Voluntary vs. Involuntary Commitment
Individuals with mental illness can voluntarily request and receive services or treatment from a variety of government, community, and private programs, including inpatient treatment in hospitals or institutions. However, individuals with mental illness cannot be placed in inpatient institutions or treatment facilities, such as the Utah State Hospital (USH) or private hospitals, against their will for longer than 24-hours without going through involuntary civil commitment proceedings required by Utah law.
An individual who has a mental illness may be voluntarily admitted to a mental health facility for treatment. If the person is less than 16 years old, a parent or legal guardian must sign the admission papers.
(However, see Utah Code 62A-15-703 “A child may receive services from a local mental health authority in an inpatient or residential setting only after a commitment proceeding, for the purpose of transferring physical custody, has been conducted in accordance with the requirements of this section.”)
A voluntary patient has the right to agree to, or refuse, the treatment. The patient also has the right to ask to be released from the facility at any time unless the mental health facility decides that the release of the person would be unsafe for either the person or for others. If so, the mental health facility may delay release of the person for up to 48-hours, not including weekends and holidays. The patient has the right to receive written notice of the reason(s) they are not being released. During the 48-hours, the mental health facility must apply to the court to have the person committed for treatment against their will.
Through the involuntary civil commitment process, a judge or court commissioner can require the person to receive mental health treatment against their will. A person cannot be held for mental health treatment against their will without a hearing before a judge or court commissioner. The process is outlined below. If a judge or court commissioner orders involuntary commitment, a person can be admitted against their will to the Utah State Hospital (USH), an inpatient psychiatric unit in a hospital such as University Medical Care, or a community health agency. A person may be committed for treatment against their will for a short period of time called “Temporary Involuntary Commitment” or for a longer period of time called “Involuntary Commitment under Court Order.”
Temporary Involuntary Commitment
A person may be temporarily committed for inpatient mental health treatment against their will for up to 24-hours in one of two ways:
- Any reasonable individual who thinks that person is mentally ill and likely to seriously hurt themselves or other people if not immediately held must apply in writing to the court for commitment. If a licensed doctor or mental health examiner appointed by the court states in writing that the person has been examined in the last three (3) days, is mentally ill, and is likely to hurt themselves or others if not immediately held, the person under consideration will be admitted to a mental health facility.
- If a police officer sees a person acting in an unusual way, and the officer thinks that the person is mentally ill and is likely to seriously hurt themselves or other people, the officer can take that person to a mental health treatment facility and apply to have the person admitted to the facility.
By either method, a person can be held for 24-hours (not including weekends and/or legal holidays). Once the 24-hour period is up, the person must be released unless an application for an Involuntary Commitment under Court Order has been filed.
Involuntary Commitment Under Court Order
Through involuntary civil commitment proceedings, a judge or court commissioner decides whether a person has a mental illness that makes them dangerous to themselves or to other people. If the court decides that 1) there is clear and convincing evidence that a person is mentally ill and; 2) the person poses a substantial danger of physical injury to themselves or others, the judge or commissioner can order that person to receive mental health treatment against their will through the local mental health agency. This will probably be at an inpatient treatment facility, such as the Utah State Hospital (USH), for up to six (6) months.
“When the individual is not under an order of commitment at the time of the hearing, that period may not exceed six months without benefit of a review hearing. Upon such a review hearing, to be commenced prior to the expiration of the previous order, an order for commitment may be for an indeterminate period…”) Involuntary commitment proceedings begin with the request for temporary commitment described in the previous section. The application must also include a written statement from a doctor, or court-appointed examiner, that the proposed patient has been examined in the last seven (7) days and that the person is mentally ill and should be hospitalized against their will, or that the person has refused to have their mental health examined by a doctor or designated examiner.
If the court decides that the proposed patient is mentally ill and is likely to seriously hurt themselves, other people, or property, the court can order that the person be admitted to a hospital for mental health treatment. The court can also order commitment if the proposed patient refuses to be interviewed by a mental health professional, or refuses to get mental health treatment. A person is not committed to a specific place. They are committed to their local community mental health agency. The person’s treatment team decides if they need to receive services in the community or in a hospital. Most people go into the hospital when they are first committed. The treatment team can decide that the person is ready for community services at any time. Specific steps must be followed for the involuntary commitment to be valid. If the steps are not taken, the person being committed may challenge the court’s order of commitment. These steps include:
- the proposed patient being sent written notice of the date, time, and place of the hearing;
- the written notice must also give the reason(s) why the person should be committed and the facts that support that belief;
- the court must appoint two (2) examiners to evaluate the proposed patient; and
- the hearing must be held with ten (10) days after the court appoints the examiners.
