The History
Involuntary commitment has deep roots in the common sense that, troubled individuals deserve care even when the society's definition of "care" changes throughout history. First, defining "mentally ill individual" is tricky, sometimes warrants rigorous debates in court. At personal level, mental issues usually affect an individual's ability to gain insights and to make sound judgments. Consequently, those individuals do not recognize the mental issues they are having, refuse treatments and keep wandering down the destructive paths. At social level, citizens feel the need to both protect their communities and to care for the mentally ill individuals - the "Parens Patriae" principle. Burden of proof is another important component. Together with maturity in psychiatric diagnosis and treatment capabilities, all these components form the basis of two involuntary commitment periods: the Institutionalization period (before 1960) and the De-institutionalization period (after 1960) (Testa & West, 2010).The institutionalization period has distinct characteristics of: all admissions were involuntary; significantly high number of patients (up to 559,000 patients in 1953); immature standards on defining mental illness and burden of proof (Testa & West, 2010). For example, influential family members can simply send another member into a psychiatric hospital as long as they have enough money to pay for the member's "stay". The lack of knowledge in treating mentally ill people may also explain why the society was easily on board with separating "weird" individuals from the society by confining them in psychiatric hospitals.
The de-institutionalization begins with advancements in treating mental illness. Especially with the use of new medications, people started to wonder if some mentally ill people can be treated outside of psychiatric hospitals. There are three major improvements in legally defining key aspects of the issue (Testa & West, 2010). First, the Community Mental Health Centers Act in 1963 paved the way for easier patients' transition from psychiatric hospitals back to society. Second, the standard for civil commitment was instituted in 1964 requiring stronger proofs of mental illness before admission to hospitals. Finally, the laws put stronger emphasis on the definition of the terms "gravely disabled" and "imminent threat to self or society".
The Laws
Current Ohio laws on civil commitment specifies five key criteria for "mentally ill person subject to court order": 1. Carries substantial risks of harm to self; 2. Represents a substantial risk to others; 3. Represents immediate risk of serious physical impairment/injury to self; 4. Is in need of psychiatric treatments; 5. Would benefit from psychiatric treatments through types of evidences as outlined in R.C. 5122.111 (Civil Commitment of The Mentally Ill, n.d.). Ohio's Involuntary Civil Commitment Process consists of filing of an affidavit, and emergency hospitalization process (LegalRightsService,2010). Affidavit Process (ORC 5122.11) can be filed with the court by any person with reliable knowledge/information about the person with mental issues, providing a factual statement, alleging proper category(es) as specified in ORC 5122.01(B), and following proper form provided by the Ohio Department of Mental Health. Emergency Hospitalization (ORC 5122.10) can be initiated by any psychiatrist, licensed clinical psychologist, licensed physician, health/parole/police officer, or sheriff following the criteria of: believing the person has mental illness subject to court order per ORC 5122.01(B); believing the person is at substantial risk of harm to self if remains at liberty; and treating the person not as a criminal. Ohio laws \cite{CivilSetting} further state that the initial hearing per R.C. 5122.141(A) and (B) must be held within 5 court days or 10 calendar days since the affidavit was filled or the person was detained, whichever occurs first. Court findings must be based on clear and convincing evidence, with testimonies from medical professionals. Individuals who found to meet only criteria as specified in R.C. 5122.01(B)(5)(a) will not be hospitalized.As mentioned in the Ohio's Involuntary Civil Commitment Process \cite{LegalRightsService2010OhiosMethods}, there are huge differences between the affidavit process and the emergency process. The affidavit process is much more formal with rigorous judicial review process, allowing possible triggering of other due process protections. For example, the process allows the individual to challenge findings and in some cases, negotiate for different treatment strategies including alternative setting, and switching to voluntary commitment. Emergency process is basically an exception to the affidavit process, allowing immediate detention of the individuals without a prior and proper judicial process. Thus, this process attracts more human errors, debates, and legal changes.
