Involuntary Commitment of a Mentally Ill Person

Involuntary Commitment (sometimes called Civil Commitment ) is a legal procedure to place a mentally ill person in a designated treatment facility against the person's will in order to protect that person or other people from harm because of the person's mental illness.

• Only a judge or a magistrate can order an involuntary commitment for evaluation.
• The decision will be based on information provided by health care providers, family members, and any others who know the person or who have witnessed the person’s behaviors.

The person (adult or adolescent) being committed for evaluation must be alleged to be mentally ill and, as a result of that mental illness, be gravely disabled or present a likelihood of serious harm to self or others.

• “ Gravely disabled ” generally refers to a condition in which, as a result of a mental illness, a person meets one or both of the following criteria:
  • Is in danger of physical harm because he is so ill that he cannot take care of even basic needs like food, clothing, and shelter; this inability places the person at such risk that it is highly probable he will suffer a serious injury or accident, become very ill, or even die from neglect if immediate care is not taken by another person to protect this mentally ill individual.
  • Will, if not treated, suffer (or continue to suffer) such severe and abnormal mental, emotional, or physical distress that the distress associated with the illness will cause significant impairment of the person's judgment, reason, or behavior, resulting in a substantial deterioration of his previous ability to function independently.
• A person is “likely to cause serious harm” if she:
  • Poses a substantial risk of physical harm to self, as indicated by behavior causing, attempting, or threatening to do harm to herself.
  • Poses a substantial risk of harm to others, as indicated by recent behavior causing, attempting, or threatening harm to others, and is likely in the near future to physically injure or abuse someone else or cause substantial damage to another’s property.
  • Shows or expresses current intentions to carry out a plan of serious harm to self or another.

When you believe someone in your community or region is experiencing a mental health crisis, follow your organizational procedures for responding to and supporting the client. For clients who have ongoing needs related to the severity of their mental illness,youare encouraged to form a team or work with an existing team of local or regional health care workers and residents, including:

• Community behavioral health center social workers.
• BHA/Ps.
• Primary care doctors, or nurses, or CHA/Ps.
• Law enforcement personnel.
• Parents.
• Family and friends

People in crisis often do best when law enforcement, community health care providers, and caring community members team up together to locally manage the person in crisis, when they have people working hard to maintain them in their home community and in a culture and environment they are familiar with, and when they are well supported by their family and friends.

• For this reason, every effort to stabilize and treat a person in crisis without removing the person from the home community, or taking the person no farther than to the regional hub, is important to the person’s long-term wellbeing and ability to recover as quickly as possible.
• In some cases, it is preferable that this be accomplished without filing paperwork to temporarily detain the person against their will or involuntarily commit the person for evaluation.

There are time limits on how long a person can be held or detained involuntarily against his wishes. In a crisis, it is essential to help the person find treatment in his home community, a regional hub, or a more urban setting for evaluation and treatment.

Any mentally ill person being detained for the safety of the self or others is required to be reevaluated at fixed intervals to determine whether continued involuntary detention and evaluation or treatment is appropriate and legal.

This chapter discusses several court forms required to be used throughout the involuntary commitment process. See the Alaska Court System site for current State of Alaska forms.

24 hours

In an emergency, a law enforcement officer, psychiatrist, doctor, or PhD-level psychologist may complete court form MC-105 : “ Notice of Emergency Detention and Application for Evaluation ” to take the person into protective custody for 24 hours and seek a mental health evaluation.

• The MC-105 Notice of Detention form allows law enforcement personnel to take custody of a person they have probable cause to believe is mentally ill and a danger to self or others, or is gravely disabled. Law enforcement must deliver the person alleged to be mentally ill to a location for an emergency mental health evaluation.
• Only a law enforcement officer, psychiatrist, doctor, or PhD-level psychologist may file a MC-105. The Notice of Emergency Detention cannot be signed by a social worker or other healthcare professional or paraprofessional. It is limited to these four groups because the MC-105 grants considerable power to these professionals to take away a resident’s freedom and place them in custody.
• A psychiatrist, doctor, or PhD-level psychologist can sign the form and ask law enforcement to locate and take an allegedly mentally ill person into custody.