(UT Code §62A-15-631 (2015)(4) (notice) (8)(a) (two examiners) (8)(c) (10 calendar days))
During the hearing, the person to be committed has rights. If those rights are ignored, the court’s order of commitment may be challenged. These rights include:
- requesting that another mental health professional examine them;
- access to an attorney, at no cost if the proposed patient cannot pay for one;
- being present at the hearing;
- giving evidence and testifying at the hearing; and
- the right to present witnesses and cross examine witnesses.
(UT Code §62A-15-631 (2015)(8)(1)(request another examiner) (9)(a) attorney (9)(b) opportunity to appear, testify and witnesses)
At the end of the hearing, the judge or court commissioner decides whether to order that the proposed patient be committed to the local public mental health agency. This usually means that the person will be admitted to a hospital for mental health treatment. Most of the time, people are committed for six (6) months. However, if a person has been committed repeatedly, the judge can order an “indeterminate” commitment. If a person has an indeterminate commitment, they can ask to have it reviewed.
They do not have to wait for a certain period of time before they can ask for a review. The judge can order involuntary commitment if the judge decides the evidence presented at the hearing is clear and convincing that:
- The proposed patient has a mental illness.
- Because of the proposed patient’s mental illness they pose a substantial danger of physical injury to themselves, other people, or are not able to take care of their basic needs such as food, shelter, and clothing.
- The proposed patient is unable to make decisions about their mental health treatment because they cannot evaluate the positives and negatives of treatment.
- There is no less restrictive way for the proposed patient to get treatment.
- The local public mental health agency that the proposed patient is sent to can give the patient appropriate treatment.
Rehearing of the Commitment Order
Any proposed patient that is court ordered to be committed for mental health treatment has the right to request a second hearing (called a rehearing). The proposed patient must make the request to the court within thirty (30) days from the date of the commitment order. If the proposed patient states that the judge or court commissioner has made a mistake, the judge or court commissioner must appoint three (3) different mental health professionals to do three (3) more evaluations of the proposed patient. At the rehearing, all the steps and rights described in the previous section, must be followed.
Review of the Commitment
When the first order of commitment expires (at most, after 6-months), a hearing (called a commitment review hearing) is automatically held by the judge or court commissioner to decide whether the commitment should continue. Before the review hearing, the mental health facility must review the reason for the patient’s commitment. If the mental health facility decides that the reason(s) for commitment no longer apply, the patient will be released. If the mental health facility decides that the reason(s) for the patient’s commitment are still valid, the patient must get a written notice of the mental health facility’s decision and of the patient’s right to the first review hearing to challenge the clinical director’s decision.
At this review hearing, all steps and rights described in the “Involuntary Commitment Under Court Order” section of this fact sheet must be followed. If the judge or court commissioner decides that the patient still needs to be committed, the person can be committed indefinitely. If the person is ordered to be committed indefinitely, they must be reexamined by the local public mental health agency.
If the reason(s) for the person’s commitment no longer exists, they must be released. If the reason(s) still exist, the local public mental health agency must send a report to the court that the commitment must continue. If the report says that the commitment must continue, the person and their attorney must be notified in writing that the commitment will continue, the reason(s) why the commitment will continue, and that the person has the right to ask for another rehearing.
At the hearing, the judge or court commissioner can order that the person’s commitment should continue if the judge or court commissioner decides that the person is still mentally ill, that without the treatment the person will suffer severe and abnormal mental and emotional distress, and that their ability to function on their own will worsen.
Transfer and/or Discharge of a Patient
When a patient’s condition has improved, the mental health facility may transfer the patient to another facility for treatment. The patient must agree in writing to this transfer.
When the mental health facility decides that the reason(s) for the commitment are gone, the patient will be released. The mental health facility where the patient was treated must do discharge planning for the patient to help them get other services for which they are eligible. A six (6) month commitment does not mean that a person needs to stay in the hospital for the entire 6-months. If the person’s treatment team decides they are ready for a less restrictive placement, they can move before the 6-month commitment expires.
Placement into a More Restrictive Environment
A mental health facility may order the immediate transfer of a patient to a more restrictive environment if the facility decides that the present placement is making the patient’s mental illness worse, or the patient had violated their treatment plan.
The patient has the right to receive a copy of the order stating the reasons for the transfer. The order must also let the patient know of their right to a hearing, their right to an attorney, and their rights listed in the “Involuntary Commitment Under Court Order” section of this fact sheet.