Involuntary commitment or civil commitment is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily. Criteria for civil commitment are established by laws, which vary between nations.
United Nations United Nations General Assembly (resolution 46/119 of 1991), "Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care" is a non-binding resolution advocating certain broadly-drawn procedures for the carrying out of involuntary commitment. These principles have been used in many countries where local laws have been revised or new ones implemented. The UN runs programs in some countries to assist in this process.
Australia In Australia, court hearings are not required for involuntary commitment. Mental health law falls under state powers constitutionally. Each state thus has different laws, many of which have been updated in recent years.
Referral for service The usual requirement is that a police officer or a physician determine that a person requires a psychiatric examination, usually through a psychiatric hospital. If the person is detained in the hospital, they usually must be seen by an authorized psychiatrist within a set period of time. In some states, after a further set period or at the request of the person or their representative, a tribunal hearing is held to determine whether the person should continue to be detained. In states where tribunals are not instituted, there is another form of appeal. Some Australian states require that the person is a danger to the society or themselves; other states only require that the person be suffering from a mental illness that requires treatment. The Victorian Mental Health Act (1986) specifies in part that:
"(1) A person may be admitted to and detained in an approved mental health service as an involuntary patient in accordance with the procedures specified in this Act only if— (a) the person appears to be mentally ill; and (b) the person's mental illness requires immediate treatment and that treatment can be obtained by admission to and detention in an approved mental health service; and (c) because of the person's mental illness, the person should be admitted and detained for treatment as an involuntary patient for his or her health or safety (whether to prevent a deterioration in the person's physical or mental condition or otherwise) or for the protection of members of the public; and (d) the person has refused or is unable to consent to the necessary treatment for the mental illness; and (e) the person cannot receive adequate treatment for the mental illness in a manner less restrictive of that person's freedom of decision and action. There are additional qualifications and restrictions but the effect of these provisions is that people who are assessed by doctors as being in need of treatment may be admitted involuntarily without the need of demonstrating a risk of danger. This overcomes the pressure described above to exaggerate issues of violence, or to verbal statements, to obtain an admission.
Treatment In general, once the person is under involuntary commitment, treatment may be instituted without further requirements. Some treatments, such as electroconvulsive therapy (ECT), often require further procedures to comply with the law before they may be administered involuntarily. Community treatment orders can be used in the first instance or after a period of admission to hospital as a voluntary/involuntary patient. With the trend towards deinstitutionalization, this situation is becoming increasingly frequent, and hospital admission is restricted to people with severe mental illnesses.
Finland Involuntary commitment requires three criteria: 1) severe mental illness with impaired insight; 2) that a lack of treatment would worsen the condition or endanger the safety or security of the patient or others; 3) and other treatments or services are insufficient or inapplicable. If found insane, criminal offenders may not be sentenced. Instead, they must be referred to THL (National Institute for Health and Welfare) for involuntary treatment. Niuvanniemi hospital specializes in involuntary commitment of criminal patients.
France About 24% of patients in French psychiatric wards are committed involuntarily. A person may be committed if they are an imminent danger or at the request of either a third party, usually a family member, one or two physicians or a representative of the state.
Classic admission: To involuntarily commit a person, are needed: a handwritten request from a third party with a relationship to the person (e.g. a member of the patient's family or a care giver), excluding care givers working in the institution caring for the sick person, two supporting medical certificates, at least one of which is drawn up by a doctor outside of the institution giving care to the person. Admission in case of imminent danger: a single medical certificate drawn up by a doctor who is not part of any establishment caring for the person, suffices to involuntarily commit a person. This practice has led to abusive banalisation according to a report by the health ministry. Admission in case of emergency: A handwritten request from a third party and a medical certificate suffice to involuntarily commit a person. From an admission at the request of a representative the state to occur, the mentally ill person must be a danger to themselves or others, or cause a serious breach of public order, in which case the mayor (temporarily and only when there is a danger to the safety of persons) or the prefect, may issue a decree in support of a medical certificate issued by a doctor outside the receiving institution to admit that person.
Germany In Germany, there is a growing tendency to use the law on legal guardianship instead of mental health law for justification of involuntary commitment or treatment. A legal guardian decides that their ward must go into mental hospital for treatment, and the police then acts on this decision. This is simpler for the government and family members than the formal process for commitment under mental health laws. In German criminal law, a person who was convicted of certain crimes can also be sentenced to be kept in preventive detention; see article on preventive detention.
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