Involuntary Commitment Laws for Substance Abuse Vary Across States

Civil commitment statutes vary greatly by state in terms of clarity and specificity regarding which mental illnesses are included for the purpose of involuntary hospitalization. The status of substance abuse is especially problematic: many states do not clearly reference substance abuse in civil commitment laws while others specifically exclude it.  Those are the findings of a report appearing online in Psychiatric Services in Advance, “Statutory Definitions of Mental Illness for Involuntary Hospitalization as Related to Substance Use Disorders.”

Robin Williams, M.D., M.B.E. and colleagues in the Department of Psychiatry at New York University School of Medicine, examined state mental health statutes to better understand the national landscape of civil commitment law with a specific focus on substance use disorders.

“In New York City, individuals gravely disabled by substance use disorders repeatedly present to emergency rooms,” the authors stated. “Although these individuals are at high risk of death and often lack the capacity to make treatment decisions, the laws in New York State are unclear about whether substance use disorders qualify as mental illnesses for the purpose of involuntary hospitalization."

Their review revealed that New York is not alone. They found that 21 states and Washington, D.C., do not reference substance use disorders in their statutory definitions of mental illness. Of the 29 that do, eight states include substance use disorders, and 21 explicitly exclude them. In addition, nine states have separate inpatient commitment laws specifically addressing substance use disorders.

“Mental health professionals and policymakers should discuss whether individuals gravely disabled by substance use disorders, a complex and vulnerable population, should be more widely included under standard civil commitment law,” they wrote.

For more on involuntary treatment see the Psychiatric News article, "Rulings Guide Psychiatrists on Forced-Treatment Limits."

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Groundbreaking Mental Health Law to Take Effect in China

China is transforming the provision of mental health to its citizens under a new law that takes effect tomorrow. Its first national mental health legislation should have wide-ranging effects on provision of mental health services, but perhaps the most significant and controversial change is one that banishes most forms of involuntary treatment. The law also mandates strict limits on use of seclusion and restraints and ends the use of psychiatric admission as punishment or to enforce treatment of individuals who do not have a mental illness. It also forbids the practice of requiring patients to participate in labor or limiting their right to communicate with the outside world.

An editorial appearing online in AJP in Advance yesterday calls the new law visionary, but emphasizes that it will present China with many challenges—especially the need for more psychiatrists and community-based psychiatric services. “This new law is a high-water mark for Chinese psychiatry, and potentially for global mental health,” according to the editorial.

In comments to Psychiatric News today, lead author of the editorial Michael Phillips, M.D., said the new law is much more comprehensive than laws in other countries. “China's experience in providing a more holistic approach to mental health problems will, hopefully, generate lessons that all countries can learn from,” he said. Phillips, who is executive director of the World Health Organization's Collaborating Center for Research and Training in Suicide Prevention at China's Beijing Huilongguan Hospital, added, “Like the U.S., China is struggling with finding the right balance between the care and control of the mentally ill…. Both China and the U.S. need to work on finding the right balance between individual freedom, family responsibility, and protection of the community. There are no absolute answers to these issues, so the U.S. and China can learn from each other as they work towards finding the solutions that best fit their respective cultural and health-care environments.”

The AJP editorial, “China’s New Mental Health Law: Reframing Involuntary Treatment,” is online here.

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