Involuntary Outpatient Commitment: What’s the Big Deal?

The term “involuntary civil commitment” covers more than just forced incarceration at the psychiatric ward of a hospital or mental institution. In substantially increasing numbers, Wisconsin residents have been subjected to outpatient involuntary commitments, which more often than not are extended year after year on little more than a rubber stamp, all at taxpayer expense.

On the surface, it may seem as though the outpatient involuntary commitment is only a minor intrusion on the rights of the “subject,” as the person is referred to in the applicable statute. After all, the individual is free to live and work in the community, subject only to the terms of the involuntary commitment order. Those terms typically require that the individual comply with any terms of treatment that might be imposed by the treating psychiatrist, including involuntary administration of psychotropic and other medications, most of which have debilitating and often irreversible side effects. Additionally, the standard involuntary commitment order requires the individual to abstain from non-prescribed drugs and alcohol, and includes a lifetime ban on possession of firearms. And the order gives the treating psychiatrist troubling authority to order arrest and incarceration of the “subject” if the doctor—without inconvenient limitations of due process of law—determines that the conditions of the order have been violated.

A psychiatrist in conversation with me once likened the involuntary outpatient commitment to “training wheels;” simply a “safety net” to assure that a person diagnosed with a mental illness would not stray from the rigors of prescribed treatment. Such a description reflects a lack of understanding of the very significant intrusion involuntary commitment represents to the civil liberties of the individual so restricted. It is difficult for a person accustomed to freedom—one who has always had the ability to go about his or her business unfettered—to appreciate the massive intrusion represented by involuntary commitment, be it inpatient or outpatient.

Imagine a scenario where one of us not subject to an involuntary commitment is driving to a doctor’s appointment. Our car stalls in traffic. We pick up our cell phone, dial the doctor’s office, and explain the situation to the receptionist. We apologize, and re-schedule our appointment. For Andrew, as the “subject” of an involuntary outpatient commitment, the situation is much different. His car stalls in traffic on the way to his appointment; he calls the only number he has been given for the doctor’s office; he listens to a pre-recorded message, which then goes to dial tone with no opportunity to speak to a person or leave a message. He deals with the stalled vehicle and goes home. Then, he waits for the inevitable … a squad car arrives at his house, lights flashing. Curious neighbors come to their porches and windows to see what is going on. The officers pound on the front door, in full view of the neighbors. Then, when Andrew emerges, he is hand-cuffed, thrown into the back of the squad car, and delivered to the lock-down psych ward, where he is shot up with medication and held for 72 hours, risking loss of his job, loss of his home, loss of his pets, and other significant consequences which are of no apparent concern to the County or its appointed doctors.

Here are Andrew’s words on the subject, taken from the transcript of his December 2, 2018 recommitment hearing:

“I feel [the commitment] is unnecessarily restrictive…You know, those appointments they said that I missed. I don’t feel that I got any type of proper notice to come and show up. I got arrested almost the day after the appointment [in] both cases. The cops showed up at my house—in front of my house and made me look bad in front of my neighbors and came and cuffed me and brought me to K-1. [Note: K-1 is a reference to the lock-down psychiatric unit at Aurora Memorial Hospital in Sheboygan, WI.] Somebody could have called me and asked me to come to K-1. I would have showed up, you know…[They] make it sound like it’s all really nice and good and helpful and everything, but it’s not really the same when you’re going through it on the other side. And, you know, I mean, I’m trying—I do my best to comply with all the rules and everything, but to me it seems like a never-ending process. Honestly, like, some aspects of it seem borderline unconstitutional.”

Andrew was right. He had a constitutional right to due process of law, which the current system denies to him and others similarly situated when doctors arbitrarily order “subjects” to be arrested and incarcerated for perceived minor violations of the terms of the commitment order. Further, he had a constitutional right to application of the “least restrictive alternative” in all aspects of his treatment. Clearly, picking up the phone to ask him to appear for a missed appointment is less restrictive than the heavy-handed arrest, complete with flashing lights, door-pounding, handcuffs and incarceration.

We can and must do better than this.