Ethical and Legal Issues 733
long they can commit a defendant to a mental health facility to determine whether
treatment may lead to competence to stand trial. Such treatment may last several
years. If the defendant does not become competent, he or she may not remain com-
mitted for the original reason—to receive treatment in order to become competent.
In this case, the process of deciding whether he or she should be released from the
mental health facility proceeds just as it does for anyone who hasn’t been criminally
charged. If the individual is deemed to be dangerous, however, he or she may be
civilly committed.
Civil Commitment
When an individual hasn’t committed a crime but is deemed to be at signifi cant risk
of harming himself or herself, or of harming a specifi c other person, the judicial sys-
tem can confi ne that individual in a mental health facility, which is referred to as a
civil commitment. This is the more common type of commitment.
There are two types of civil commitment: (1) inpatient commitment to a 24-hourinpatient facility, and (2) outpatient commitment to some type of monitoring and/
or treatment program (Meyer & Weaver, 2006). Civil commitment grows out of the
idea that the government can act as a caregiver, functioning as a “parent” to people
who are not able to care for themselves; this legal concept is called parens patriae.
The interplay between dangerousness, duty to warn, and civil commitment isillustrated by what happened to Mr. Smith, described in Case 16.3.
CASE 16.3 • FROM THE OUTSIDE: Civil Commitment and Duty to Warn
Smith has experienced a life-long pattern of diffi culty in interacting with others and in func-
tioning effectively in social and occupational situations. He tends to be emotionally uncom-
fortable and interpersonally awkward. He is inclined to interpret the words and actions of
others idiosyncratically, and he characteristically avoids situations that require interpersonal
exchanges. He manages to provide for his basic tangible needs, but he remains emotionally
withdrawn and interpersonally isolated. He works as a janitor who cleans offi ce buildings at
night after closing. He lives in a rooming house populated primarily by residents who have
had mental health diffi culties. He has no friends among the residents, but he ordinarily gets
along in the house without serious diffi culty by limiting interaction with the other residents.
Smith has been convicted of assault on three occasions. In each of the fi rst two incidents,
he struck another individual, causing minor injuries involving bruises and abrasions. Follow-
ing the fi rst assault, he was convicted and placed on probation. Following the second convic-
tion, he served 60 days in the county jail and was released on parole. In the third incident,
he struck a coworker with a wrench, causing serious but not permanent or life-threatening
injuries. He served 6 months in the county jail for that offense. During legal proceedings fol-
lowing each assault, various participants in the legal system realized that he suffered some
psychological disorder, but none believed that his impairment was suffi cient to support an
insanity defense or civil commitment. These individuals recommended that Smith seek treat-
ment after release.
He refused to seek treatment after the fi rst conviction, but he began attending weekly psy-
chotherapy sessions as a condition of his release on parole following the second conviction,
and he returned to therapy following release from jail following the third offense. The treat-
ing psychologist has diagnosed Smith as suffering from a personality disorder with schizoid
and paranoid features. Although he is no longer on parole, Smith has continued attending
the weekly sessions. During these sessions, he expressed his belief that the convictions were
unfair because in each case he had struck out to protect himself from others who had begun
watching him, picking on him, and looking for an opportunity to harm him.
During the last few sessions, Smith told the psychologist that “now, they’re starting
again.” He reported having missed work twice during the previous couple of weeks because
a coworker named Brown had made comments that Smith interpreted as either warnings
or threats. As they were leaving work early in the morning, Brown stated, “be careful” and
“watch your step out there.” Smith reported that he was uncertain whether Brown was threat-
ening him or warning him about others who might harm him.
The psychologist encouraged Smith to consider alternative interpretations of Brown’s com-
ments. When Smith seemed unable to consider any alternative interpretation, the psycholo-
gist became increasingly concerned that Smith’s reality testing was deteriorating and thatCivil commitment
The involuntary commitment to a mental
health facility of a person deemed to be at
signifi cant risk of harming himself or herself
or a specifi c other person.
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