State statutes governing involuntary outpatient civil commitment.

Abstract

Involuntary outpatient civil commitment (IOC) is the legal nd psychosocial process whereby an allegedly mentally disordered and dangerous person is forced to undergo mental health treatment or care in an outpatient setting. IOC has been viewed as a viable means to pro vide mental health and social services to mental patients who do not require continuous inpatient hospitalization, but who, nevertheless, resist needed treatment and care in voluntary settings less restrictive than a hospital. Perceived failures of deinstitutionalization, the plight of homeless mentally ill persons, and dissatisfaction with in flexible civil commitment laws have spawned considerable interest in the IOC alternative to compulsory inpatient treatment.1 Until now there have been no surveys of state laws governing this form of compulsory outpatient treatment. Indeed, there appears to be considerable disagreement whether IOC is even permitted in various states.2 This brief commentary and table survey state laws governing IOC and summarize those that make explicit provision for IOC; general civil commitment laws, which may or may not be applicable to IOC, are not included.3 For the purposes of this survey, IOC is narrowly defined as the dispositional options (tying between inpatient hospitaliza tion and outright release) available to a civil court after an adjudication of involuntary civil commitment. IOC is distinguished from conditional release that follows a period of court-ordered hospitalization by (1) the decision-making authority (i.e., court versus treatment facility) and (2) the stage in the commitment process at which it is applied (i.e., the commitment hearing versus following initial institutionalization). IOC also is distinguished from guardianship and protective services procedures that may achieve results similar to IOC. Final ly, this definition of IOC does not encompass the involun tary outpatient commitment of persons found permanently incompetent to stand trial or not guilty by reason of insanity. Although virtually all the states permit IOC, a few ? North Carolina, Hawaii, and Arizona ? have been touted as trailblazers willing to experiment with IOC laws.4 Only New York appears to prohibit IOC by equating involuntary civil commitment with inpatient hospitalization.5 Twenty-six states and the District of Col umbia make explicit provision for IOC. The remaining 23 states (not including New York) may permit IOC by not explicitly prohibiting a court from committing a men tally disturbed individual to compulsory community based treatment and care. Virtually all states provide at least a partial guarantee of compulsory treatment and care in the least restrictive environment.6 It is unclear, however, whether the 24 states that do not make explicit provisions for IOC view IOC as a necessary corollary to the least restrictive alternative guarantee; whether authori ty to order IOC in fact is implicit in these states; or if the legislatures intended to preclude IOC altogether, as seems to be the case in New York. Even among the states that have explicit provisions for IOC, the table reveals little unanimity in their approaches. Alaska, Delaware, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, and Virginia provide the statutory authority for a court to order IOC but are silent on the myriad issues attendant to that authority.7 Arizona, Hawaii, Illinois, Michigan, North Carolina, and Oklahoma, however, have more elaborate provisions ad dressing such issues as the definition of an outpatient set ting; the standard for IOC; the prerequisites for IOC disposition; the role of the courts in formulating and ordering IOC; hearing requirements; the duration of IOC; early release procedures; monitoring and supervi sion of IOC; review of compliance with IOC conditions; and revocation of IOC status. Most states authorizing IOC require a court determina tion that the person involved meets the general commit ment criteria of mental illness and dangerousness. Four states ? Hawaii, North Carolina and, arguably, Arizona and Arkansas ? impose different standards of mental impairment and dangerousness for IOC than apply for inpatient hospitalization.8 The North Carolina IOC law, for example, seems expressly designed to widen the net This commentary and table are an abridged version of a forthcoming journal article that describes the legislative development of involuntary outpatient commitment, reviews relevant case law, and discusses various im pediments to widespread implementation of laws govern ing compulsory outpatient treatment. The survey is based on research of the Involuntary Civil Commitment Proj ect, which is conducted by the Institute on Mental Disability and the Law and the National Center for State Courts, and is supported by the John D., and Catherine T. Mac Arthur Foundation. The authors are researchers at the institute.