Mental Health Law III: Civil Commitment & Dangerousness

Question 1

The concept of commitment came out of the historical concept of

Answer 1

parens patriae

Question 2

parens patriae

Answer 2

“state or government as parent or caregiver.”

Gives the government a parental role of caring for people who are otherwise unable to care for themselves

Question 3

first to define the government’s role in mental illness

Answer 3

Aristotle

Question 4

Aristotle noted that the government has two basic powers

Answer 4

(1) police power

(2) parens patriae power.

Question 5

police power

Answer 5

power of the government to protect its citizens from danger or harm

Question 6

first articulated the basis for civil commitment in America.

Answer 6

In re Oakes (1845)

Question 7

4 important (though not necessarily desirable) precedents were established in Oakes:

Answer 7

(1) The state has a right to confine someone against his or her own free will;
(2) caretakers should have the major role in decision making for the mentally disordered, including length of treatment;
(3) civil proceedings do not require the same strict due process considerations as criminal matters; and
(4) involuntary treatment is justified not only by the detainee’s dangerousness but also for his or her own welfare.

Question 8

implications of the Oakes decision

Answer 8

• that mentally disordered individuals lacked free will

* that family and professional caretakers would act in the best interests of the patient and make decisions for them

Question 9

Rouse v. Cameron (1967)

Answer 9

Court considered whether those committed could be confined only for the purpose of custodial care, and concluded that there was a constitutional right to treatment.

Court ruled that confinement alone did not serve the purpose of civil commitment, because there must be a “bona fide effort at treatment.”

Question 10

Lake v. Cameron (1966)

Answer 10

first articulation of the concept of “least restrictive alternative”

Question 11

“least restrictive alternative”

Answer 11

dictates that any kind of forced treatment must be the least restrictive option available

Question 12

Wyatt v. Stickney (1971)

Answer 12

a lawsuit was brought about by patients complaining about the poor conditions at Bryce Hospital in Alabama.
The Court’s ruling defined the “minimal standard of care”

patients forced against their will to reside in an inpatient treatment facility had a right to adequate treatment.

Question 13

Terms of “minimal standard of care” in Wyatt v. Stickney

Answer 13

+appropriate patient-to-staff ratios,
+hours of active treatment per week,
+existence of continuing therapeutic programs +utilization of individualized treatment planning

Question 14

Rennie v Klein (1978)

Answer 14

the first significant case to recognize that those who are civilly committed have a constitutional right to refuse medications

Question 15

May the right to refuse medication be overridden?

Answer 15

Yes; so long as the patient was given due process

Question 16

Four factors to be considered by an independent party to overrule the patient’s refusal of medications

Answer 16

(1) the patient’s capacity to decide on his or her particular treatment;
(2) the patient’s physical threat to other patients and staff;
(3) whether any less restrictive treatment exists; and
(4) the risk of permanent side effects from the proposed treatment.

Question 17

O’Connor v. Donaldson (1975)

Answer 17

U.S. Supreme Court addressed the due process requirements for civil commitment

Over the 15 years in inpatient care, Donaldson essentially received nothing more than custodial care and did not receive treatment for the supposed illness for which he had been put there.

At no point during his confinement did Donaldson pose a danger to himself or to others

Question 18

What are the grounds for continued confinement? (O’Connor v. Donaldson)

Answer 18

involuntary confinement was “to prevent injury to the public, to ensure his own survival or alleviate or cure his illness”

Question 19

Supreme Court statements and decision on O’Connor v. Donaldson

Answer 19

“a finding of mental illness alone cannot justify a State’s locking a person up against his will and keeping him indefinitely in simple custodial care”

“A State cannot constitutionally confine in a mental institution, a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends and since the jury found…that [O’Connor] did so confine [Donaldson], it properly concluded that [O’Connor] had violated [Donaldson’s] right to liberty”

Question 20

Addington v. Texas (1979)

Answer 20

Addington’s mother petitioned that her son be indefinitely committed to a state mental hospital

Addington was found to be “mentally ill and [requiring] hospitalization in a mental hospital”

The jury found that, based on “clear, unequivocal, and convincing evidence,” Addington was mentally ill and required hospitalization

Addington was indefinitely committed and appealed claiming that the trial court should have employed the stricter “beyond a reasonable doubt” standard of proof.

the U.S. Supreme Court placed the burden of proof on the petitioner and the state, which must demonstrate by “clear and convincing evidence” that the detainee meets the statutory criteria for commitment.

Question 21

Olmstead v. LC (1999)

Answer 21

The Supreme Court held that people with disabilities have a qualified right to receive state funded supports and services in the community rather than institutions

Question 22

Olmstead v. LC requires a three part test which is:

Answer 22

1. the person’s treatment professionals determine that community supports are appropriate;
2. the person does not object to living in the community; and
3. the provision of services in the community would be a reasonable accommodation when balanced with other similarly situated individuals with disabilities

Question 23

Barefoot v. Estelle (1983)

Answer 23

the U.S. Supreme Court addressed the controversial issue of mental health professionals’ opinions on dangerousness, and the value that should be awarded to them in making decisions to commit
The Court stated, “The suggestion that no psychiatrist’s testimony may be presented with respect to defendant’s future dangerousness is somewhat like asking us to disinvent the wheel”

Question 24

Foucha v. Louisiana (1992) relevant case facts prior to U.S. supreme court

Answer 24

Terry Foucha was charged with aggravated burglary and illegal discharge of a firearm.
The Court held that Foucha was dangerous to himself and to others, and he was not only insane at the time the offense was committed but also at the time of the trial.
committed to the East Feliciana Forensic Facility
In March 1988, a panel assessed pt mental state and if dangerous if released. Pt showed no signs of mental illness other than Antisocial PD. The panel’s recommended release. Trial judge convened a “sanity commission” which agreed with the panel but could not guarantee that Pt would not be a danger to self or others.
The court consequently held that Foucha was in fact a danger to himself and others, and returned him to the Feliciana mental facility. This decision was upheld by the State Supreme Court of Louisiana.

Question 25

Foucha v. Louisiana (1992) at supreme court level

Answer 25

U.S. Supreme Court was faced with making a decision regarding the grounds for which a person can be forced to remain at a mental institution.
The Court reversed the decision of the lower courts, stating that the state of Louisiana “violates the Due Process Clause because it allows an insanity acquittee to be committed to a mental institution until he is able to demonstrate that he is not dangerous to himself and others, even though he does not suffer from any mental illness”

Question 26

Kansas v. Hendricks, 1997

Answer 26

U.S. Supreme Court allowed personality disorder to be considered a mental illness with sex offenders (So far, the courts have not resolved the contradictory rulings with Foucha v. Louisiana)

Question 27

How was the level of proof in Addington v. Texas a compromise?

Answer 27

It reflected the loss of a liberty interest in civil commitment, but also acknowledging that the purpose of the “confinement” would be to receive treatment that was in the patient’s best interest.

Question 28

civil commitment today honors a number of due process rights. Although they vary somewhat across jurisdictions, these rights generally include

Answer 28

(1) right to an attorney;
(2) notification of charges and when hearings occur;
(3) hearings on the issue, with a statement of charges;
(4) the standard of proof being stated; and
(5) commitment procedures that follow rules of evidence.