Involuntary Civil Commitment

Where We Stand

NAMI believes that all people should have the right to make their own decisions about mental health treatment. However, in rare instances where voluntary engagement is not possible, NAMI supports involuntary civil commitment only when used as a last resort and only when it is believed to be in the best interests of the individual.

Why We Care

When people with serious mental illness (SMI) are unable to access quality mental health treatment, it can have profoundly negative consequences on their short- and long-term health and wellbeing. For people who experience clinical deterioration and an increase in symptoms, they may be unable to get treatment due to a lack of available mental health care or, in some cases, due to an unwillingness to voluntarily receive treatment. Not accessing timely and quality treatment — regardless of the reason — can put a person’s long-term mental and physical health at risk.

Involuntary civil commitment refers to the legal process by which a judge orders an adult with severe symptoms of mental illness, such as delusions or paranoia that may contribute to an unwillingness to receive treatment, to receive inpatient psychiatric treatment or supervised outpatient treatment without the individual’s consent. Each state has laws that regulate involuntary civil commitment and often include options for law enforcement or mental health providers to initiate an initial hold for evaluation that lasts for a set period of time, typically between 24 to 72 hours. NAMI believes that involuntary civil commitment should be used in instances where all other options have been exhausted, or as an “option of last resort.”

One form of involuntary civil commitment is known as Assisted Outpatient Treatment (AOT). AOT legally mandates participation in outpatient treatment, which may include services such as case management; specialty, intensive services like assertive community treatment (ACT); and psychopharmacological services via medication management. Nearly all states have AOT laws, and some studies have shown AOT to be associated with short-term improvements in treatment engagement, clinical functioning, and social outcomes. While state laws vary, to be eligible for AOT, an individual must be 18 years of age or older and be eligible under the state’s law, which often requires that the individual have a diagnosed SMI and a record of repeated consequences of not engaging with treatment, such as repeated hospitalization, arrest, or homelessness.

However, involuntary civil commitment does not produce positive results for everyone, and NAMI recognizes that discussions about involuntary civil commitment and its use can be challenging and emotionally charged for both peers and family members. Ideally, the need for involuntary civil commitment would be reduced as the availability of effective, comprehensive, community-based systems of care for people with mental illness increases. This is supported by evidence that engaging someone in their own mental health care is key to recovery and treatment satisfaction. This is why early intervention, engagement of the individual (as well as the family, where possible), and robust community mental health services should be in place to support people with mental illness in every community, and why involuntary civil commitment should only be used as a last resort for the small percentage of people that require this type of intensive intervention.

How We Talk About It

• There is a lack of availability of effective, comprehensive, community-based care for people with mental illness.
• However, better access to care — provided as early as possible — can lead to better long-term outcomes and wellbeing.
• The best scenario is for a person with severe symptoms of mental illness to be engaged in their own treatment and to receive community-based care.
• Unfortunately, many people have fallen through the cracks of our mental health system, putting their physical and mental well-being at risk.
• When people have untreated symptoms, it can often lead to negative outcomes like homelessness, hospitalization, and incarceration.
• Involuntary, court-ordered civil commitment is a legal process that can benefit some individuals with the most severe symptoms when their mental health has deteriorated to a point that they are not willing to voluntarily engage in treatment — but their wellbeing is at risk.
• People should be able to make their own treatment decisions whenever possible, so involuntary civil commitment should only be used as an option of last resort.
• When involuntary civil commitment is used, courts and the mental health system must work together to ensure that people receive the care they need and are engaged as much as is possible in their treatment.
• All treatment decisions should always be made based on the best interests of the individual.
• Communities should continue to prioritize early intervention strategies to reduce the necessity of involuntary commitment while utilizing involuntary civil commitment when all other options have failed.

What We’ve Done

• NAMI State Legislation Report: Trends in State Mental Health Policy (2022), Understanding the Issue: Civil Commitment
• NAMI policy position on Problem Solving Courts/Specialty Courts