Who should be responsible for the mentally ill when they can't be responsible for themselves? Some say is should be their families, but what if they have none or if they are too violent or too sick to be cared for, even by loved ones? Others say treatment providers, but what if they refuse treatment? When all is said and done, it is states, primarily through state-run psychiatric facilities, community mental health centers and court-ordered treatment, that shoulder the responsibility. But concern that the deinstitutionalization movement that began in the 1970s will be undone if states begin, once again, to commit the mentally ill to institutions, has led to exploration of an alternative: mandatory outpatient civil commitment, sometimes called assisted outpatient treatment. 40 states and the District of Columbia currently have outpatient commitment laws, however, 23 rarely use them to order treatment for the mentally ill who refuse. Many civil commitment laws--such as California's Lanterman, Petris, Short Act (LPS Act)--were written 20 to 30 years ago. Some laws have been amended to include outpatient commitment, but judges in many states are not familiar or comfortable with the laws and are reluctant to use them. Pointing to a string of recent tragedies involving the mentally ill-subway killings in New York City, for example, and a car driven into a California day care center-proponents of outpatient commitment believe that because most of the laws were written long ago, they do not contain appropriate criteria. They argue that using criteria that require "dangerousness" or "grave disability" makes the laws very difficult to have someone committed under rendering them ineffective. The understanding of mental illness has progressed significantly in the past 10 years and advocates of assisted treatment laws believe that legislation, the judicial system and public awareness about the process, must progress as well. Opponents of mandatory treatment say it could impinge on a person's civil rights and further that the deinstitutionalization movement may be undone if the strategy is commonly used. Everyone agrees that many mentally ill people too often end up in jail or homeless where the opportunity for treatment is minimal.

In 1999, legislator's in 23 states have introduced at least 51 bills (including 14 in New York) regarding civil commitment and laws relating specifically to outpatient commitment and/or advance directives have been enacted in seven states--Arizona, Georgia, Maine, Texas, Virginia, Washington and Wyoming--this year. Wyoming is the only state that has enacted a new outpatient civil commitment law so far this year.

Source: A National Survey of the Use of Outpatient Commitment, Psychiatric Services, August 1995

Summarizes a full Issue Brief on outpatient civil commitment and may not be reproduced
without the express permission of the Health Policy Tracking Service. © July 1999.