Voluntary/Involuntary Commitment & Patient Rights
The symptoms of Borderline Personality Disorder, while not normally associated with a substantial loss of the
capacity to reason, can include brief periods of parapsychotic behaviors, while the rageful impulsivity associated with the
disorder can also frequently escalate into episodes of physical violence.
Situations can indeed arise with BPD that
necessitate summoning police or emergency aid in order to protect the sufferer from the risk of "causing harm to self
or others" (the standard legal clause in most US states underwriting involuntary commitment).
Please educate yourself on these treatment possibilities: it can mean the difference between life and death for
your loved one -- or you.
National Organizations
for BPD Advocacy and Family Outreach
If you are currently experiencing a mental health crisis
with your loved one, please dial 911.
If you need live advice and support for dealing with a BPD
crisis, please call
The National Alliance for the Mentally Ill
HelpLine:
1-800-950-6264
or the:
TARA APD Helpline: 1-888-482-7227
The Problem
Involuntary commitment is the legal and ethical bugaboo of public mental health care, and one of
the most deeply perplexing issues for the loved ones of someone suffering from Borderline
Personality Disorder. Florida's Baker Act was the first US State Law passed
to ensure a legal foundation for commitment to psychiatric care regardless of the desires of
the person with mental illness, and since its enactment, others such as New York's 'Kendra's Law' have followed suit.
Despite this legislative validation, intense debates over the public need for "baker acting" continue
to emerge in American
communities, with strong arguments to be made both pro & contra. Commitment orders can be obtained for outpatient treatment, as well (see below).
In US States in general, there are three basic legal criteria that must be met in order for a person to be involuntarily committed:
1. the person is a danger to other people;
2. the person is a danger to her/himself (generally meaning a suicide risk); or
3. the person is unable to provide for her/his basic needs, such as food, clothing and shelter
It is particularly difficult, in many cases, for loved ones of those
with BPD to extricate themselves from a long-standing emotional dynamic of loyalty in order to take such action.
This personal dilemma is often greatly exacerbated by the sufferer's threats:
"I'll kill myself if you tell anyone or call the police!" "Don't betray me or you'll never see me again!"
Despite the sometimes heart-rending pain of the decision to request involuntary intervention and commitment, I personally believe it is an ethical
obligation of all who love the sufferer to pledge themselves to putting this possibility into action,
should the need arise. Please acquaint yourself with your local emergency services; many larger urban areas offer
hospital-, city- or state-run mental health emergency response teams. In case of doubt, you may always dial 911.
Clearly it is in everyone's best interest for the sufferer to voluntarily enter emergency treatment if it becomes necessary.
Unfortunately, due to the emotional instability and extremely deep-seated fear of abandonment that defines this disorder,
this is not always possible.
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Involuntary Commitment, or "Baker Acting"
Treatment Advocacy Center
This is a fabulous non-profit organization "working to
eliminate barriers to treatment of severe mental illness."
TAC issues a free bimonthly newsletter,
Catalyst, offering updates and perspectives on the legal issues of mental health care.
Subscribe to Catalyst here.
Bazelon Center for Mental Health Law.
Excellent compilation of the latest on treatment law and legal advocacy for those with mental health issues.
Commitment Laws, state-by-state
Details of laws regarding the involuntary commitment
of the mentally ill who are "at risk to themselves or
others."
A Guide to Attorneys Specializing in Assisted Treatment
"In an effort to bridge the gap between those who are suffering from mental illness and those who can provide assistance, TAC created an attorney directory in response to the urgings of countless friends and family members who have called our office for help understanding state assisted treatment laws. Our hope is that the directory will be an invaluable resource in the battle to get help and understanding for those who suffer from mental illness.
Unfortunately, for those who are currently embroiled in the battle to get help for a loved-one, changing the laws may seem like a "too little, too late" proposition. But you should not have to be alone when you fight the battle to get treatment for someone with a mental illness. A qualified attorney can be instrumental in guiding you through the legal maze surrounding mental illness laws."
Basics on Outpatient CommitmentVery helpful overview from the
National Alliance for the Mentally Ill.
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Family and Loved Ones' Perspectives
CONFIDENTIALITY. Advice to carers: Ways of approaching the problem
by George Szmukler, Dean Institute of Psychiatry, UK
Ê
Committing a Loved One Can Be the Best Medicine
by Eve Kupersanin
Coercion or Care: Involuntary Treatment of the
Mentally Ill, A Human Rights Issue
by Douglas Baker
An excellent overview of the ethical issues
confronting the family member/spouse who wishes to get
treatment for their reluctant loved one. Written by the
husband of a sufferer.
Involuntary Treatment: A Family's
Perspective
Good essay on the emotional conundrum of one family
over the legal necessity for the mentally loved one to
display criminal behavior before they are accepted for
involuntary treatment.
ARREST MY KID: arrest may be only
means for parents to get proper mental health care for
their children
by Anne-Marie Cusac, July 2001
Analysis of the conundrums of medical insurance &
managed health care in the USA.
Psychiatric Survivors and
Nonsurvivors
Excellent essay on the anti-commitment movement and
its dillemmas for the families involved.
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Perspectives from Those with BPD
Bazelon Center for Mental Health Law.
Excellent compilation of the latest on treatment law and legal advocacy for those with mental health issues.
Advance Directives
by Ronald S. Honberg
An article detailing an alternative to involuntary
commitment: 'advance directives', whereby the sufferer
signs an agreement in advance detailing the types of
treatment they are willing/not willing to receive.
See a sample advance directive.
Packing for a Hospital Stay
by Ann Palmer
Excellent tips for either voluntary entrance or
for family members of the sufferer.
Patients' Rights, Interrupted
An overview essay on the legalities of laws such as NY
State's "Kendra's Law" that enforce involuntary
commitment
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This Page Last Updated: June 20, 2003
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