Involuntary Commitment and Other Civil Liberties

Abstract

Civil libertarians and patient’s rights advocates consistently argue against involuntary civil commitment because of the significant deprivation of liberties involved. Where does one draw the line, balancing individual liberties against protection of society? Did the public hospital system in New York City discharge Goldstein after four days because of concern for his civil rights? Or, did they have a long waiting list and prefer to provide treatment for more compliant, less violent individuals? Did it see Goldstein’s violence as a product of his mental illness or rather, as a personality disorder that could not be treated? These questions have no easy answers. Under what circumstances should people be hospitalized against their will if they have not committed a crime? Today it is agreed by most states that anyone who has a mental illness and is dangerous to him or herself or others, including being unable to care for him or herself would fit the definition. But, assessment and implementation of this standard is variable; many factors impacting upon it, not the least of which is the availability of resources. This chapter will look at some of the legal history behind involuntary commitment as well as some issues involved in the assessment of violent behavior.

Andrew Goldstein pushed a young woman, Kendra Webdale, to her death in a New York City subway station in January 1999. In the two years preceding this attack, Goldstein had been voluntarily hospitalized in psychiatric hospitals 13 times, but had been frequently discharged after 3–4 days. Psychiatric hospital administrators make decisions whether to admit a patient for long term care, if the patient requests it (and can afford it), to refer him or her to another treatment facility, or if the patient does not want to remain in treatment voluntarily, to determine whether the patient meets the criteria for involuntary hospitalization which requires a mentally ill person to be a danger to him or herself or others. Despite the fact that in the two years prior to Kendra’s death, Goldstein had assaulted at lease 13 people, including treatment staff at several of the hospitals, he was NOT seen as meeting the criteria for involuntary commitment.