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Health Resource Center

Emotional Well-Being

Inpatient and Outpatient Commitment

Involuntary psychiatric commitment, also known as civil commitment, is a process by which an individual is found by a court, mental health, or medical professional to be mentally ill and a danger to herself or himself or to others and is institutionalized in a mental health facility against her or his will in order to receive treatment.  In the United States, the laws and procedures regarding civil commitment vary from state to state.  However, every state has statutes that allow for people to be committed against their will.

Involuntary commitment is controversial and many mental health advocates and health law organizations oppose its use (see the Bazelon Center for Mental Health Law).

It is important to note that generally, a person who is involuntarily committed is still presumed to be competent to make treatment decisions. If a hospital wishes to forcibly treat a person with medications, the hospital must have the person deemed incompetent by a court.

Following the trend of deinstitutionalization, involuntary outpatient commitment (IOC) has evolved as an alternative to inpatient commitment. With IOC, people are not forced into hospitalization, but may be required by the court to receive medications or treatments in their communities.  Studies have found conflicting results as to whether IOC is preferable to inpatient commitment. The general consensus is that, at least, IOC mandates treatments that might not have been otherwise available.

If you think that you may at some point be subject to involuntary psychiatric treatment, you might consider preparing an “advance psychiatric directive” to make your preferences known about what kind of treatment you do or don’t want and to appoint a person to make decisions for you in case you are found incompetent to do so. To find out how to prepare such a document, see The National Resource Center on Psychiatric Advance Directives. Such directives are not legally binding documents, but may be considered by a judge or doctor when they are deciding the most appropriate course of treatment.

Written by: Christina Lachance. Special thanks to Leonard Glantz.
Last revised: March 2005

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