Civil Commitment

Question 1

2 Legal Bases for Civil Commitment

Answer 1

1. Parens patriae
2. Police power

Question 2

Historical Shift

Answer 2

Medical model (need for tx) -> Legal model (dangerousness)

Question 3

Dorothea Dix

Answer 3

In 1800s, lobbied successfully for creation of state hospitals

Question 4

4 Drivers of Deinstitutionalization

Answer 4

1. Sociopolitical movement for CMH + Open Hospitals
2. Advent of psychotropics
3. Class action lawsuits on behalf of institutionalized pts
4. Financial imperatives to shift from state to fed budgets

Question 5

Community Mental Health Act of 1963

Answer 5

JFK act to provide fed funding for CMH across US

Question 6

Lanterman-Petris-Short Act (1969)

Answer 6

CA act that endorsed voluntary tx and repealed indefinite commitment
- Included provisions for procedural protection if invol intervention

Question 7

SCOTUS Substantive Criteria for Commitment

Answer 7

Never formally ruled

Question 8

Dangerousness in Civil Commitment (3)

Answer 8

• 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

Question 9

Probable Cause in CC

Answer 9

Amount of evidence req’d for LEO to carry out MH seizure and take individual into emergency custody/eval

Question 10

Total Institution

Answer 10

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)

Question 11

Matter of Josiah Oakes (what it was, significance, other)

Answer 11

• 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

Question 12

4 (Generally) Criteria for Civil Commitment

Answer 12

MI
Dangerousness (causally related to MI)
Grave Disability (explicitly stated in 75% states)
Least Restrictive (req’d 2/3 states)

Question 13

Grave Disability Justification

Answer 13

Parens patriae

Question 14

3 Determinants of Effectiveness of IOC/AOT

Answer 14

Systematic implementation
Intensive community-based services
Duration of court order

Question 15

3 (Often) Reqs of IOC/AOT

Answer 15

1. Likelihood of serious harm to others if not so committed
2. Likelihood nonadh w/ tx if no court order
3. Hx multiple hosps

Question 16

3 Types IOC/AOT

Answer 16

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

Question 17

2 APA Recs for IOC/AOT and Another Point

Answer 17

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

Question 18

Kendra’s Law

Answer 18

NY AOT/OCC law, named after Kendra Webdale pushed in front of subway by man w/ SMI

Question 19

State Hosp Pop Trend

Answer 19

Peaked in 1950s at about 550k, fell sharply, now around 45k

Question 20

Penrose Hypothesis (another name & what it is)

Answer 20

Traninstitutionalism - Inverse relationship of prison and mental hospital pops - if one form reduced, the other will incr (controversial)

Question 21

Stone-Roth Proposal (What it as and 5 elements)

Answer 21

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

Question 22

Duke AOT Study (significance, methods)

Answer 22

Most comprehensive, RCT of AOT
- Compared people offered CMH services with people offered same services + court order

Question 23

Duke AOT Study 5 + 1 Findings

Answer 23

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