Involuntary Commitment Part 1
I often have been asked about the involuntary commitment process for mental illness. Because of that, I decided to write 2 posts about it. This post will cover only the law and the process of commitment. The next post will cover some of my thoughts on involuntary commitment.
First, I want to say that this is only covering Maine law, I don’t know anything about the laws of other states. Second, this is only a very basic over view of the process and law. Lastly, I’ve included some links at the end of the post that will take you to some pages that will give you more information on the process if you are interested or looking for something more in depth.
Involuntary commitment is when a person is admitted into a psychiatric facility against their will.
This is the law requirements under which individuals can be involuntarily committed under:
ME. REV. STAT. ANN. tit. 34-B, § 3864(6)(A). The District Court shall so state in the record, if it finds upon completion of the hearing and consideration of the record:
(1) Clear and convincing evidence that the person is mentally ill and that the person’s recent actions and behavior demonstrate that the person’s illness poses a likelihood of serious harm;
(2) That inpatient hospitalization is the best available means for treatment of the patient; and
(3) That it is satisfied with the individual treatment plan offered by the hospital to which the applicant seeks the patient’s involuntary commitment.
ME. REV. STAT. ANN. tit. 34B, § 3801(4). “Likelihood of serious harm” means:
A. A substantial risk of physical harm to the person himself as manifested by evidence of recent threats of, or attempts at, suicide or serious bodily harm to himself and, after consideration of less restrictive treatment settings and modalities, a determination that community resources for his care and treatment are unavailable;
B. A substantial risk of physical harm to other persons as manifested by recent evidence of homicidal or other violent behavior or recent evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them and, after consideration of less restrictive treatment settings and modalities, a determination that community resources for his care and treatment are unavailable; or
C. A reasonable certainty that severe physical or mental impairment or injury will result to the person alleged to be mentally ill as manifested by recent evidence of his actions or behavior which demonstrate his inability to avoid or protect himself from such impairment or injury, and, after consideration of less restrictive treatment settings and modalities, a determination that suitable community resources for his care are unavailable.
* Maine does not have an assisted outpatient treatment law. Meaning that all court required treatment will be on an inpatient level of care.
This basically comes down to the person has to be homicidal, suicidal or at risk of serious self injury for the court to require a patient to receive care. An example of risk for serious self injury: a person is found naked, laying in the snow and reports that they plan to lay in such manner until the aliens come for them. This person does not plan on killing themselves but their mental illness puts themselves at risk for dying. The cases regarding risk of serious self injury are much more complex.
Most of the time the involuntary process starts when a person is brought into the emergency room by the police via protective custody. This is when the police have reasonable grounds to believe that the person has mental illness and is a threat to themselves or others. This gives the police the authority to bring the person to the emergency room for evaluation by a doctor rather then arresting them for their threatening behaviors.
The first step is a “Blue Paper” which is the request to have someone involuntary committed. Anyone can start the blue paper, but it is usually started by health care staff or law enforcement officers. They complete part 1. Then they find a doctor to examine the patient who must complete an assessment of the patient’s level of risk and complete part 2 of the form. This is normally done in the emergency room. Then a judge or justice of the peace must certify that the blue paper has been completed and file the completion in the record. They are not verifying the information on the paper or committing the person at that time.
Side Note: It’s called a blue paper because it is literally a blue paper. The various papers are colored so that it is simple to tell which are the originals (for the most important steps) and to tell which steps in the process have been completed.
Then the person goes to a hospital. Once there: they can be admitted involuntary as long as the blue paper wasn’t completed more then 2 days prior. They can be admitted voluntary if the patient agrees. Or the person might not be admitted at all if the psychiatrist seeing the patient does not agree that they meet involuntary criteria and the person does not want to be admitted.
Once they are admitted involuntary, they must be seen by another doctor (not the admitting doctor or the one completing the blue paper) with in 24 hours. That doctor must decide if they meet involuntary criteria. If they do, a 24 hour certification or “Yellow Paper” is completed and the person continues to stay at the hospital as a involuntary patient. If they do not agree then the patient is discharged.
If the person continues as an involuntary patient, the hospital then has up to 3 business days to file a “White Paper” or The Request for Court Order of Hospitalization which is filed with the District Court. Once the white paper is filed several things happen. A copy is given to the person and guardian if applicable. Next of kin are also notified if they are listed within the patient’s chart as being individuals to be notified in the event of important changes in the person’s status. The person has the right to choose a lawyer or they have one appointed. They can choose an independent examiner (psychiatrist or psychologist not affiliated with the hospital the person is currently at) or the court will appoint both. They will then be assigned a court date and receive notice of that date within 2 days of the filing of the white paper.
The person is seen by both independent examiners prior to the hearing. The hearing is within 14 days of the filing of the white paper. A 10 day postponement can be applied for by the patient or the hospital.
At the hearing, the court decides: 1. if the person has mental illness, 2. if there is likelihood of serious harm, 3. if hospitalization is the best treatment, 4. if the treatment plan offered by the hospital is satisfactory
If the court answers YES to all of the questions it may commit the person to the hospital as an involuntary patient for a period up to 4 months.
If the court answers YES to the first three questions but is not satisfied with the treatment plan it may postpone the hearing for 10 days to let the hospital revise its treatment plan.
If the court answers NO to ANY of the first three questions, the application must be dismissed and the person must be discharged from the hospital.
The person may appeal an order of commitment to the Superior Court. The appeal must be filed within 21 days of the District Court’s order.
When the commitment period is ending, the hospital may apply for re-commitment for a period of up to 12 months if it believes that the person needs continued involuntary hospitalization. Otherwise the person is discharged when the commitment period is completed. A hospital is not required to hospitalize a person for the entire period of commitment. In fact, it must discharge a person during the commitment period if it determines that conditions have changed and that the person no longer needs hospitalization.
The hospital can stop the process at any time. If a blue paper has been filed and the person is no longer a threat, they do not have to file a yellow paper. If a white paper is filed, and the person is no longer a threat, they can notify the court and drop The Request for Court Order of Hospitalization.
So, as you can see, the involuntary commitment process is complex and long but there are plenty of places that a person can be discharged and the process can be discontinued. The other good thing is the number of doctors required to evaluate the person before they can be committed for a long period of time.
I hope this long winded post was helpful!