Involuntary commitment is on the rise

You may have noticed a disturbing trend unfolding in the news and in your own community. Cities and states—including some that once pioneered compassionate approaches to mental health—are now tightening their civil-commitment laws, reinstating stricter measures under the guise of public safety. The impact is stark: individuals struggling with severe mental illness (SMI), often entangled with substance use and homelessness, are bearing the brunt of these policy shifts. 

While involuntary commitment is legally designed to protect individuals who, due to their mental state, pose a danger to themselves or others, the dramatic increase in these proceedings – and the ways they’re now being implemented – is raising serious questions and reshaping your daily work.  

You stand at a critical juncture, navigating the complex interplay between client autonomy, public safety, and a system under immense pressure. How do you reconcile your clinical practice with laws that seem to contradict the very principles of care you’ve dedicated your career to?  The rules are changing, and with them, the delicate balance between safeguarding your clients’ rights and ensuring their safety – and that of the community – has grown more precarious. Your expertise is needed now more than ever to navigate this new landscape, inform policy discussions, and advocate for the resources your clients desperately need. Here’s what’s happening, why it’s happening, and how you can respond. 

What’s changing, and why?

This policy reversal isn’t happening in a vacuum. It’s largely a response to very visible crises and mounting public and political pressure.  

We’re facing a profound acute mental health crisis, worsened by societal challenges like homelessness, substance use, and a chronic lack of accessible community-based care. Reports from the National Center for Health Workforce Analysis (HRSA), for instance, consistently confirm a persistent shortage of mental health professionals, particularly in rural areas.  

When outpatient resources are scarce and crisis stabilization options are limited, involuntary commitment often becomes the default—or even the only—perceived option in moments of acute distress. You’ve likely seen this play out: systemic gaps, from inadequate insurance coverage for preventative care to racial disparities in crisis response, funnel vulnerable individuals into coercive systems. A client who couldn’t access timely support may now face a choice between jail, homelessness, or hospitalization. 

Then there’s the stigma factor. Despite progress, misconceptions about mental illness persist. Families and even some healthcare providers may push for commitment out of fear or misunderstanding, viewing it as the only way to “keep someone safe.” 

Furthermore, changes in state laws have broadened the criteria for involuntary commitment. Some states now allow for commitment based on “clear and present danger,” which can be interpreted more broadly than simply a threat of violence.  

These legislative shifts are deeply influenced by public sentiment, especially in communities grappling with intersecting crises of housing, the opioid and methamphetamine epidemics, and highly visible behavioral health challenges. In cities like San Francisco and Portland, voter backlash against progressive policies has escalated, fueled by a demand for safer public spaces. As Keith Humphreys, a Stanford psychiatry professor, documented, that the public’s empathy has eroded, replaced by a demand for “safer-feeling” public spaces. Politicians, sensing voter unease, opted for quick-fix solutions: “get people off the streets, into beds, for their own safety.” It’s politically expedient, but clinically hollow. 

This shift is codified in initiatives like California’s CARE Courts, New York City’s first-responder directives, and Oregon’s rollback of drug decriminalization. On the surface, these policies aim to bridge treatment gaps – especially for individuals with anosognosia, who may not recognize their need for care.  

Unfortunately, just as our systems were unprepared to implement progressive reforms effectively, we now lack the infrastructure, funding, and trained workforce to meaningfully support the very people we’re rushing into “mental health beds.” 

The gap between mandate and reality

A key concern driving the disquiet about this trend is that the push for mandated treatment often outpaces the development of the resources needed to make it effective. 

Mandating treatment raises a fundamental question: treatment  where, and by whom? 
Many regions lack sufficient psychiatric hospital beds, crisis stabilization units, supportive housing, and robust, community-based outpatient programs. Without a functioning infrastructure and adequate funding, individuals may be held temporarily, then discharged with inadequate follow-up, potentially cycling through emergency rooms, shelters, or the justice system, rather than engaging in meaningful recovery. 

Furthermore, there is a real risk, voiced by critics including the ACLU, that these policies could lead to the “criminalization” of homelessness and mental illness, prioritizing an “out-of-sight, out-of-mind” approach over a truly health-based one, and potentially take us “back to a dark era of forced treatment.” Early reports on some initiatives suggest they are struggling to meet initial goals and raise concerns about equitable implementation. 

The impact of involuntary commitment on therapists

Your caseload may shift: more clients may arrive involuntarily, with acute crises layered by trauma from sudden detention. Being aware of this, screening for it, and employing trauma-informed principles are more critical than ever, whether you are working with a client during or after an involuntary hold. You’ll need clear protocols for intake, risk assessment, and collaboration with legal or case-management teams. 

You may find yourself working with clients who are, or fear being, compelled into care. Balancing beneficence (helping clients) and autonomy (honoring their choices) grows more challenging when treatment isn’t voluntary. Reflect with peers or ethics committees on consent, capacity assessments, and rights restoration. Building a therapeutic alliance may be significantly more challenging if a client perceives therapy as part of a coercive system. 

Early reviews of hardline programs point to racial disparities in who gets committed. Staying vigilant about bias—both systemic and unconscious—will help you preserve therapeutic alliance. 

