Civil Commitment Flashcards
2 Legal Bases for Civil Commitment
- Parens patriae
- Police power
Historical Shift
Medical model (need for tx) -> Legal model (dangerousness)
Dorothea Dix
In 1800s, lobbied successfully for creation of state hospitals
4 Drivers of Deinstitutionalization
- Sociopolitical movement for CMH + Open Hospitals
- Advent of psychotropics
- Class action lawsuits on behalf of institutionalized pts
- Financial imperatives to shift from state to fed budgets
Community Mental Health Act of 1963
JFK act to provide fed funding for CMH across US
Lanterman-Petris-Short Act (1969)
CA act that endorsed voluntary tx and repealed indefinite commitment
- Included provisions for procedural protection if invol intervention
SCOTUS Substantive Criteria for Commitment
Never formally ruled
Dangerousness in Civil Commitment (3)
- Most frequently used and required criterion
- Most jurisdictions req actual behavior (verbal or physical) as necessary
- Also reqs causal nexus b/w dangerous actions and MI
Probable Cause in CC
Amount of evidence req’d for LEO to carry out MH seizure and take individual into emergency custody/eval
Total Institution
Place of work/residence where number of similar people cut off from wider community & live enclosed, formally administered life (e.g., prisons or psych hospitals)
Matter of Josiah Oakes (what it was, significance, other)
- Committed by family for infatuation with younger woman
- First “danger to self or others,” court basically said necessary to confine those
- Rec’d both police powers and parens patriae
4 (Generally) Criteria for Civil Commitment
MI
Dangerousness (causally related to MI)
Grave Disability (explicitly stated in 75% states)
Least Restrictive (req’d 2/3 states)
Grave Disability Justification
Parens patriae
3 Determinants of Effectiveness of IOC/AOT
Systematic implementation
Intensive community-based services
Duration of court order
3 (Often) Reqs of IOC/AOT
- Likelihood of serious harm to others if not so committed
- Likelihood nonadh w/ tx if no court order
- Hx multiple hosps
3 Types IOC/AOT
Type 1: Post-discharge, unattached to hosp supervision
2: Alt for hosp for individuals meeting civ commitment critieria but outpt sufficient
3. Preventative for individuals who don’t meet hosp criteria but need tx to prevent decomp
2 APA Recs for IOC/AOT and Another Point
Statutes should:
1. Authorize initial commitment periods of 180 days
2. Permit extensions based on criteria at hearings
- Invol meds should require separate review/approval
Kendra’s Law
NY AOT/OCC law, named after Kendra Webdale pushed in front of subway by man w/ SMI
State Hosp Pop Trend
Peaked in 1950s at about 550k, fell sharply, now around 45k
Penrose Hypothesis (another name & what it is)
Traninstitutionalism - Inverse relationship of prison and mental hospital pops - if one form reduced, the other will incr (controversial)
Stone-Roth Proposal (What it as and 5 elements)
Proposed CC model favoring parens patriae over dangerousness
1. Reliable dx of SMI
2. Px of major distress w/o tx
3. Tx decision-making impaired
4. Tx available
5. Tx favorable risk-benefit ratio
Duke AOT Study (significance, methods)
Most comprehensive, RCT of AOT
- Compared people offered CMH services with people offered same services + court order
Duke AOT Study 5 + 1 Findings
Combining CO w/ services for at least 6 months:
- Reduced: hospitalization
- Arrests
- Victimization
- Violence
- Improved Tx Compliance
Sustained periods of AOT had greater subjective QOL
