Almost every American state allows civil commitment upon a finding that a person, as a result of mental illness, is gravely disabled and unable to meet their basic needs for food and shelter. Yet in spite of these statutes, most psychiatrists and courts will not commit an individual until they are found to pose a danger to themselves or others. All people have certain rights to be free from unwanted medical treatment, but for people with serious mental illness, those civil liberties are an abstraction, safeguarded for them by a system that is not otherwise ensuring access to shelter and basic medical care.
States’ continued and primary use of dangerousness standard in civil commitment proceedings does not meet our obligations to people with serious mental illness. Continued perceptions of the link between mental illness and violence, coupled with the strict interpretation of commitment statutes based on states’ parens patriae authority, have resulted in commitment standards that effectively commit people only when they are dangerous, which is often far past the point that they are in need of help. Courts and psychiatrists should recognize states’ obligations to provide health care to people with mental illness by interpreting gravely disabled statutes to allow for commitment when an individual is unable to provide for her basic needs but does not pose a danger to herself.