March 8, 2000
INVOLUNTARY CIVIL COMMITMENT
By: Sandra Norman-Eady, Senior Attorney
You wanted a summary of the law on involuntary civil commitment.
The law permits the involuntary commitment of people with psychiatric disabilities who are either dangerous to themselves or others or gravely disabled. A gravely disabled person is someone who may suffer serious harm because he fails to provide for his basic human needs and refuses to accept necessary hospitalization.
Anyone may begin the commitment process by filing with the probate court an application alleging that someone has psychiatric disabilities and is dangerous to himself or others or gravely disabled. Two court-selected physicians examine the person to be committed and a hearing is scheduled 10 days later. The court must order commitment if it finds by clear and convincing evidence that the person meets the commitment requirements. The commitment is for the duration of the psychiatric disabilities or until the patient is discharged in due course of law.
A person may be committed on an emergency basis without a prior hearing, however, if a physician or psychologist signs an emergency certificate stating that he has psychiatric disabilities, is dangerous or gravely disabled, and in need of immediate care and treatment. Emergency confinement is permitted for up to 15 days but may be extended for an additional 15 days if probate proceedings are commenced.
A police officer may take a person with psychiatric disabilities into custody and deliver him to a general hospital upon a court warrant or reasonable belief that the person meets the criteria for emergency commitment.
Hospitals must annually advise all committed patients of their right to a hearing on whether they can be released. Additionally, a court-appointed psychiatrist must examine each such patient annually. A full hearing is required at least every two years. Patients may also apply for release at any time and receive a full hearing on the application.
CONNECTICUT LAW ON COMMITMENT OF MENTALLY ILL ADULTS
CGS §17a-495 defines “person with psychiatric disabilities,” “dangerous to himself or herself or others,” “gravely disabled,” and “voluntary” and “involuntary patient(s).”
A “person with psychiatric disabilities” is anyone who has a mental or emotional condition that substantially and adversely affects his ability to function and who requires care and treatment. The definition excludes alcohol- or drug-dependant people. (The commitment of an alcohol- or drug-dependant person is covered under a different chapter of Title 17a, see Chapter 318j, § 17a-621 et seq., and will not be discussed in this report).
“Dangerous to himself or others” means there is a substantial risk the individual will inflict physical harm upon his own person or upon another person.
“Gravely disabled” refers to a person who, due to mental or emotional impairment, is in danger of serious harm because he has failed or is unable to provide for his basic needs such as essential food, clothing, shelter, or safety. The person needs hospital treatment, which is available, but his psychiatric disabilities make him incapable of determining whether to accept it.
A “voluntary patient” is a person 16 years of age or older who has applied in writing and been admitted to a hospital for psychiatric disabilities, or a person under age 16 for whom a parent or guardian has obtained admission. An “involuntary patient” is one who has been hospitalized by order of a probate court after a hearing, or by certification of a qualified physician for emergency diagnosis, observation, or treatment.
II. The Commitment Process
A. Probate Court Jurisdiction. §17a-497(a) vests commitment jurisdiction in the probate courts.
B. Commencement of Proceeding Upon Application. Sections 17a-497 and 17a-498 establish the basic commitment procedures, commencing with an application to the appropriate probate court, but mandating no actual detention until after a full hearing. If, however, emergency detention is required prior to the full hearing, §17a-502 and 17a-503 govern.
§17a-497(a) permits anyone to complete a commitment application. If a person with psychiatric disabilities is at large and is dangerous to the community, the first selectman or chief executive officer of the town in which he resides or is at large must make the application. The probate courts can assert jurisdiction only if a written application alleges in substance that the person has psychiatric disabilities and is dangerous to himself or others or gravely disabled.
The respondent, his attorney, or the probate judge having jurisdiction over the matter may ask the probate court administrator to appoint a three-judge court to hear the commitment application. The respondent may not be involuntarily confined without the vote of at least two of the three judges (CGS § 17a-497(b)).
§17a-498(a) requires the probate court to assign a hearing date for no later than 10 business days after receipt of the application. Reasonable notice of the hearing must be given to the respondent and relatives and friends, as the court deems advisable. The notice should inform the respondent of the right to (1) be present at the hearing, (2) have counsel, (3) have counsel appointed if he is indigent, and (4) cross-examine witnesses testifying at the hearing. The court is required to appoint counsel for an indigent respondent. However, the respondent can refuse court-appointed counsel if the court determines he understands the implications. The Judicial Department establishes an equitable fee and pays appointed counsel if the General Assembly specifically appropriates money to the department for that purpose. Otherwise, the Probate Court establishes and pays the fee (CGS § 17a-498(b)).