The rise of involuntary commitment also means you’ll likely have greater interface with court systems (like CARE Courts), hospitals, and case managers operating under these new mandates. Understanding the legal thresholds and processes in your specific state and city is becoming increasingly necessary to effectively support your clients. However, this also adds a significant burden. Navigating subpoenas, familiarizing yourself with legal documentation requirements, and providing supporting information can be an overwhelming task, particularly for small or solo practices with limited administrative resources. 

Your role in advocating for, and participating in, robust discharge planning and warm hand-offs to community-based resources is magnified. Preventing relapse and re-hospitalization relies heavily on the availability and accessibility of the ongoing, voluntary, community-based care that therapists provide. 

As clinicians, you see the resource gaps firsthand. This trend underscores the urgent need for therapists to be part of the public conversation, advocating for increased funding (including protecting vital streams like Medicaid) for a full continuum of care – from crisis services and inpatient beds to outpatient therapy, peer support, and stable housing. Compelled care cannot succeed in a vacuum; it must be integrated with accessible, high-quality, voluntary services. 

How to navigate the rise of involuntary commitment with integrity 

While the systemic factors contributing to the rise in involuntary commitment are vast, you are not without agency. You play a vital role in both navigating these situations and advocating for better outcomes. So, how do you honor client autonomy while working within a flawed system? Start by expanding your toolkit: 

Foster proactive crisis planning with your clients 

Don’t wait for a crisis to unfold. When clients are stable, initiate conversations about crisis planning. This means collaborating with them to identify early warning signs, develop coping strategies, and articulate their preferences for care during an acute episode. Discuss what they would want, and what they would not want, should their judgment become impaired. This proactive approach supports their self-determination, offering them a voice in their care even during difficult future times. Help them understand legal advance directives for mental health treatment – these are crucial documents that can guide care providers should a crisis arise. 

Deepen your knowledge of local resources and legal frameworks 

Familiarize yourself with the specific involuntary commitment laws in your state or region. Understand the criteria, the process, and the rights of individuals once they are committed. You could even create cheat sheets or PDFs to distribute. Advocate for co-located services (mental health, primary care, social work) so that when courts release clients, there’s a seamless handoff to wraparound supports. 

Knowing this information allows you to speak plainly with clients, helping them comprehend the serious implications and potential pathways. Additionally, build a robust network of local crisis intervention teams, emergency services, and legal aid organizations. Knowing who to call and what to expect can make a significant difference in a volatile situation. The more alternatives you can offer, the less often commitment becomes the “only” option.  

Prioritize thorough and objective documentation 

In situations that might lead to involuntary commitment, clear, objective, and detailed documentation is essential. Focus on observable behaviors, direct quotes, and your clinical assessment of risk, rather than subjective interpretations. Document your attempts to mitigate risk, your discussions with the client about safety, and any consultations you have had. This helps ensure that if a commitment proceeds, there is a clear, defensible rationale, and it provides a vital record should you need to advocate for your client within the legal or medical system.  

Also document outcomes and data, and push for transparent reporting on outcomes: Are involuntary programs reducing hospital readmissions? Improving long-term recovery? What do you see in your community? 

Strengthen your collaboration with care teams and families 

When appropriate and with client consent, work closely with other healthcare providers, psychiatrists, and family members. A unified care team can offer comprehensive support, identify escalating risks earlier, and coordinate interventions more effectively. Family involvement, when handled sensitively, can be invaluable in crisis prevention and in supporting a client through and beyond commitment. 

Advocate for your clients and systemic change 

If a client is committed, continue to advocate for their rights and preferences within the treatment setting as much as possible. This might involve communicating with the inpatient team to convey your client’s wishes or providing context from their outpatient history. When systemic barriers arise (e.g., a client denied community care due to insurance), document the issue and escalate it.  

Beyond individual advocacy, consider how you can contribute to broader systemic change. This could mean participating in professional organizations that lobby for increased funding for community mental health, supporting initiatives for crisis diversion programs, or speaking up about the need for more accessible outpatient services. Your professional voice holds weight. Include people with lived experience in advisory boards or program design. Their insights can prevent one-size-fits-all policies that miss cultural and individual needs. 

Keep pushing for accountability. Systems change when we stop accepting ‘this is how it is.’” 

Seek consistent ethical consultation and peer support 

These are incredibly difficult situations, fraught with ethical dilemmas and emotional weight. Do not carry this burden alone. Regularly consult with supervisors, ethical review boards, or trusted peers when facing complex situations. Discussing these cases helps you gain perspective, explore all options, and ensure you are acting in the most ethically sound manner. Peer support also provides a crucial outlet for processing the emotional toll of this work. 

Supporting yourself, too 

This work is emotionally taxing, and you’re on the front lines. You may face backlash from clients, families, or even institutions. Regular supervision and peer consultation aren’t just advisable—they’re essential. And while advocating for your clients and for change is important, don’t burn yourself out.  

Moving forward 

The trend toward involuntary commitment reflects genuine concerns about public safety and the well-being of people in crisis. But without adequate beds, community support, or equitable processes, the system inadvertently criminalizes the very people it aims to help. It’s a challenge that requires a collective response – from policymakers, mental health professionals, and the community as a whole.   

By staying informed, forging cross-sector partnerships, and elevating client rights, you can shape a more humane response—one where treatment is timely, just, and grounded in compassion. You’re on the front lines of this debate. Your knowledge, advocacy, and clinical wisdom can help tip the scales toward policies that truly heal, rather than coerce, those experiencing a mental health crisis.