Involuntary Commitment: Barriers to optimal service delivery

Psychiatric interventions for crisis care through the legal mechanism of civil commitments are a reality across the U.S. With a comprehensive, community-based system of adequately funded mental health services that are accessible by all and provided in the least restrictive environment, optimal service delivery is envisioned. However, there are barriers to optimal mental health service delivery resulting in less than optimal outcomes. This study investigates barriers to optimal mental health service delivery in one Southern state and associated issues related to the process of civil commitment. A qualitative study including stakeholders in the civil commitment process was conducted. Focus groups, dialogue groups and interviews were used to gather data. Participants included consumers of mental health services, families of consumers, mental health care providers, Special Justices/Judges, Appointed Counsel, Magistrates and others. Analytic procedures guided by the principles of Grounded Theory were used in the analyses. Over 160 individuals participated in a statewide study. Themes emerged across and within groups including the problem of the stigma of mental illness, lack of knowledge among the public and professionals that mental illnesses are biologically based brain disorders that are treatable, problems with law enforcement being involved in facilitating the care of consumers with mental illness, lack of alternative options for service delivery in the community, reimbursement issues, and others. Barriers to optimal mental health service delivery include system issues; resource issues; differences in mental health service delivery assumptions and beliefs; ethical issues, legal issues; and individual human rights issues, among others.