Involuntary Commitment in Washington State – Part II

In Part 1 of this series on involuntary commitment we reviewed the criteria under which a person can be involuntarily committed. Broadly speaking, the criteria –   showing a “substantial likelihood of serious harm” or “gravely disability” – define individuals who are considered mentally ill and have engaged in behavior which suggests they are a danger to themselves or others. Certain individuals, known as designated mental health professionals (DMHP), are authorized by the state to investigate someone to see if they meet those criteria.

When, in the opinion of the DMHP, a person meets the criteria for involuntary commitment, the DMHP can file a petition to have the person picked up and held for 72 hours (not including weekends or holidays) to be evaluated.

First commitment – 14 days

At the end of the 72-hour hold, a court hearing is held.  According to RCW 71.05.240 (3),

“ …if the court finds by a preponderance of the evidence that such person, as the result of mental disorder, presents a likelihood of serious harm, or is gravely disabled, and, after considering less restrictive alternatives to involuntary detention and treatment, finds that no such alternatives are in the best interests of such person or others, the court shall order that such person be detained for involuntary treatment not to exceed fourteen days in a facility certified to provide treatment by the department. If the court finds that such person, as the result of a mental disorder, presents a likelihood of serious harm, or is gravely disabled, but that treatment in a less restrictive setting than detention is in the best interest of such person or others, the court shall order an appropriate less restrictive course of treatment for not to exceed ninety days.

Less restrictive treatment is court ordered psychiatric drugging that takes place outside the confines of a mental hospital/prison.

Second commitment – 90 days

At the end of the 14-day commitment period, the period of involuntary commitment may be continued for an additional 90 days (either in confinement or under a less restrictive alternative) if the individual continues to meet the criteria for likelihood of serious harm or is gravely disabled. (RCW 71.05.280 and RCW 71.05.320).

Third commitment – 180 days

Following the 90 day commitment, the person may be recommitted for an additional 180 days (see RCW 71.05.320 (3) (a), (b), (d), (5) and (6)) if the person in charge of the facility where they are confined, or the DMHP in the case of a less restrictive alternative, files a petition for involuntary commitment on the grounds that:

(a) During the current period of court ordered treatment: (i) Has threatened, attempted, or inflicted physical   harm upon the person of another, or substantial damage upon the property of another, and (ii) as a result of mental disorder or developmental disability presents a likelihood of serious harm; or

(b) Was taken into custody as a result of conduct in which he or she attempted or inflicted serious physical harm upon the person of another, and continues to present, as a result of mental disorder or developmental disability a likelihood of serious harm; or

… (d) Continues to be gravely disabled.

Successive 180 day commitments are permitted.

Efforts to weaken involuntary commitment law

Those who oppose the protections offered by involuntary commitment laws attack them by changing definitions of “likelihood of serious harm” and “gravely disabled,” and by creating new, less restrictive, criteria under which an individual can be involuntarily committed.

For example, the law was recently amended so that an individual could be found to present a likelihood of serious harm even though their behavior did not meet the criteria for likelihood of serious harm. The law (RCW 71.05.245) states:

Symptoms or behavior which standing alone would not justify civil commitment may support a finding of grave disability or likelihood of serious harm when: (a) Such symptoms or behavior are closely associated with symptoms or behavior which preceded and led to a past incident of involuntary hospitalization, severe deterioration, or one or more violent acts; (b) these symptoms or behavior represent a marked and concerning change in the baseline behavior of the respondent; and (c) without treatment, the continued deterioration of the respondent is probable.

Regarding less restrictive treatment, the law allows for continued less restrictive treatment even if the person does not meet the normal criteria for likelihood of serious harm or grave disability. Per 71.05.320 (4), following the 90 day less restrictive treatment, the DMHP may file a new petition for continued less restrictive treatment if

(a) The person was previously committed by a court to detention for involuntary mental health treatment during the thirty-six months that preceded the person’s initial detention date during the current involuntary commitment cycle, excluding any time spent in a mental health facility or in confinement as a result of a criminal conviction;

(b) In view of the person’s treatment history or current behavior, the person is unlikely to voluntarily participate in outpatient treatment without an order for less restrictive treatment; and

(c) Outpatient treatment that would be provided under a less restrictive treatment order is necessary to prevent a relapse, decompensation [see Decompensation section below], or deterioration that is likely to result in the person presenting a likelihood of serious harm or the person becoming gravely disabled within a reasonably short period of time.

The law also says,

In determining whether an inpatient or less restrictive alternative commitment … is appropriate, great weight shall be given to evidence of a prior history or pattern of decompensation and discontinuation of treatment resulting in: (1) Repeated hospitalizations; or (2) repeated peace officer interventions resulting in juvenile offenses, criminal charges, diversion programs, or jail admissions. Such evidence may be used to provide a factual basis for concluding that the individual would not receive, if released, such care as is essential for his or her health or safety. (RCW 71.05.285)

Decompensation

You’ll find the word “decompensation used frequently in involuntary commitment law and by proponents of more repressive commitment laws. Wikipedia defines the word as follows:

In medicine, decompensation is the functional deterioration of a previously working structure or system. Decompensation may occur due to fatigue, stress, illness, or old age. When a system is “compensated”, it is able to function despite stressors or defects. Decompensation describes an inability to compensate for these deficiencies. It is a general term commonly used in medicine to describe a variety of situations.

Psychiatrists and proponents of forced psychiatric treatment generally use the term to refer to the relapse of individuals with psychiatric disorders, mainly psychotic disorders and mood disorders like depression or bipolar disorder. The word is essentially used to blame psychiatric patients for the failure of treatment and at the same time get patients to blame themselves. This is a common goal of psychiatry, seen also when patients are accused of having “treatment resistant depression.” In both cases the goal is to perpetuate the lie that the treatment is generally effective, but there are certain individuals who are resistant to treatment. In the case of individuals with psychotic disorders, the public is told that an individual “went off his (or her) meds and decompensated.”

In fact, rigorous drug studies continually verify that psychiatric treatments are extremely ineffective and frequently have intolerable and damaging side effects.  Individuals quit taking the drugs for the same reason anyone would quit – because the drugs are not working or are causing debilitating adverse reactions.

This brings us to one final point. Besides the obvious violations of human rights inherent in forced psychiatric treatment, involuntary commitment is indefensible from a purely practical point of view. The individual is being forced to participate in a “treatment” that has been proven to be damaging and ineffective. Underlying involuntary commitment laws are false assumptions that make mental patients completely responsible for treatment outcomes and leave the mental health system totally unaccountable for treatment failure. We will go into more detail on this point in part 3 of this series.