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Articles   |    
Statutory Definitions of Mental Illness for Involuntary Hospitalization as Related to Substance Use Disorders
Arthur Robin Williams, M.D., M.B.E.; Shelly Cohen, M.D., J.D.; Elizabeth B. Ford, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300175
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The authors are with the Department of Psychiatry, New York University School of Medicine, New York City (e-mail: ar.williams@nyumc.org). Part of this study was presented as a workshop at the Institute on Psychiatric Services, New York City, October 4–7, 2012.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  In New York City, individuals gravely disabled by substance use disorders repeatedly present to emergency rooms yet rarely remain in treatment for more than several days and often sign out against medical advice. Although these individuals are at high risk of death and often lack the capacity to make treatment decisions, the laws in New York State are unclear about whether substance use disorders qualify as mental illnesses for the purpose of involuntary hospitalization. To better understand the national landscape of civil commitment law, with a specific focus on substance use disorders, a review was conducted of mental health statutes in all 50 states and the District of Columbia (D.C.).

Methods  Two independent reviewers examined all state mental health statutes using LexisNexis and Westlaw search engines.

Results  A total of 22 states, including D.C., do not reference substance use disorders in their statutory definitions of mental illness. Of the 29 that do, eight include substance use disorders and 21 explicitly exclude them. In addition, nine states have separate inpatient commitment laws specifically addressing substance use disorders.

Conclusions  Civil commitment statutes vary greatly by state in terms of clarity and specificity regarding which mental illnesses are included for the purpose of involuntary hospitalization. Mental health professionals and policy makers should discuss whether individuals gravely disabled by substance use disorders, a complex and vulnerable population, should be more widely included under standard civil commitment law.

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Table 1Inclusion or exclusion of substance use disorders in state laws defining mental illness for the purpose of involuntary hospitalization
Table Footer Note

a Rather than “mental illness,” some states use terms such as “mental disorder,” “mental disability,” or “mental condition.”

Table Footer Note

b Separate law specifically permits commitment of persons with substance use disorders.

Table Footer Note

c California does not define mental disorder; however, its definition of grave disability for the purposes of hospitalization of persons with mental disorders explicitly includes “chronic alcoholism.” There is no reference to other drug dependence.

Table Footer Note

d Involuntary commitment of persons with substance use disorders is allowed in addition to persons with mental illness.

Table Footer Note

e State does not define mental illness.

Table Footer Note

f New Jersey statutes state that involuntary hospitalization is not allowed for “simple” intoxication unless there are severe complications but do not explicitly reference substance use disorders.

Table Footer Note

g Alcoholism excluded but other substance use disorders (that is, illicit drug dependence) not referenced

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