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Civil Commitment and Mental Health Care

Civil Commitment and Mental Health Care Continuum: Historical Trends and Principles for Law and Practice

1. A record of involuntary commitment can affect the right of private citizens to possess firearms.

A. True

B. False


Origins and Current Status of Civil Commitment

2. The court has ruled that “dangerousness” necessary for commitment must be all of the following, except:

A. Immediate

B. Evidenced by a recent overt act, attempt, or threat to do substantial harm to oneself or another

C. Evidenced by a past occurrence

D. Be proved beyond a reasonable doubt


3. Every state’s statute requires that persons subject to commitment have a mental illness.

A. True

B. False


4. New restrictive laws were the cause of deinstitutionalization.

A. True

B. False


5. All of the following are the most important factors shaping deinstitutionalization, except for:

A. The advent of effective medications

B. Stricter commitment laws

C. The Community Mental Health Act of 1963

D. Changes in Medicaid laws


6. Psychiatric care is the only medical care in the U.S. that has experienced deinstitutionalization.

A. True

B. False


7. Dangerousness must always mean a risk of violent behavior.

A. True

B. False


8. Which of the following is true in order for a person to be committable?

A. That but for the presence of a treatable mental illness, the person’s risk of harmful acts (or omissions) would not rise above a threshold of concern.

B. A person’s potential harmful behavior must be caused by mental illness.

C. A person’s mental illness itself provides a sufficient scientific explanation for the behavior.

D. A person’s harmful behavior must be categorized as violence towards others.


9. The purpose of commitment is to assure treatment - treatment to ameliorate those symptoms of mental illness that contribute significantly to an individual’s elevated risk of harm to self or others.

A. True

B. False


10. Nearly every state provides _____ as grounds for commitment.

A. Active dangerousness

B. Grave disability

C. Serious deterioration

D. Active dangerousness, grave disability, or serious deterioration are all grounds for commitment


11. Which of the following, where it appears, is always coupled with the risk that a person, without treatment, will become dangerous in some sense?

A. Mental illness present

B. Grave disability

C. Serious deterioration

D. Having a mental illness present, grave disability, and serious deterioration are all coupled with the risk of future dangerousness


12. Dangerousness requires prediction that an individual will act in a way that results in harm.

A. True

B. False


13. Which inpatient commitment law currently in effect is required in every state?

A. Mental illness

B. Dangerousness to self or others

C. Grave disability

D. Need for treatment


14. Inpatient commitment law allows for proceedings to be initiated by a family member, a mental health provider, a law enforcement officer, or a court official.

A. True

B. False


15. Only in some states do individuals have the right to:

A. The assistance of counsel

B. Request a jury

C. Appear, testify, and present witnesses and other evidence contesting commitment

D. Confront witnesses appearing against them


16. Outpatient commitment orders, if kept in place for at least _____ months and paired with intensive services, are associated with reduced incidence of hospitalization and improved quality of life for many persons with a serious mental illness.

A. 3

B. 6

C. 9

D. 12


17. Outpatient commitment laws and policies, implementation models, and practices, if badly designed, poorly implemented, or under-resourced, pose the risk of subjecting individuals they commit to services that are non-existent or of poor quality, further alienating these individuals from the services system.

A. True

B. False


18. Which law requires that a candidate for AOT have been hospitalized at least twice within the prior three years as a result of non-compliance with treatment, or have committed, attempted, or threatened an act of violence or self-harm within the prior two years?

A. Kendra’s Law

B. Laura’s Law

C. Kevin’s Law

D. Amber’s Law


19. Research has shown a strong link between mental illness and violent behavior.

A. True

B. False


20. The promotion of AOT as a way to prevent violence - especially with regard to rare and extreme acts such as multi-casualty mass public shootings - is largely misplaced, and can have the unintended adverse effect of reinforcing and increasing the social stigma associated with mental illness.

A. True

B. False


21. All of the following are goals of involuntary outpatient commitment, except:

A. To mobilize appropriate treatment resources.

B. To enhance the effectiveness of treatment and improve an individual’s adherence to the treatment plan.

C. To act as a primary tool to prevent acts of violence.

D. Mobilizing appropriate treatment, enhancing its effectiveness, improving adherence, and preventing acts of violence are all goals of involuntary outpatient commitment.


Ethical Principles to Guide Civil Commitment

22. All of the following are Beauchamp and Childress’ main ethical principles, except for:

A. Respect for autonomy

B. Non-maleficence

C. Beneficence

D. No undue cost burden


23. Ethical critiques of outpatient commitment based on _____ - also applicable to inpatient commitment - focus on the inherent coerciveness of “forced treatment” and the theoretical notion that removing choice makes recovery difficult or impossible.

A. Respect for autonomy

B. Justice

C. Beneficence

D. Non-maleficence


24. In civil commitment, which of the following means balancing the value of self-determination and choice with the social responsibility to care for persons who, at times, have a diminished capacity to act in their own best interest?

A. Respect for autonomy

B. Justice

C. Beneficence

D. Non-maleficence


Practical Tools to Assist Policy Makers in Evaluating, Reforming, and Implementing Involuntary Civil Commitment

25. If the person is willing and able to engage with services voluntarily, he or she should not be committed.

A. True

B. False


26. Unless the serious mental illness for which treatment is needed places the person at risk for harm, inpatient commitment should not be used.

A. True

B. False


27. If law enforcement agencies are responsible for transporting individuals proposed for or under order of commitment:

A. They should assign plainclothes officers.

B. They should use unmarked cars.

C. Shackles and other restraints should be used only if necessary, never as a matter of routine.

D. If law enforcement agencies are responsible for transporting individuals proposed for or under order of commitment they should assign plainclothes officers in unmarked cars, and shackles and other restraints should be used only if necessary, never as a matter of routine.


28. Unless already incarcerated for a criminal offense, or facing criminal charges, no candidate for commitment should be detained in a jail or other correctional facility pending commitment, and no person who has been committed should be placed in a correctional facility for treatment services.

A. True

B. False


29. Treatment staff should have the authority to terminate commitment without the court’s authorization and should terminate commitment as soon as the individual progresses to the point where he or she no longer meets commitment criteria.

A. True

B. False


30. No court should insist that a hospital or other treatment provider retain an individual in services at a level of care that the hospital or provider believes is unnecessary.

A. True

B. False


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