Lecture Notes: Civil Commitment and Involuntary Psychiatric Treatment

Introduction

• Speaker: Dr. Renee Binder
• Background: Full professor, ran inpatient psychiatry unit, started the Forensic Psychiatry Fellowship Program at UCSF, past president of the APA.

Historical Perspective on Civil Commitment

• 1970s Inpatient Psychiatry: Patients could be held on a 5250 hold.
• Probable Cause Hearings: Known as Dovi Galino hearings and Reese hearings.
• Patient Rights Advocates: Initially viewed as a nuisance but recognized as important for patient rights.

Reasons for Civil Commitment Laws

• Movements to make institutionalization easier due to homelessness and lack of state hospitals.
• Difference in Medical Conditions:
  • Example of a CEO with a heart condition vs. a suicidal woman.
  • Legal and ethical considerations in psychiatric vs. non-psychiatric medical emergencies.

Legal Basis for Civil Commitment

• Dangerousness: Requirement to hold someone involuntarily.
• Mental Illness: Necessary criteria for civil commitment.
• Historical Cases: Andrew Goldstein and Kendra’s Law; Laura’s Law in California.

History of Involuntary Treatment

• Civil Commitment Abuse: Historical misuse (e.g., Charles Dickens’ wife, Soviet Union dissidents).
• Legal Developments:
  • Wyatt v. Stickney (1970): Required treatment if liberty deprived.
  • Lessard v. Schmidt (1972): Established due process and criteria (mental illness, dangerousness).

Criteria and Challenges in Civil Commitment

• Involuntary Hospitalization Requirements: Mental illness, dangerousness, gravely disabled.
• Patients’ Rights: Privacy, autonomy, due process, and the right to refuse treatment.
• Balancing Interests: State interests vs. individual liberty.

Involuntary Medication and Competency

• Reese Hearings: Determine competency to refuse medication.
• Medical Emergency Exceptions: Situations where medication can be given without consent.
• Patient Reactions: Mixed feelings about involuntary treatment; studies show varied perceptions of coercion.

Legal and Ethical Considerations

• Malpractice Risks: False imprisonment, failure to treat, abandonment.
• Documentation: Importance in legal protection and ethical justification.

Modern Challenges and Legislative Perspectives

• Outpatient Commitment Laws: Kendra’s Law, Laura’s Law, and controversies.
• Current Proposals and Bills: SB1045, housing conservatorships.
• Resource Allocation: Importance of intensive case management and resource mobilization.

Conclusion

• Reflection on Civil Commitment: Importance of due process, ethical considerations, and balancing individual rights with societal interests.