C. Examination by Two Physicians. Two court-selected impartial physicians examine the respondent and provide certificates, signed under penalty of false statement, indicating they personally examined respondent within 10 days of the hearing. One of the physicians must be a practicing psychiatrist. Each physician reports to the court on a form provided by the Department of Mental Health and Addictive Services. This form must state the specific psychiatric disabilities alleged and whether (1) the respondent is dangerous to himself or others, (2) the illness has resulted or will result in serious disruption of his mental and behavioral functioning, (3) hospital treatment is both necessary and available, (4) less restrictive placement is recommended and available, and (5) he is capable of understanding the need to accept the recommended treatment on a voluntary basis. Each physician must provide the reasons for his opinions (CGS § 17a-498(c)).
If the respondent refuses to be examined, the probate court may issue a warrant for his apprehension. A police officer then must deliver him to a general hospital. At the hospital, two physicians, one of whom must be a psychiatrist, will examine him. If he is not committed immediately on an emergency basis pursuant to a physician's certificate under §17a-502, he must be released (CGS § 17a-498(d)).
D. The Hearing. Prior to the hearing, a respondent is entitled to access to all records, including hospital records if he is hospitalized. All hospital records are admissible upon request in any proceeding relating to confinement or release. The admissibility of evidence may be challenged in accordance with the rules of civil procedure (CGS § 17a-498(b)).
The respondent must be present at any commitment hearing (CGS § 17a-498(f)). He has the right to present evidence and cross-examine witnesses. If he notifies the court at least three days before the hearing that he wishes to confront the examining physicians, the court must order the physicians to appear (CGS § 17a-498(c)).
E. Basis for Commitment. If the court finds by clear and convincing evidence that the person has psychiatric disabilities and is dangerous to himself or others, or gravely disabled, it must order commitment to a hospital for psychiatric disabilities. The confinement is for the duration of the psychiatric disabilities or until the patient is discharged or converted to voluntary status in due course of law (CGS § 17a-498(c)).
III. Emergency Confinement
A. Detention by Police. Any person may apply to the appropriate probate court alleging that another person has psychiatric disabilities and dangerous to himself or others or gravely disabled, and needs immediate care and treatment in a hospital for psychiatric disabilities. The court may then issue a warrant for his apprehension. After the person is brought before the court, it must order that he be taken to a general hospital if it determines there is probable cause to believe that he has psychiatric disabilities and is dangerous to himself or others or gravely disabled. The person must be examined within 24 hours and cannot be held for more than 72 hours unless he is committed on a physician's emergency certificate under §17a-502 (§ 17a-503(b)).
A police officer is also authorized to take into custody any person whom the officer reasonably believes meets the criteria for commitment. The officer may take him to a general hospital for emergency examination. He must be examined within 24 hours and released within 72 hours, unless detained and committed on an emergency basis under §17a-502 (CGS §17a-503(a)).
B. Commitment Under Psychologist's Emergency Certificate. A licensed psychologist may order a person transported to a general hospital for examination and possible emergency confinement when he has reasonable cause to believe that the person has psychiatric disabilities and is dangerous to himself or others or gravely disabled and in need of immediate care an treatment. The psychologist can issue a written emergency certificate authorizing and directing that the person be taken to a general hospital for purposes of a medical examination. He must be examined within 24 hours and released within 72, unless detained and committed under the certificate (CGS Sec. 17a-503 (c)).
C. Commitment Under Physician's Emergency Certificate. Under §17a-502, a person may be confined for up to 15 days without a court order, pursuant to a physician's emergency certificate. The physician must have concluded that the person has psychiatric disabilities and is a danger to himself or others or gravely disabled, and needs immediate care and treatment in a hospital for psychiatric disabilities. The certificate must state (1) the date of examination, which shall not be more than three days prior to the date of the certificate; (2) the physician's findings relative to the person's physical and psychiatric condition and the history of the case, if known; (3) the physician's opinion that the person has psychiatric disabilities and is dangerous to himself or others or gravely disabled and needs immediate care and treatment in a hospital for psychiatric disabilities; and (4) the reasons for his opinion (CGS § 17a-502(a)).
