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Involuntary commitment standards remain sufficient

BY DI EDITORIAL BOARD | APRIL 13, 2011 7:20 AM

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The balance between protecting the public and protecting individual liberties is sometimes a delicate one, particularly regarding the involuntary commitment of people with mental illnesses. Any violent incident involving someone with a mental illness stirs controversy over whether it is too difficult to institutionalize people against their will. The recent murder of a Keokuk County Sheriff’s sergeant and concerns about standardizing mental-health care across Iowa’s 99 counties have raised these questions.

Under Iowa law, people may be committed to a mental institution if the court finds by “clear and convincing evidence” that they poses a physical or serious emotional threat to themselves or others or that they cannot adequately meet their own basic needs.

While many people wonder whether a lower standard might prevent crime, Iowa’s current law for committing the mentally ill is sufficient. To lower the threshold for commitment would open the door to unfairly diagnosing individuals as threats to society, particularly as most people with mental illnesses are not violent (and, indeed, are more likely to be the victims of violent crimes than the perpetrators).

This issue was brought to light recently in the April 5 shooting of Keokuk County Sheriff’s Deputy Eric Stein. A man who had been diagnosed with bipolar disorder shot and killed Stein and later was fatally shot by law-enforcement officers after a four-hour standoff. The man’s family had tried to commit him in March.

If Iowa’s bar for committing individuals to institutions were lower, it is possible Stein would not have been killed, but the cost of changing the laws would be high.

Iowa’s threshold for involuntary institutionalization is similar to that of most other states. “The requirements Iowa uses are fairly common nationally,” UI Associate Professor Tim Hagle, a legal scholar, told the DI Editorial Board Tuesday. “But there can be variations in what meets the language of the law.”

In Iowa, a commitment must be the result of a hearing demonstrating a severe mental impairment in people with clear and convincing evidence — a standard of proof between a preponderance of evidence and reasonable doubt. The hearing must prove that people are likely to physically injure themselves or others, that they are likely to inflict serious emotional injury on family members or others, or that people cannot meet their own basic needs. Families applying for involuntary commitment on behalf of family members must provide a reason for the request supported by pertinent facts, along with a written statement by a physician supporting the application and one or more affidavits corroborating the application.

The process is a deliberate one, although judges can order immediate detention pending a commitment hearing if they have probable cause to believe people pose an immediate threat to themselves or others.

There are several areas of the process that could be tweaked to make involuntary commitment easier or harder. One is changing the application process, another is by changing the elements of commitment, and another is changing the burden of proof required for a commitment.

But none of these are necessary. While the image of the insane killer runs rampant in the American psyche, people with even severe mental illnesses are more frequently victims of violent crimes than perpetrators. In one year, 8.2 percent of people with severe mental illness are the targets of by violent crime; only 3.1 percent of people without mental illness are similarly victimized. Drug and alcohol abuse, as well as a history of violence, are more significant predictors of future violence — remove these risk factors, and people with mental illnesses are no more likely to commit a violent offense as people without.

If we are loath to commit people simply for alcohol and drug abuse, we can’t drop the bar any lower on mental illness. There is little justification for an easier incarceration — in institutions or otherwise — of depressed, bipolar, or schizophrenic individuals.

Occasionally, there are tragedies that might have been prevented by a lower threshold. These tragedies always prompt a sense of curiosity about what might have been. But involuntary commitment without a likelihood of harm constitutes far greater infringements on the rights of people with mental illnesses. The potential for misuse by even well-meaning caretakers and family members (already more likely to abuse people with mental illnesses than those without) is staggering.

Rather than increasing the stigma surrounding mental illness, it’s better to devote resources to fixing Iowa’s patchwork mental-health-care system and get better help to people in need. Iowa’s laws for committing individuals put the threshold at the right level. In our sorrow for unnecessary deaths, let’s not forget why the standards exist — and why Iowa, like most states, has placed the bar where it lies.


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