
shown available before outpatient commitment
is granted.
Common Characteristics of
Involuntary Treatment Statutes
continued
A person’s history of behavior and treatment
can be taken into account when determining
whether an individual meets commitment
standards.
Medication compliance is usually addressed
separate from the civil commitment hearing.
Outpatient commitment is most often used at
the point of discharge from inpatient treatment.
Texas
Requires a court order for outpatient
commitment.
Inpatient and outpatient civil commitment uses
same processes.
Some overlap in inpatient and outpatient
criteria.
Prior history of up to two years preceding the
commitment hearing may be considered.
Texas
Court may order outpatient treatment if
Person has mental illness that is “severe and persistent.”
Untreated illness will lead to severe distress and the
individual will be unable to live safely in the community
without mental health services.
The individual is unable to participate voluntarily in
treatment as evidenced by past history or current clinical
condition making it impossible to make a rational decision
to seek outpatient treatment.
Michigan
Initial detention initiated by psychiatrist or
psychologist, peace officer, application of an
individual to a court.
Availability of community mental health services
must be assessed.
At least one deposition or testimony by a physician or
psychologist must be submitted to the court.
Court provides law enforcement with involuntary
treatment order.
Michigan continued
Types of involuntary treatment orders
Hospitalization
Alternative to
hospitalization
Combination of hospitalization and alternative treatment
Length of time of treatment orders vary.
Person with combined order can be returned to the
hospital without hearing if deemed clinically
appropriate.
North Carolina
Inpatient and outpatient commitment statutes
differ greatly.
Outpatient treatment is defined in the statute as
a mechanism to avoid inpatient commitment.
Prior history may be used to determine civil
commitment.
Anyone can petition the court to take the
person into custody for assessment.
North Carolina continued
If outpatient commitment is recommended, the
court schedules a hearing with the individual
and proposed treatment center or physician.
Counsel not automatically assigned for IOC
Forced medication and treatment not allowed
pending hearing.
Hearing must be held within 10 days.
North Carolina continued
Five criteria for outpatient commitment:
Mental illness
Capable of surviving safely in the community with
available supervision
Threat of dangerousness (defined in statute) based
on history
Mental illness leads to inability to voluntarily seek
and participate in treatment
Outpatient treatment is available
North Carolina continued
Combination of inpatient and outpatient
treatment can be ordered.
Medication cannot be forced unless immediate
danger to self or others.
Anecdotal evidence that outpatient
commitment is most often used at point of
discharge from inpatient treatment.
Ohio
Treatment of those civilly committed lies with the
local boards of alcohol, drug addiction, and mental
health services, including financial responsibility.
Provides incentives for local boards to limit
commitment and increase community services.
Court can order person into a variety of settings, but
the treatment provider designated to provide care
must consent.
Commitment is usually to the local board, who then
makes decision.
Ohio continued
Medication compliance is separate issue from
civil commitment and requires a judicial
hearing.
2000 Ohio Supreme Court Decision: Steele v.
Hamilton County Community Board
Oregon
Court and Mental Health Division Director work
closely together during civil commitment
procedures.
With the approval of the court, Mental Health
Division Director can commit individual to
outpatient treatment only if the treatment is
available.
Director establishes terms of outpatient
commitment.
Outpatient commitment can be revoked or modified
by Director when “it is in the best interest of the
person.”
Oregon continued
Outpatient commitment used rarely in Oregon,
trial visits from hospital used more frequently.
Anecdotal evidence that lack of community
resources may place individuals at greater risk
for commitment.
Inconsistencies between rural and urban
application of the statute.
Wisconsin
Permits the use of medical records data in making commitment
determination.
Specifies what does not constitute adequate proof that the
individual meets commitment criteria.
If protection/treatment exists in the community and the person is likely
to take advantage of those services.
Provides for a “settlement agreement” postponing commitment
hearing for up to 90 days while person participates in
outpatient treatment.
5th Standard-question of capacity and prospect of deterioration
in the absence of treatment.
Wisconsin
Enrollment in a health plan determination
before assessment or treatment under civil
commitment.
Court may appoint a temporary guardian for
up to 30 days.
Policy Issues
The statute is only one element of the treatment issue.
IOC is only successful if there are adequate community
resources.
Outpatient commitment relies on good communication
between the court, assessing psychiatrist or psychologist,
treatment provider, and often the mental health authority.
IOC is often administered inconsistently, especially between
rural and urban areas.
Availability of evidence-based treatment prevents the need for
IOC.
Sarah Steverman
Phone: 202-624-3583
Email:
sarah.steverman@ncsl.org
Resources:
M. Susan Ridgely, John Borum, John Petrila
“The Effectiveness of Involuntary Outpatient Treatment: Empirical
Evidence and the Experience of Eight States”
http://www.rand.org/pubs/monograph_reports/MR1340/
NCSL Mental Health Webpage
http://www.ncsl.org/programs/health/mental.htm