Civil Commitment and the Opioid Epidemic: A Call for Research

By Scott Burris, JD

There is a lot of interest in civil commitment these days, as a possible tool to fight two big health problems. As we continue to watch the rates of opioid-related deaths climb, and in the wake of an unfunded emergency declaration by President Trump, some policymakers are looking to involuntarily commit overdose survivors for drug treatment. On the gun violence side, experts like Jeffrey Swanson have argued for applying gun-access restrictions that now cover people subject to long-term civil commitment to those subjected to short-term civil commitment.

With those kinds of ideas in the air, it is important to recognize how little modern data we have on commitment and its effects. In a recent article in the Washington Post discussing commitment for opioid treatment, Michael Stein and Paul Christopher emphasize how little we know. I entirely agree on the need for more research, and offer a couple of things to help.

The first is the Policy Surveillance Program’s LawAtlas dataset that maps civil commitment laws across all 50 states and the District of Columbia. If we’re going to examine these laws and their impact, this is the place to start. We also put out the call to anyone interested in studying this to work with us not only to update this data through 2017, but also to make sure we’re mining these laws and their characteristics for the right information in these circumstances — Are we asking the right questions? Read More

Involuntary Outpatient Commitment in the US

Civil commitment laws in the United States variably give authority to mental health providers, law enforcement, and others to compel someone to receive treatment if they may be a danger to themselves or others because of mental illness. These laws have long been a topic of discussion, but there has been limited research on their impact to patients and their communities, largely because the laws have not been effectively or reliably catalogued. The Policy Surveillance Program has been actively collecting and coding state civil commitment laws and regulations to create an index.

The research breaks down civil commitment into three categories: short-term, long-term, and involuntary outpatient commitment.

Under involuntary outpatient commitment laws, individuals with mental illness who meet certain criteria, such as danger to self or others, are required to receive mandatory treatment in an outpatient setting. An individual may be placed directly into outpatient treatment with a court order or after the patient has already been placed in an inpatient treatment facility (more commonly referred to as conditional release). Read More

Is our legal commitment process an evidence-based model?

By Bryan Kozusko

The research methods used by the Policy Surveillance Program to develop datasets mapping health laws and policies include secondary research that provides context to the law, identifies the legal strategy it embodies, and uncovers any evidence to suggest whether it is improving health and well-being. While policy surveillance is meant to facilitate an evidence-building process by producing robust data for analysis, researchers attempt to uncover some indication that existing policies are evidence-based.

The Policy Surveillance Program has been mapping involuntary civil commitment laws at various levels: short-term inpatient commitment, long-term inpatient commitment, and outpatient civil commitment. So far, a literature review is inconclusive on the effectiveness of involuntary outpatient civil commitment.

Domestically, a handful of studies appear to exist. To date, only two systematic studies have been performed, both of which yield inconclusive or inconsistent results (see Kisely & Campbell, 2014, and Ridgely, Borum & Petrila, 2001). The Kisely and Campbell review shows an overall improvement in areas such as social functioning and quality of life; however, researchers acknowledge the sample size is very small and the quality of the trials range from low to medium. The Ridgely et al. review gathered similar unreliable data, inconsistent or conflicting results on quality of life after commitment. Read More

Short-Term Emergency Commitment Laws and their Impact on Firearm Possession Rights

By Andrew T. Campbell, Esq.

The Policy Surveillance Program recently updated its dataset analyzing state laws governing the short-term emergency commitment process. This dataset includes state laws that limit an individual’s right to possess a firearm following short-term emergency commitment. This aspect of the law captured by the dataset is particularly relevant given the unfortunate rise in mass shootings throughout the United States in recent years, with the latest shooting occurring in Kalamazoo, Michigan on February 21 (see also Deadliest U.S. mass shootings – 1984-2015 from the Los Angeles Times). These mass shooting tragedies have spurred debate and legislative action on gun control, to which issues of mental health have become inextricably intertwined despite research that indicates that mental illness is only a small factor in violence (see for example Mental health legislation complicated by gun control debate from The Washington Post; and Debate over gun control, mental health starts anew from CBS News). Additionally, on January 5, 2016, President Obama announced an executive action to battle gun violence, which includes a $500 million investment toward increasing access to mental health care.

With respect to the legal landscape, federal law restricts the sale of firearms to individuals who have been adjudicated as a “mental defective” or “committed to any mental institution.” Committed to a mental institution in this instance encompasses long-term involuntary commitments, but does not include those admitted for observation, i.e., short-term emergency commitment. Some states, however, have gone further and have enacted more extensive legislation that limits the right to possess a firearm for individuals who have been subject to short-term emergency commitment. With short-term emergency commitment, law enforcement officers and certain other individuals have the right to involuntarily admit individuals to a mental health care facility for a short period of time if they are displaying symptoms of a mental illness and pose a danger to themselves or others. Read More