THERE ARE CRACKS IN THE CIVIL COMMITMENT PROCESS: A PRACTITIONER'S RECOMMENDATIONS TO PATCH THE SYSTEM.

Author:Stone, Donald
 
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Introduction 790 I. The Government's Power to Confine, Minimal Due Process Protections, and the Remaining Void of Due Process Protections 791 A. The Government's Power to Apprehend and Confine a Person with a Mental Illness 791 B. Minimal Due Process Protections Afforded by the Supreme Court 793 C. The Void of Due Process Safeguards in the Civil Commitment Process: Lessard v. Schmidt 794 II. The Constitutional Right To Remain Silent: Does It Apply To Civil Commitment Proceedings? 798 A. Miranda and the Civil Commitment Process 799 B. State Laws on the Right to Remain Silent in the Civil Commitment Setting 801 III. The Authority of a Mental Health Professional to Testify at a Civil Commitment Hearing: Can the Patient Prevent the Introduction of Statements Made During the Course of the Psychiatric Evaluation? 804 IV. The Applicability of Evidence Rules and the Use of Hearsay at the Commitment Hearing 807 V. The Burden of Proof Standard Employed in the Civil Commitment Hearing 810 VI. The Right To An Independent Psychiatric Evaluation 811 VII. Alternatives To The Adversarial Civil Commitment Hearing 812 VIII. Other Than The Mentally Ill Person, Who Should Be Permitted To Consent To In-Patient Treatment?: Guardian, Power of Attorney or Parent 814 IX. Recommendations to Repair the Broken Involuntary Civil Commitment Process 817 Appendix A: Rights to Remain Silent, Against Compelled Testimony, or Against Self-incrimination 820 Appendix B: Applicability of Evidence Rules and Use of Hearsay at Commitment Hearing 825 Appendix C: Burden of Proof 830 Appendix D: Right to Independent Evaluation 833 Appendix E: Guardian Mental Health Care Decision Statutes 837 INTRODUCTION

When a dangerously mentally ill person is in need of in-patient psychiatric hospitalization, the apparatus for involuntary civil commitment goes into motion. As a result, a mentally ill person can be confined against his or her will, to remain in the hospital indefinitely. The mentally ill person's freedom depends on the outcome of a single hearing. The civil commitment process raises a number of legal questions: What are the constitutional protections against self-incrimination and the right to remain silent? Who presides over the hearing? Do the rules of evidence apply, specifically hearsay? Is the burden of proof standard by the preponderance of evidence, clear and convincing, or beyond a reasonable doubt? Should the mentally ill person have the right to an independent evaluation of his or her psychiatric condition to contest the view of the hospital psychiatrist? Is the adversarial hearing process best suited to address the need for in-patient hospitalization? Should legal guardians and those designated as power of attorney be given the authority to voluntarily admit a patient into a psychiatric hospital?

This Article will explore the current involuntary civil commitment process for confining a mentally ill and dangerous person in a psychiatric hospital. A criminal defendant is often guaranteed greater protections than a mentally ill person facing involuntary civil commitment. As a person's freedom is at stake, the serious nature of confinement warrants a critical review of how we address the need for psychiatric treatment of our dangerously mentally ill.

Part I will examine the government's power to confine a mentally ill person and the minimum due process safeguards for involuntary admission. Part II will explore the applicability of the constitutional right to remain silent in civil commitment proceedings. Part III will discuss the authority of mental health professionals to testify at the civil commitment hearings and consider issues of privileged communication. Parts IV and V will look at issues pertaining to the rules of evidence, ranging from the burden of proof to hearsay evidence as heard by the hearing judge. Parts VI and VII will analyze respectively the right to an independent psychiatric evaluation and alternative procedures to resolve the determination of the need for hospitalization. Part VIII will address the rights of others to consent to voluntary hospitalization of a mentally ill person, including guardians, persons with power of attorney, and parents of minor persons. Part IX will make recommendations for improving the involuntary civil confinement process.

This Article provides an analysis of the current system and practical, concrete suggestions for improving the involuntary civil confinement process through the eyes of the attorney representing the mentally ill client facing involuntary psychiatric hospitalization.

