UCLA

Why rates of civil commitment appear to vary substantially across states is unknown. This study describes laws governing the court involvement during the initial or emergency civil commitment proceedings across all US states and attempts to link specific provisions regarding the timing of court hearings to the rates of psychiatric inpatient admissions in different states, used as a proxy for states’ rates of longer-term commitment. First, texts of laws that authorize the court to order involuntary psychiatric detentions in 50 states and the District of Columbia were systematically coded. It was found that only four states do not authorize the court to act as one of the designated authorities to order emergency detention, evaluation, and/or involuntary commitment. In 36 states, a non-professional person may directly petition the court for emergency detention, evaluation, or involuntary commitment without a clinical certificate. Only two states did not require some form of hearing to extend emergency detention into a longer-term commitment, but the statutory timings of hearings varied substantially across the 51 jurisdictions (ranging from 1 to 34 days). In a regression analysis of 36 states submitting data to the Substance Abuse and Mental Health Administration’s annual Uniform Reporting System in 2018, it was found that a longer statutory timing of hearing in a state—i.e., the longer a person can be legally detained without a court order—was statistically significantly associated with a lower rate of adult admission to inpatient psychiatric facilities in the state, controlling for population-adjusted numbers of adults served in community mental health centers and numbers of psychiatric beds or psychiatric facilities in the state. By operationally defining the different phases of commitment, quantifying the timing of court involvement in emergency detention and testing its real-world relevance on states submitting inpatient admission data to a federal database, this study adds firmer grounding to the study of relations between commitment laws and the practice of commitment.