Encyclopedia of Psychology and Law

• The person is 18 years of age or older.


• He or she suffers from a mental illness.


• The individual is unlikely to survive safely in the
  community without supervision.


• He or she has a history of lack of adherence to treat-
  ment for mental illness.


• As a result, within a defined period in the past (usu-
  ally 36 or 48 months), he or she has been hospitalized
  or jailed or has engaged in dangerous conduct
  (including threats).


• The individual refuses treatment or lacks the capacity
  to accept treatment voluntarily.


• In light of the person’s history and condition, the per-
  son requires treatment to prevent a relapse or deterio-
  ration that could result in harm to the person or others.

A primary difference between criteria such as these

and more typical involuntary commitment criteria is

that these criteria are preventive in nature, permitting

intervention in anticipation of the person’s relapse or

deterioration. In contrast, most civil commitment

statutes permit intervention only after the occurrence

of specified behavior, typically defined as being dan-

gerous to either self or others, or an inability to meet

basic needs.

These “pure” outpatient commitment statutes also

typically require a finding by the judge that treatment

will be available to the person if the court orders it.

The statute may specify the types of treatment that

may be ordered as part of an outpatient treatment

order. For example, the New York law (which uses the

phrase “assisted outpatient treatment” rather than

involuntary outpatient civil commitment) states that

ordered treatment

shall include case management services or assertive

community treatment services to provide care coor-

dinate, and may also include any of the following

categories of services: medication; periodic blood

tests or urinalysis to determine compliance with pre-

scribed medications; individual or group therapy;

day or partial day programming activities; educa-

tional and vocational training or activities; alcohol or

substance abuse treatment and counseling and peri-

odic tests for the presence of alcohol or substance

abuse; supervision of living arrangements; and any

other services...prescribed to treat the person’s

mental illness and to assist the person in living and

functioning in the community, or to attempt to pre-

vent a relapse or deterioration that may reasonably

be predicted to result in suicide or the need for hos-

pitalization. (N.Y. Mental Hygiene Law § 9.60(a)(1))

The specific definition of services that must and

may be included as part of an outpatient treatment

order also differs from a typical involuntary commit-

ment statute, which does not provide such specificity.

Consequence of Noncompliance

With an Outpatient Treatment Order

If the person fails to comply with the treatment order,

state law typically permits one of two responses. The

person may be brought back to court, and the court may

impose new conditions, emphasize the importance of

complying with the existing conditions, or hold the per-

son in contempt of court—something that rarely, if

ever, happens. Second, the person may be ordered to an

inpatient setting for assessment to determine whether

the person now meets the criteria for inpatient commit-

ment. If so, the person may be hospitalized under the

state’s involuntary commitment provisions.

One of the primary reasons for the enactment of out-

patient civil commitment provisions is the argument

that individuals with mental illnesses who quit taking

prescribed medication are the group of people most at

risk for deterioration and ultimately behavior that

endangers them or others. Outpatient commitment laws

typically permit a judge to order the person to take

medication as part of the commitment order. However,

before a person may be forced to take medication, state

laws usually require another court hearing to determine

if the person lacks the capacity to make decisions

regarding medication. If the person is found to have the

capacity (i.e., the legal competency) to make decisions

about medication, then the person is usually permitted

to continue to refuse medication despite the fact that he

or she is under an outpatient treatment order.

The Legality of Outpatient

Commitment Statutes

Some have criticized outpatient commitment statutes

on legal grounds, arguing that they represent an unwar-

ranted and legally suspect extension of the state’s

authority to force people to accept treatment against

their will. However, courts have uniformly upheld the

constitutionality of outpatient commitment statutes

and in doing so have provided judicial endorsement of

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