  1. THE GOVERNMENT'S POWER TO CONFINE, MINIMAL DUE PROCESS PROTECTIONS, AND THE REMAINING VOID OF DUE PROCESS PROTECTIONS

    This section outlines a historical perspective of the civil commitment process, including the source of the government's power to confine mentally ill persons, the minimum due process safeguards for the procedure, and the voids that still exist in those safeguards.

    1. The Government's Power to Apprehend and Confine a Person with a Mental Illness

      Half a century ago, it was recognized that the current treatment of persons with mental illness was inhumane and that change was imperative. State and federal courts, acknowledging that civil commitment was a significant curtailment of liberty interests, (1) established procedural limitations to the previously unchallenged practice of committing mentally ill persons for treatment purposes under parens patriae powers. (2) Following landmark Supreme Court decisions, (3) most states adopted a stricter criterion for civil commitment requiring, at a minimum, a showing of "dangerousness." (4)

      According to the United States Supreme Court, the State has a legitimate interest under its parens patriae power in providing care to the mentally ill who are unable to care for themselves. (5) In addition, the Court recognizes the state has the authority under its police power to protect the community from the dangerously mentally ill. (6) The interplay of these two opposing governmental roles presents conflict when the rights of the involuntarily confined are at stake.

      Unfortunately, several decades later attitudes have changed and the pendulum has swung in the opposite direction, lowering the threshold. (7) State legislatures, with the broad support of the medical community, (8) have moved to expand the definition of "dangerousness" back to the dark ages prior to the 1960s. Only eight states still define dangerousness solely as a "danger to self or others." (9) Forty-two states provide criteria broader than dangerousness that often include either a "grave disability" (10) or a "need for treatment" (11) provision.

      The regressive trend in civil commitment laws requires scrutiny. In most cases, criminal defendants, whom the government has authority to confine via the police power, are afforded greater protections than mentally ill persons facing involuntary civil commitment.

    2. Minimal Due Process Protections Afforded by the Supreme Court

      The United States Supreme Court articulated in O'Connor v. Donaldson that the purpose of involuntary hospitalization is treatment and not mere custodial care or punishment if the patient is not a danger to himself or others. (12) The Court declared that a state cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends. (13) The Court specifically held:

      A finding of 'mental illness' alone cannot justify a State's locking a person up against his will and keeping him indefinitely in simple custodial confinement. Assuming that that term can be given a reasonably precise content and that the 'mentally ill' can be identified with reasonable accuracy, there is still no constitutional basis for confining such persons involuntarily if they are dangerous to no one and can live safely in freedom. (14) Thus, the confinement of a non-dangerous person based upon mental illness alone is not constitutionally sufficient. (15)

      In the landmark case Addington v. Texas, the Supreme Court recognized that civil commitment "constitutes a significant deprivation of liberty" (16) and that mentally ill individuals facing involuntary civil commitment can lead to adverse social consequences. (17) The Court noted the very significant impact an involuntary commitment to a mental hospital would have on the individual by stating:

      [I]t is indisputable that involuntary commitment to a mental hospital... can engender adverse social consequences to the individual. Whether we label this phenomena "stigma" or choose to call it something else is less important than that we recognize that it can occur and that it can have a very significant impact on the individual. (18) The Court appreciated the individual's interest in the outcome of a civil commitment proceeding is of the weight and gravity that due process requires the state to justify confinement by proof more substantial than a mere preponderance of the evidence. (19) The Court held that the proper burden of proof at the civil commitment hearing was a clear and convincing evidence standard of proof, (20) although as will be discussed later, several states laws have applied the more stringent beyond a reasonable doubt standard. (21)

      Another significant cornerstone of due process protections for persons facing civil commitment is limiting the length of the stay in the hospital. In Jackson v. Indiana. (22) the Court announced its prohibition on indefinite confinement, holding that it violates the Fourteenth Amendment's guarantee of due process. (23) In so holding, the Court imposed a rule of reasonableness, requiring that without a finding of dangerousness, one committed through the civil commitment process could only be held for a reasonable period of time. (24)

    3. The Void of Due Process Safeguards in the Civil Commitment Process: Lessard v. Schmidt

      Lessard v. Schmidt, a landmark mental...

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