Chapter 51 Vs Chapter 55 - an Informative Use Case
By Dewitt Rose & Stevens Law Firm 2013
If you or a loved one is in need of inpatient care, voluntary commitment is preferred. Voluntary commitment means you have chosen to be admitted to treatment. Involuntary commitment or civil commitment is a legal process through which you are ordered by the court into treatment. In either case, will be through an inpatient facility, or sometimes on an outpatient basis.
While the majority of people with mental health conditions will likely not need to spend time in a hospital or treatment center, an individual may need to be hospitalized so that they can be closely monitored and accurately diagnosed, have their medications adjusted or stabilized, or be monitored during an acute episode when their mental illness temporarily worsens. Hospitalization may occur because someone decides it is the best decision for themselves, at the insistence of a family member or professional or as a result of an encounter with a first responder (emt/paramedic, police officer, etc.).
It is important to carefully assess if hospitalization is necessary for yourself or a loved one and if it is the best option under the circumstances. If you are contemplating hospitalization as an option for yourself, it can reduce the stress of daily responsibilities for a brief period of time, which allows you to concentrate on recovery from a mental health crisis. As your crisis lessens, and you are better able to care for yourself, you can begin planning for your discharge. In-patient care is not designed to keep you confined indefinitely; the goal is to maximize independent living by using the appropriate level of care for your specific illness.
There are also times when a person becomes so ill that they are at risk of hurting themselves or others and hospitalization becomes necessary even though the individual does not wish to enter a hospital. While seeking help voluntarily is always preferable, a family member may have to make the decision to hospitalize someone with a mental illness involuntarily. This act, while difficult, can be more caring than it seems if that is the only way to get someone the care they need, especially if there is a risk of suicide or harm to others.
Court Intervention Services
At times, an adult may need court intervention in order to receive needed services. This occurs most often when the adult with the disability does not see the need for treatment, while family and friends are concerned. Wisconsin State Law provides for civil commitment of a person. This procedure allows a court to order that the person with the disability take medications, attend counseling, or even enter a psychiatric inpatient center.
The required criteria to determine the need for commitment is that a person must be:
- Mentally ill or developmentally disabled,
- “A proper subject for treatment”, and
- Dangerous to themselves or others.
- Dangerous to themselves includes self neglect (not providing themselves with proper shelter, medical care, nourishment, etc), or impaired judgment. This may also include evidence of recent threats or attempts at suicide or serious bodily harm.
A “proper subject for treatment” means that the person can be proven to be treatable—that the symptoms could be improved or controlled.
Civil commitments can be started in three ways:
- By a law enforcement officer,
- Three adults, at least one of which has first knowledge of the person to be committed,
- Or by a medical professional in a psychiatric hospital where the person is already receiving voluntary treatment.
- Three-Party Commitment Petition
If a person is willing to seek help on a voluntary basis, there is no need to pursue a Three-Party Petition.
Since Wisconsin is a least restrictive state, the law governing our mental health system (Chapter 51) emphasizes protecting individual rights and liberties. The laws favor voluntary over involuntary treatment. However, there are three ways in which to force involuntary treatment in the State of Wisconsin:
- Emergency Detention
- Director’s Petition (also known as Director’s Hold)
- Three-Party Petition
- Emergency Detentions - (51.15, WI STATS)
These are initiated when an individual is presently a danger to themselves or others. The detention is obtained by contacting law enforcement.
Director’s Petitions (or “Director’s Hold”) - (51.10(5)(c) and 51.15 (10), WI STATS)
These are used only by psychiatrists when a person who has been seeking services voluntarily and then decides that they want to leave the psychiatric unit and the psychiatrist does not believe that is appropriate for the person. The psychiatrist must be able to state that the person will be dangerous (to self and/or others) if allowed to leave the hospital.
Three-Party Petitions - (51.20 (1), WI STATS)
These actions occur if there are recent dangerous conducts/behaviors present AND one or more of the following disabilities exists: mental illness, drug dependency and/or developmental disabilities.
