LANDMARK CASES IN FORENSIC PSYCHIATRY:
Civil Commitment
Lake v. Cameron, 1966
Case Summary:
Lake, an elderly woman, was psychiatrically hospitalized after she was found wandering, and a petition for civil commitment was initiated. Lake filed for habeas corpus against Cameron, the Superintendent of St. Elizabeth’s Hospital, which was dismissed.
Lake was found to be of “unsound mind“ due to “chronic brain syndrome” and committed to St. Elizabeth’s.
DC Court of Appeals ruled that confinement should be limited to that reasonably required for protection from harm, considered only as a last resort after exploring less restrictive treatment alternatives.
Key Concepts:
Psychiatric patients should not be confined via civil commitment if a less restrictive alternative treatment option is available.
Lessard v. Schmidt, 1972
Case Summary:
Lessard was brought to the hospital by police, held under emergency detention, and subsequently civilly committed for an extended period.
Lessard wasn’t informed of the commitment hearings or decisions, and filed a class action suit for Due Process violations.
District Court found civil commitment requires:
Evidence of mental illness and immediate dangerousness proven beyond a reasonable doubt
No less restrictive treatments available
The same Due Process protections as those afforded in criminal proceedings.
Key Concepts:
Patients undergoing civil commitment proceedings are entitled to the same Due Process protections as those afforded in criminal proceedings..
Note: US Supreme Court has never ruled on minimum constitutional standards for civil commitment.
O’Connor v. Donaldson, 1975
Case Summary:
Donaldson, a man with schizophrenia, was committed by his father to a FL state hospital where he was confined for 15 years.
He received milieu therapy, but no medications or therapy. He wasn’t dangerous. He requested discharge from the superintendent, Dr. O’Connor, which was denied. After Dr. O’Connor retired, Donaldson was released and filed suit.
District court found a Right to Treatment under the 14th Amendment.
Supreme Court found that civil commitment for mental illness alone is unconstitutional, there must also be a finding of dangerousness.
Key Concepts:
It’s unconstitutional to confine, without more, a non dangerous patient capable of surviving safely on their own or with the help of friends and family
Civil commitment requires a finding of dangerousness, not just mental illness alone.
Supreme Court did not explicitly accept nor reject a constitutional right to treatment.
Some states have interpreted “without more” to mean a right to treatment.
Addington v. Texas, 1979
Case Summary:
Addington was petitioned for civil commitment by his mother after he threatened her. He requested a jury trial regarding the need for commitment.
Addington was indefinitely committed based on a clear and convincing evidence standard.
US Supreme Court ruled that the minimum standard of evidence for civil commitment is clear and convincing evidence.
Key Concepts:
The minimum standard of evidence for civil commitment of psychiatric patients is clear and convincing evidence.
Civil commitment involves significant liberty interests, greater than loss of money.
Parham v. JR, 1979
Case Summary:
JR was a minor whose foster parents applied for admission to a state hospital. A patient class action suit was filed arguing due process violations, with concern that admissions weren’t justified, and procedures were inadequate to prevent use of the state hospital as a “dumping ground.”
District court found that the voluntary admission procedures for minors violated due process, lacking notice and a hearing.
US Supreme Court disagreed, and found that due process is not violated by use of informal medical techniques (such as an admission application) rather than a formal hearing..
Key Concepts:
The full due process protections provided to adults facing civil commitment don’t extend to the voluntary admission of children.
If a parent has requested hospitalization, a full judicial hearing isn’t required. Review by a neutral medical professional is adequate.
A judicial hearing may intrude into the parent-child relationship. Parents are generally assumed to act in their child’s best interest, and formal judicial hearings may deter them from seeking treatment.
Zinermon v. Burch, 1990
Case Summary:
Burch signed papers for voluntary psychiatric admission in the context of psychosis. His capacity to consent to treatment was not evaluated.
Burch claimed violation of Due Process, arguing that he was incompetent to consent to admission, and that the hospital should’ve provided procedural safeguards.
US Supreme Court found procedural safeguards are necessary for voluntary psychiatric admission given the loss of liberty inherent with confinement. A lack of capacity to consent to psychiatric admission is reasonably foreseeable.
Key Concepts:
Patients must be competent in order to provide valid consent to voluntary psychiatric hospitalization.