If a written application for commitment has been filed in probate court prior to the expiration of the 15 days, the emergency commitment may be continued for an additional 15 days or until completion of probate proceedings, whichever is sooner (CGS § 17a-502(a)). Any person admitted on an emergency basis must be examined by a psychiatrist within 24 hours of admission. If the psychiatrist determines that the person does not meet the criteria for emergency detention and treatment, he must be released (CGS § 17a-502(b)).
D. Probable Cause Hearing. Any person detained on an emergency basis must be promptly informed of his right to (1) consult an attorney; (2) have an attorney appointed if he is indigent; and (3) have a hearing (CGS § 17a-502(c)). This hearing must be held within 72 hours of receipt of the person's written request, excluding weekends and holidays. The hearing will be before the probate court with commitment jurisdiction. At the hearing, the court must determine whether there is probable cause to conclude that the person is subject to involuntary confinement under this section and that continued treatment is advisable. If the court finds probable cause, detention will be continued until the completion of commitment proceedings under §17a-498, or the expiration of 30 days from the beginning of detention, whichever occurs first (CGS § 17a-502(d)).
IV. Commitment After a Voluntary Admission
A person may elect voluntary admission to a hospital for psychiatric disabilities pursuant to §17a-506 at any time prior to adjudication of the commitment application. A hospital must notify a hospitalized individual within 24 hours prior to the time the application for commitment is filed, that he may continue as a voluntary patient pursuant to §17a-506. Similarly, the notice of hearing given a person not already hospitalized must state that he can enter a hospital voluntarily. If he so chooses, the application for commitment must be withdrawn (CGS § 17a-498(e)).
If, upon an application for commitment, a person agrees to become a voluntary patient and then requests release, a new application for commitment may be filed. If a voluntary patient refuses medication or treatment and is imminently dangerous to himself or others, an application for involuntary commitment may be filed (CGS § 17a-498(e)).
Whenever a voluntarily admitted patient requests to be released, any person, including the head of the hospital, may institute commitment proceedings. Confinement will be continued for an additional period of time in order for the patient to prepare for the commitment hearings, but not for more than 15 days from the date the patient requested release. Furthermore, the patient may not be confined upon an emergency certificate issued prior to discharge and within 15 days after giving notice of his desire to leave. An individual confined after giving notice has the right to a probable cause hearing under CGS § 17a-502 (CGS § 17a-506(e)).
V. Commitment After Expiration of Period Specified in Court Order
If any person confined to a hospital pursuant to court order has psychiatric disabilities at the expiration of the specified confinement period, the head of the hospital must institute commitment proceedings in the probate court for the town in which the hospital is located (CGS § 17a-508).
VI. Hearings After Commitment
A. Statutorily Required At Least Every Two Years. Hospitals for psychiatric disabilities must notify patients at least annually of their right to a hearing. If a patient requests a hearing, the hospital must immediately file the request with the appropriate court. The probate court that ordered the confinement must conduct the hearing in the same manner and following the same procedures as the original commitment hearing.
In addition, a hospital must provide each probate court with a monthly list of all patients involuntarily confined by that court for one year since the last annual review or the original commitment. Within 15 days of this notification, the probate court must appoint a psychiatrist to examine each patient. Based on this examination the court can decide whether to hold a hearing on possible release. Every patient, however, must have a hearing at least every two years (CGS § 17a-498(g)).
B. On Patient's Request. Any patient hospitalized pursuant to a probate court order may apply for release. This application should be filed in the probate court for the district in which the hospital is located. The court must assign a hearing date for no later than 10 days after receipt of the request. Reasonable notice of the hearing is to be given to the applicant, the superintendent of the hospital, and the applicant's friends and relatives, as the court deems advisable. The applicant also must be notified of his right to be present, present evidence, have counsel, have court-appointed counsel if he is indigent, and cross-examine witnesses. Hospital records are admissible, and the rules of civil procedure govern the admissibility of evidence (CGS § 17a-510).
The court must order the patient released unless it finds by clear and convincing evidence that confinement is necessary because the person has psychiatric disabilities and is dangerous to himself or others or gravely disabled (CGS § 17a-510).
VII. Transferring Psychiatric Patients
Psychiatric patients may be transferred from one psychiatric hospital to another upon the agreement of the hospitals' superintendents. The DMHAS commissioner, or Department of Children and Families' commissioner in the case of patients under 18, must approve the transfer. Patients who are voluntarily admitted must consent to the transfer and receive a copy of the transfer agreement (CGS § 17a-511, as amended by PA 99-84).