The Notice of Emergency Detention should only be used when the level of local risk is such that deploying normal community response procedures could result in placing the person or local residents in immediate danger. In such instances, the MC-105 allows law enforcement to detain a person experiencing a potentially dangerous mental health crisis for up to 24 hours while the normal, slower, involuntary civil commitment court procedures are activated.

While the person is being held for safety reasons on a Notice of Emergency Detention, another court form, the MC-100 “ Petition for Involuntary Commitment for Evaluation,” must be filed if the person is to be held for more than 24 hours.

• The MC-100 Commitment Petition must state the reasons why the person filing the Petition (known as “the Petitioner”) believes the person “meets commitment criteria.” This means that the Petitioner must justify her statements that the person is mentally ill and presents a danger to self or others.
• The individual who is experiencing a mental health crisis is known in court paperwork as "the Respondent."

The MC-100 Commitment Petition can be filed by any adult in Alaska, including a guardian or a caregiver, but generally the MC-100 Petition is filed by behavioral health care workers, doctors, or health care providers (hospitals, primary care clinics, or behavioral health care clinics) aware of the person’s mental health status.

72 Hours

Once the court receives a MC-100 Commitment Petition, the local (or regional) judge or master will generally hold a hearing (either in person or telephonically), call witnesses (including the Petitioner), and allow people to address the court concerning the person’s observed behaviors.

If you are the Petitioner and the Respondent is a client of a local or regional behavioral health center or community health center, you may provide information in the Petition for Hospitalization that you are aware of because of previous behavioral health services provided to the Respondent. In addition, when taking testimony, the judge or master may ask you for information based on any recent contact with the individual.

• All hearings on petitions to hospitalize for evaluation are confidential court proceedings and not a matter of public record.
• The court may record the proceedings, but the record itself is not available to the public, and the hearing is not open to the public. Witnesses must be invited by the court or allowed to be present by the court.

If, after reviewing the Petition and conducting the hearing, the court agrees that the Respondent is mentally ill and presents a danger to self or others, then the judge or master will issue court form MC-305 “ Order on Petition for Involuntary Commitment for Evaluation.”

This Order will state the reasons why the court finds that the Respondent meets the criteria for an involuntary commitment and order the Respondent to be transported to the nearest designated facility for evaluation or treatment.

• Once it is signed by the judge or master, the MC-305 Order for Involuntary Evaluation takes effect immediately.
• The MC-305 Order for Evaluation is good for only 72 hours, but the 72 hours does not start until the Respondent arrives at the designated evaluation facility. If the Respondent arrives at the evaluation facility on a weekend day or holiday, the 72 hours does not start until 8:00 a.m. on the first regular business day.

Currently, there are only three designated evaluation facilities(hospitals) in the State of Alaska:

1. Alaska Psychiatric Institute (API) in Anchorage.
2. Bartlett Regional Hospital’s Mental Health Unit in Juneau.
3. Fairbanks Memorial Hospital’s Mental Health Unit in Fairbanks.

The hospitals listed above are called Designated Evaluation and Treatment (DET) facilities. These hospitals can evaluate and treat persons for up to 30 inpatient days in most cases, and more if necessary.

Generally, patients are sent to hospitals based on geographical location:

• Southeast Alaska residents are sent to Bartlett Regional Hospital.
• Northern and Interior residents are sent to Fairbanks Memorial Hospital.
• Northwestern, Southwestern, and Southcentral (including Kenai Peninsula) residents are sent to API.

Currently, API is the only hospital in the state that can accept minors for involuntary evaluation and/or treatment. API accepts minors between the ages of 13 and 17.

A Respondent may be held up to 72 hours on a hospitalization order for evaluation. If additional treatment is indicated and the person opposes continued voluntary treatment, API or the DET hospital treating the Respondent will seek an involuntary commitment of the Respondent for up to 30 days of additional treatment.

During the 72 hours that a Respondent is being held for evaluation, both a physical examination and a mental status examination must be conducted and the date and time for a possible 30-day commitment hearing must be set.