Coming to effect on September 2004, Ohio's Senate Bill 43 expanded the definition of mentally ill person subject to court order and also allowed courts to order outpatient treatment instead (Changes to Ohio Civil Commitment Laws, 2014). Specifically, court may also order people who refused treatments or did not comply with treatment plans. Court may order hospitalization or outpatient treatment which consist of treatment plans and services that the individuals must use while remaining outside of hospitals. Involuntary commitment can end in situations where: the hospital admitted the individuals as voluntary patients; the individual followed treatment plan for 90 days and at the end of that period, the hospital tells the court that the patient had agreed to the treatment plan; or the court holds hearing 90 days after treatment and every two years after that in which hearing, the court decides that the individuals no longer meet the criteria for involuntary commitment. More recently in 2019, HB354 bill proposed the addition of moderate or severe substance use disorder into mental illness subjecting to involuntary commitment (HB354 - Ohio Legislative Service Commission, 2019). SB58 bill proposed many improvements among which are: prohibiting a court from ordering a criminal defendant to undergo inpatient evaluation unless there is an immediate need for hospitalization; allowing the defendant, the defendant's guardian and the defendant's mental treatment team to inspect reports filed by examiners; requiring the court to consider availability of housing and supportive services in determining the place of commitment (Sandberg, 2019).
Commentaries
In a survey of psychiatrists' opinions regarding involuntary commitment laws, the results showed that there is a consensus on commitment grounds of "dangerous to oneself", "dangerous to others" and "inability to care for oneself"; and there are strong supports for outpatient commitment (Brooks, 2007). There are areas where disagreements are high both among the professionals and the law makers. For example, while professionals demand more evidence on illness relapse, there are already laws in sixteen states enacting illness relapse as the ground for involuntary commitment. Sometimes, people cannot seem to agree on fundamental terms such as what constitutes "mental illness". For example, laws in most states define mental illness in terms of vague effects on a person's thinking or behavior while laws in other states may require more specific psychiatric diagnoses (Menninger, n.d.). On top lacking the required knowledge and having different perspectives, there are also bias in diagnosis, law enforcement, community pressures, etc.Despite all of those issues, involuntary commitment on the grounds of being dangerous to self and others is fair and necessary. It goes back to the fact that some mentally ill individuals do not have the ability to recognize the mental issues they are having and they will fail without assistance from the communities. In some rare cases, such as mass shooting due to mental issues, there can be grave damages. The dual process of affidavit and emergency are both helpful and complementing each other. While there are potential issues with the Emergency process, potential mistakes can be corrected in follow up processes such as post-emergency court hearing. In addition, the legalization of outpatient commitment is another pathway to help patients get back to the society.
Much more efforts need to be invested in hybrid situations such as having mental issues while committing criminal acts. A criminal act may have nothing to do with a mental issue but the defendant may leverage the mental issue to escape criminal punishment. For example, there are disagreements on classifying some cases of child sexual abuse as mental illness. More evidence need to be gathered to build up the case for illness relapse. For example, if there is a mental illness that makes a person kills another, what kind of evidence should be fathered to justify the level of improvement and relapse prevention that this person will not be harmful upon termination of involuntary commitment.
References
Brooks, R. A. (2007).Psychiatrists’ Opinions About Involuntary Civil Commitment:
Results of a National Survey
Changes to Ohio Civil Commitment Laws. (2014). Disability Rights Ohio. Retrieved from https://www.disabilityrightsohio.org/news/new-publication-explains-changes-to-ohios-civil-commitment-laws
Civil Commitment of The Mentally Ill (From Community or Hospital Setting). (n.d.).
HB354 - Ohio Legislative Service Commission . (2019). Retrieved from www.lsc.ohio.gov
Legal Rights Service, O. (2010).
Ohio’s Involuntary Civil Commitment Process Ohio’s
Involuntary Civil Commitment Process Judicial Hospitalization A Comparison of
the Affi davit and Emergency Hospitalization Methods
. Retrieved fromhttp://olrs.ohio.gov
Menninger, J. A. (n.d.).Involuntary Treatment: Hospitalization and Medications.
Sandberg, L. (2019).SB58 - Ohio Legislative Service Commission Bill Analysis
.Retrieved from www.lsc.ohio.gov
Testa, M., & West, S. G. (2010). Civil Commitment in The United States (tech. rep.
No. 10).
