Reforming Civil Commitment: Serving Consumers' Needs While Protecting Their Rights

Article excerpt

Preface

I am pleased to be here and to share the podium with the Chief Justice. For many years I have studied the laws that affect people with mental illness and have many thoughts about what these laws should look like. But I have been asked to be here for a specific reason--to sound the keynote and to set the tone for today's conference on "Reforming the Involuntary Commitment Process" in the Commonwealth of Virginia.

So it is best to begin with the unvarnished truth--the involuntary commitment process in Virginia does need to be reformed. Many of you were among the 300 participants in this process who completed questionnaires recently sent out by the Chief Justice seeking your opinions on the current practice of civil commitment in the Commonwealth. These responses reveal a great deal of dissatisfaction with this practice across a broad range of issues. (3)

What is most striking are the responses to a question that asked what you would do if you could "fix just one thing." Many of you refused to play by the rules, saying that there are so many things that need to be fixed that you could not pick out only one thing. Moreover, the scope of the challenge we face is shown by the fact that you picked many different things. But to sum up your responses in three phrases, you want more beds, higher fees, and fewer handcuffs. Other sources of dissatisfaction are the lack of less restrictive alternatives to hospitalization, the absence of adequate mechanisms to implement mandatory outpatient treatment, the unrealistic nature of current statutory time requirements, and a failure to provide a meaningful opportunity to appeal.

We have an historic opportunity to set in motion the engine of reform for a part of the mental health code long overdue for change. It has been more than twenty years since the last time legislative attention was focused on this topic. I remember it well because I still bear the scars of battle from that failed initiative. Perhaps I ought to say a few words about this history.

Prior Efforts at Reform

The story begins in 1982 when three separate activities converged. The most important development was the appointment of a Joint Subcommittee of the General Assembly to study the commitment process. This legislative initiative was stimulated and chaired by a young Delegate from Arlington, Warren Stambaugh, who observed and participated as counsel in a number of commitment hearings. He felt that the process needed to be fixed.

A second strand was the interest of the State Human Rights Committee (SHRC), which I then chaired. Responding to complaints about civil commitment in Virginia, the SHRC appointed several task forces to look at the commitment process, including an examination of particular concerns associated with the involuntary hospitalization of children, people with substance abuse disorders, and long-term patients in state facilities.

The third thread was research conducted by the Institute of Law, Psychiatry and Public Policy (ILPPP). We had conducted a study involving systematic observations of about 200 commitment hearings across several Virginia jurisdictions. The data showed that most hearings took only a few minutes, with very little participation by the person for whom involuntary hospitalization was sought, or even by the attorney appointed to represent the person. There were also distinct variations in attitude and practice among the special justices conducting these hearings, ranging from solicitous concern to apparent indifference.

Following a conference featuring the ILPPP's research findings, the SHRC and the Joint Subcommittee held a joint meeting in Charlottesville in the summer of 1982 and took the first step in what became a two-year process of consensus-building in the drafting and re-drafting of legislation. After several false starts, the proposed legislation passed the Virginia House of Delegates, unanimously as I recall, but eventually failed in the Virginia Senate by one vote in 1984. …