Imagine a family member is in the middle of a mental health crisis—not violent, exactly, but clearly not okay. Do you have the right to have them committed for treatment against their will? Does anyone? The answer depends on three surprisingly slippery legal tests—and psychologists are often the ones asked to apply them.
Civil commitment—the legal process of hospitalizing someone for psychiatric treatment without their consent—sits at the center of one of psychology’s oldest ethical minefields. The criteria look simple on paper. Applying them to an actual human being rarely is.
Deceptively Simple: A Three-Part Test
Civil commitment laws vary from country to country and state to state, but in the United States, they generally allow involuntary commitment when one of three conditions is met: the person has a mental illness and needs treatment; the person is dangerous to themselves or others; or the person is unable to care for themselves—a legal standard often called “grave disability.”
Each of those three conditions sounds clear until you try to apply it. How severe does a mental illness have to be before it justifies taking away someone’s freedom? How confidently can anyone predict that a specific person is dangerous? And where exactly is the line between respecting someone’s right to refuse treatment and society’s interest in protecting them, or others, from harm? The best available guidelines are still, unavoidably, judgment calls—and a psychologist is often the one making them.
Even the definition of “mental illness” isn’t consistent from state to state. Some states exclude conditions like intellectual disability from the legal definition used for commitment purposes; others exclude substance use disorders entirely. A psychologist evaluating someone for possible commitment isn’t just applying clinical judgment—they’re applying it inside a legal definition that shifts depending on which state they’re standing in.
The second criterion, dangerousness, may be the hardest to pin down. Despite a persistent public assumption that mental illness and violence go hand in hand, the research tells a more specific story: elevated risk is really only associated with certain severe conditions, especially when substance use is also present—but alcohol or drug use raises the risk of violence in the general population too, not just among people with mental illness. Clinicians can identify which groups carry somewhat higher risk than the general population, but predicting whether one specific person will become violent remains, by most accounts, close to impossible.
That gap—between group-level risk and individual prediction—is what makes the dangerousness criterion an ethical minefield. A psychologist isn’t just describing a diagnosis; they’re being asked to forecast someone’s future behavior, in a legal proceeding (without a crystal ball). And there are real consequences for getting it wrong in either direction.
The third criterion creates its own dilemma: someone might genuinely be unable to care for themselves and yet may have family members who are willing to step in—or they might be judged unable to care for themselves while insisting, clearly and consistently, on their right to refuse care. In their authoritative text on psychopathology, prominent clinical psychologists David H. Barlow and V. Mark Durand point to Joyce Brown, a homeless woman with schizophrenia who successfully fought multiple attempts to commit her, arguing for her right to remain on the streets of New York City. By many people’s standards, being unable to maintain housing looks like an obvious sign of being unable to care for oneself. Brown disagreed and won.
That sort of debate hasn’t gone away—it still pops up in more recent headlines. In late 2022, New York City announced a directive allowing police and other first responders to involuntarily hospitalize people with severe, untreated mental illness living on the streets or in the subway system, based on an inability to meet their own basic needs, even when they posed no direct threat of violence. Mental health and civil rights advocates challenged the policy in federal court, arguing it violated due process protections, and a court allowed it to proceed despite the challenge. It’s the Joyce Brown question all over again, playing out at city scale, decades later.
The Historical Pendulum
Commitment standards have swung between extremes over time. Psychiatrist and prominent anti-psychiatry critic Thomas Szasz pointed to a much looser historical era in the US, when a husband could have his wife committed largely over disagreements, including political ones. Whatever one makes of Szasz’s larger critique, there have at least been some changes toward stricter standards that now require a real, demonstrable threat before someone can be committed against their will.
That stricter standard has real legal teeth in the US. In O’Connor v. Donaldson (1975), the Supreme Court held that a state cannot constitutionally confine a non-dangerous person who is capable of surviving safely in freedom, whether they do so alone or with the help of willing, responsible family or friends. Nearly fifty years later, that 1975 ruling is still the backbone that today’s most contested commitment policies—including New York City’s—have to work around.
Every time a society decides to intervene in someone’s freedom “for their own good,” a psychologist is usually the one being asked to make that judgment call, using criteria that look precise on paper and turn out to be anything but in practice. Nearly fifty years after O’Connor v. Donaldson, the tension it tried to settle hasn’t gone away—it’s just moved to new cities and new headlines. The guidelines help. But it still isn’t a cakewalk.
Key References
Barlow, D. H., and Durand, V. M., Abnormal Psychology: An Integrative Approach (5th ed., 2009)
O’Connor v. Donaldson, 422 U.S. 563 (1975).
Paterson, B., Claughan, P., & McComish, S., “New evidence or changing population? Reviewing the evidence of a link between mental illness and violence,” International Journal of Mental Health Nursing, 13, 39–52 (2004).
Szasz, T. S., The age of madness: The history of involuntary mental hospitalization (1975).
The Hastings Center, “New York City’s involuntary commitment plan: Fulfilling a moral obligation?” (January 10, 2023).
CNN, “New York City directive to potentially involuntarily commit someone suffering a mental health crisis can proceed, court rules” (2023, February 4).
