Need for treatment

Source: Treatment Advocacy Center Oct. 2011


Constitutionality Of Need-For-Treatment Standards

“It must be remembered that for the person with severe mental illness who has no treatment the most deaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our own powers to describe.”

Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581, 609-10 (1999) (Kennedy, J., Concurring).

Contrary to some widely publicized arguments, the United States Supreme Court has never held that dangerousness is constitutionally required in civil commitments.  On the contrary, U.S. Supreme Court decisions have almost universally upheld the states’ ability to use their parens patriae powers to protect citizens from harm while recognizing that this field is an inexact science, and for that reason, great deference to state legislatures’ judgments about the relationship between dangerousness and mental illness must be given.  Accordingly, over half of the states have some form of need-for-treatment standard, and most state supreme courts have upheld these standards as constitutional.

Applicable Supreme Court Cases:

·         O’Connor v. Donaldson, 422 U.S. 563 (1975);

The most cited Supreme Court case concerning involuntary treatment and substantive due process.  In O’Connor, a non-dangerous person with schizophrenia was committed for fifteen years without treatment. The Supreme Court phrased its judgment in terms of a non-dangerous person, and accordingly the Court’s opinion does not support any conclusions about the constitutional necessity or sufficiency of dangerousness in civil commitments.  In fact, the Supreme Court specifically left open the question of whether a finding of dangerousness is required by due process:

We need not decide whether… a mentally ill person may be confined by the State on any of the grounds which, under contemporary statutes are generally advanced to justify involuntary confinement of such a person – to prevent injury to the public, to ensure his own survival or safety, or to alleviate or cure his illness.

O’Connor’s case-specific holding was that a state may not, “constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”  The phrase “without more” has served as a major point of contention for both courts and commentators. Although the argument that “without more”means without dangerousness has been advanced, careful examination shows major flaws.

·         Addington v. Texas, 441 U.S. 418 (1979);

Although Addington is widely cited as mandating a dangerousness standard for all involuntary commitments, a careful examination of the court’s decisions shows this simply is not the case.  The Addington Court’s decision was examining procedural rather than substantive due process, and discussing Texas requirements for civil commitment, not constitutional mandates.  Addington, 441 U.S. at 426 (“Under the Texas Mental Health Code, however, the state has no interest in confining individuals involuntarily… if they do not pose some danger to themselves or others.”) (emphasis added).

·         Jones v. United States, 463 U.S. 354 (1983);

In Jones, the Supreme Court was looking at procedural issues concerning burdens and standard of proof.  The issue of the substantive requirements for civil commitment, or release, was not before the Court. Jones, 463 U.S. at 363 n. 11.

·         Humphrey v. Cady, 405 U.S. 504 (1972);

·         Foucha v. Louisiana, 504 U.S. 71 (1992);

Language in this plurality opinion asserts that the Constitution requires both mental illness and dangerousness, but the Court’s statements about dangerousness are both dicta and based upon a misunderstanding of the Court’s prior opinions in Jones and O’Connor.  As Justice Thomas noted in his dissent, Jones held that mental illness and dangerousness was constitutionally sufficient for commitment, whereas the plurality of the Court misstated Jones as holding that mental illness and dangerousness were necessary for a constitutional commitment. Foucha at 120.

Most importantly, this decision had only four votes.  Justice O’Connor made it clear that her fifth and deciding vote was premised on the opinion applying only to Louisiana’s criminal commitment statute, and did not apply to other, more narrowly drawn, criminal commitment statutes.  Id. at 86-87 (O’Connor J., concurring in part).  Consequently, this opinion does not apply to civil commitment standards.

Applicable State & Federal Cases:

·         Lessard v. Schmidt, 349 F. Supp. 1078 (E.D. Wis. 1972);

·         State v. Dennis H., 2002 WI 104 (2002);

·         In re LaBelle, 728 P.2d 138 (Wash. 1986);

·        In the Matter of Maricopa County, 840 P.2d 1042 (Ariz. App. 1992);