• If at any time during the first 72 evaluation hours, it is determined that the Respondent no longer meets commitment criteria, the Respondent must be immediately discharged from the hospital.
• If the hospital evaluation staff determine during the 72-hour period that the Respondent is in need of additional care and treatment because of his or her mental illness and if the Respondent continues to meet commitment criteria, the 30-day commitment hearing will be held.
• If the Respondent decides to continue the necessary, recommended treatment voluntarily, no further legal action to compel the Respondent to stay at the evaluation and treatment facility is necessary. The Respondent’s status moves from involuntary to voluntary.

30 Days

At the 30-day hearing, if a superior court judge or master finds that the Respondent’s illness is such that she should continue to be involuntarily committed for ongoing treatment, then a 30-day Commitment Order is signed.

If the Respondent no longer meets legal commitment criteria at any time during the court-ordered 30-day treatment period, then she must be immediately discharged from the hospital unless the Respondent has changed her status to voluntary and agrees to some period of additional treatment before leaving the hospital.

90–180 Days

If the person's condition has not improved t the end of the first 30 days, another hearing is held and the person may be involuntarily committed for up to 90 days. This is a very rare event. At the end of the 90 days, another hearing may be held and a commitment order for up to 180 additional days may be issued. After that, hearings are held and orders issued every 190 days. Again, such lengthy commitments are rare.

Questions regarding involuntary commitment matters may be addressed to:

• DHSS Division of Behavioral Health Offices in Juneau or Anchorage.
• Human Services Section of the Attorney General’s Office in Juneau, Anchorage, or Fairbanks.

Remember that involuntary commitment is a legal procedure. Always follow your organization’s policies and procedures and consult with your clinical supervisor in matters related to these cases.

Work as a team. You can help if you know someone who needs involuntary commitment. Be sure to include the ICWA worker, CHA/P, council members, and/or caring community members who can provide emotional support. You may be able to utilize a locally available tele-video behavioral health consultation from psychiatrists at API or other Alaska- or Washington-based (Seattle) hospitals. You may also be able to consult with itinerant behavioral health providers.

Ensure safety. To ensure everyone’s safety, it may be appropriate to contact a state trooper, a local police officer, a Village Public Safety Officer (VPSO), or a Village Safety Officer (VSO) to take immediate, emergency custody of the community member in crisis.

• If your community does not have peace officers, contact your supervisor or the 24/7 on-call emergency services clinician from your local or regional behavioral health center and follow your agency’s identified emergency mental health procedures and protocols.
• Note: A child or adolescent (a minor) can never be held in "a jail or secure facility" (AS 47.30.705).

Assessment. Contact your employer’s on-call clinician, physician, or designated evaluator to start the process to get the client assessed by a mental health professional.

• This assessment can take place via videoconferencing technology (VTC), in person, telephonically, or by other means with which the person doing the assessment is comfortable.
• You may also be able to work with your CHA/P and assigned physician.
• Follow your employer’s procedures to facilitate the assessment process. If you have any questions, ask your supervisor.

Placement. If a local judge or master determines that a client needs to be committed for evaluation, the client may be placed in one of several treatment facilities in Alaska. Your region will determine the best placement location, taking into account the needs of the client and which facility is closest to your community.

Transportation. In some regions, BHA/Ps may be asked to help make travel arrangements to get the client to the nearest evaluation hospital. Other regions will have dedicated staff (behavioral health center emergency services clinicians) to help with those arrangements. Follow your employer's procedures. Possible scenarios:

• People who have been involuntarily committed for evaluation must be escorted when being transferred out of the community.
• If transportation services are provided through the health clinic, your client may be transported by a medical evacuation (“med-evac”) service. Typically, clinic staff in consultation with regional behavioral health center staff make these decisions.
• Some clients may be held at home, in jail, in a community health clinic (with one-on-one observation), or in a hospital while waiting for transport to the location of the evaluation services.
• Some clients may be escorted by troopers on the next scheduled flight out.
• In many cases involving minors, once a youth has been transferred to a regional hospital, the State of Alaska Division of Behavioral Health will provide secure escort services to API. Your local behavioral health agency will know how to contact these private security firms in order to arrange transport.

Communication. If your client is sent outside of Alaska for services, be sure to collaborate and communicate with other providers, providing them with all key information they need to in order to provide appropriate care during the transfer, evaluation, and treatment. In all cases, good communication is essential. Parents should be involved whenever a child is the recipient of services.