New York State Mental Health Involuntary Commitment Laws

Involuntary commitment is the legal process by which a person is confined in a psychiatric hospital against their wishes. State laws differ about what type of showing is required for this type of involuntary commitment, but all states require evidence that the person has a mental illness and is at risk of harming themselves or others.

New York’s mental health involuntary commitment laws allow both inpatient and outpatient involuntary commitment when certain conditions are met.

Involuntary psychiatric commitment has a long and varied history. The first official commitment took place in 1752 in Philadelphia, but the actual history can be traced back to the 4th century B.C. This was instituted by no less an important character than Hippocrates, of Hippocratic oath fame, who first proposed that the mentally ill be confined to a secluded environment.

Additional instances of locking up those identified as mentally unfit are recorded through history, from the Roman Empire through the English Middle Ages. In 1403, the first provisional “mental asylum” was established, and judges spurred on by the pressures of the person's family members, served as judge and jury, determining not just that the person was ill, but also the term of their commitment.

In more recent times, three court decisions – ​Lake​ v. ​Cameron​ (1966), ​O’Connor​ v. ​Donaldson​ (1975), and ​Addington​ v. ​Texas​ (1978) – changed the requirements and procedures of civil commitments. These legal decisions included a requirement that confinement must be in the least restrictive setting, and set a threshold for the level of danger to self and/or others.

The courts set the burden given to the state to produce “clear and convincing” evidence to proceed with a civil commitment.

New York, like every other state, has laws permitting the involuntary commitment of people judged mentally ill. New York laws for admission include both of the required criteria discussed by the courts in the 1960s and 1970s:

• Requirement that the person has a mental illness.
• Requirement that the person presents a danger to themselves or others.

These requirements for involuntary admission are set out in New York State Mental Health Hygiene Law Section 9.27(a), which provides that the director of a hospital can accept and treat any person who has a mental illness for which immediate inpatient care and treatment in a hospital is appropriate.

If the admission is involuntary, a showing must also be made that the person's illness is likely to result in serious harm to themselves or others. Once the application is made, the person can be committed if they agree and seek admission. This is termed voluntary admission.

The New York state law lists 11 categories of persons who can submit an application for the involuntary commitment of an individual. The list includes:

• Any person who lives with the mentally ill person.
  
• A close family member.
  
• Court.
  
• Supervisor of a correctional facility.
  
• A treating psychiatrist.
  
• Other professionals familiar with the individual’s lifestyle and behavior patterns.

The person can be involuntarily committed if several things happen:

• Two physicians agree and document that the person has a mental illness necessitating inpatient care and treatment.
  
• Individual’s judgment is so impaired that they cannot understand the need for care and treatment.
  
• Person poses a substantial threat of harm to themselves or others due to the mental illness, including the inability to get food, shelter, clothing and health care in addition to dangerous conduct.
  

According to state law, the phrase "likely to result in serious harm" means either a substantial risk of physical harm to the person as manifested by threats of suicide or serious bodily harm or other conduct demonstrating that the person is dangerous to themselves.

It can also mean that the person presents a substantial risk of physical harm to others as manifested by homicidal or other violent behavior by which others are placed in reasonable fear of serious physical harm.

If the hospital where the application was made has inpatient psychiatric treatment facilities, another evaluation is made. This third evaluation must be performed by a staff psychiatrist. It's purpose is to determine whether the individual meets state standards for involuntary commitment.

What happens when the hospital doesn't have an inpatient psychiatric treatment program? In that case, police or an ambulance can transport the individual to a psychiatric facility where a qualified psychiatrist must evaluate the patient and confirm the need for commitment. If this happens, the individual can be held for up to 60 days.

When this period ends, the person's treating physician can request that the court extend the commitment period. The court weighs the request based on the evidence presented and either grants or denies the extension.

Involuntary outpatient commitment in New York started with the focus on assisting people with mental illness. However, in 1999, a series of incidents occurred in which individuals with untreated mental illness became violent and injured or killed others. Involuntary outpatient care transformed into more of a public safety issue.

The first and worst incident happened on the New York City subway in 1999. A person with schizophrenia who was off their medication pushed a woman named Kendra Webdale into the path of a train, killing her. From this, Kendra's Law was enacted in November 1999.

Kendra's Law permits a court to order individuals who have been diagnosed with mental illness to attend treatment for their illness if they wish to continue living in the community.

The law applies to anyone 18 years or older with a mental illness who is found, by clear and convincing evidence, to be unlikely to survive safely in the community without supervision. It is termed "assisted outpatient treatment" (AOT) in an apparent attempt to lessen the stigma.

The law requires that each county in New York state establish a local AOT program to implement the statute's requirements. These programs must be monitored by the state Office of Mental Health as well as by local mental health authorities.