To substantiate mental illness, drug dependency or developmental disability, you will need to provide information on the current physician, diagnoses, medications and dates of last treatment. The person also must be a proper subject for treatment.
Dangerous conduct/behavior is defined as specific acts, attempts or threats which constitute a substantial risk of physical harm to self and/or others, according to the following standards:
- Danger to oneself (for ex., suicidal thoughts/actions)
- Danger to others (for ex., homicidal thoughts/actions)
- Impaired judgment in that the person is not able to make decisions that are appropriate and potentially dangerous (for ex., believing that they possess super powers and that they can fly if they jump off a building)
- Behavior indicating the person can’t take care of themselves or meet their own basic needs(for ex., person refuses to eat or does not dress appropriately for the weather conditions) so that substantial probability exists that death, serious physical injury, debilitation or disease will imminently ensue unless the person receives prompt adequate treatment.
- Fifth Standard – This standard is different from the other involuntary civil commitment statutes because it requires a finding that the person suffering from a mental illness is in need of treatment AND there must be a finding that the person is incompetent to refuse medication. This is why the Fifth Standard is also referred to as the “need for treatment” alternative to the other four standards. The Fifth Standard also does not require the finding of dangerousness to be immediate or overt, as it is with the first four standards.
- Three-Party Petitions for Alcoholism also have a different standard. A petition may be filed if the person’s dependence on alcohol substantially impairs or endangers the person’s health AND their social or economic functioning is substantially disrupted. Please remember that simply being an alcoholic is not automatic grounds for a petition. There are many people who are alcoholics and still able to function well enough in their lives. In this context, substantially means a severe degree of impairment, endangerment or disruption.
This process may take time. Depending upon several factors and the evidence presented, some petitions could take weeks to bring to court. During this period of time, an emergency detention can be started, if necessary. If the emergency detention process is started, the three-party petition will be put “on hold.”
Please understand that, in addition to meeting the standards, the following criteria must all be met:
- There are three (3) people, including yourself, with at least one person with first-hand knowledge of the person’s situation
- All three persons are willing to sign a petition
- All three persons are willing to testify in court
- petition is required for involuntary commitment signed by three persons. Only one person of the three needs to have personal knowledge of the individual.
The petitions need to have names and mailing addresses of the petitioners and their relation to the subject individual, and shall also contain the names and mailing addresses of the individual's spouse, adult children, parents or guardian, custodian, brothers, sisters, person in the place of a parent and person with whom the individual resides or lives.
From Chapter 51 Statutes on involuntary commitment:
Each petition for examination shall be signed by 3 adult persons, at least one of whom has personal knowledge of the conduct of the subject individual, except that this requirement does not apply if the petition is filed pursuant to a court order under s. 938.30 (5) (c) 1. or (d) 1.
(c) The petition shall contain the names and mailing addresses of the petitioners and their relation to the subject individual, and shall also contain the names and mailing addresses of the individual's spouse, adult children, parents or guardian, custodian, brothers, sisters, person in the place of a parent and person with whom the individual resides or lives. If this information is unknown to the petitioners or inapplicable, the petition shall so state. The petition may be filed in the court assigned to exercise probate jurisdiction for the county where the subject individual is present or the county of the individual's legal residence. If the judge of the court or a circuit court commissioner who handles probate matters is not available, the petition may be filed and the hearing under sub. (7) may be held before a judge or circuit court commissioner of any circuit court for the county. For the purposes of this chapter, duties to be performed by a court shall be carried out by the judge of the court or a circuit court commissioner of the court who is designated by the chief judge to so act, in all matters prior to a final hearing under this section. The petition shall contain a clear and concise statement of the facts which constitute probable cause to believe the allegations of the petition. The petition shall be sworn to be true. If a petitioner is not a petitioner having personal knowledge as provided in par. (b), the petition shall contain a statement providing the basis for his or her belief.