The following is provided for general information purposes only. This is a simplified
description of the civil commitment process. You should not rely on it for
advice about a particular case. If you or someone you know is subjected to
an involuntary commitment proceeding, the court should appoint a lawyer in
the case so that advice and assistance can be given in the particular case.
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What does it mean to be “involuntarily committed?”
The term is usually used to mean confinement in the New Hampshire State
Hospital or other designated facility by order of a court. In New Hampshire, persons with mental illness
who are determined
to be dangerous may also be confined to other psychiatric facilities under
some circumstances and may be subject to certain conditions of treatment
after their release.
Who makes the decision to commit someone?
Judges make the final decision to force someone’s admission to
the hospital. However, a doctor alone can authorize the initial confinement
In cases where the person has not already been confined, the process commonly
begins when a doctor determines that a person is in such a mental condition due to mental illness that he poses a likelihood of danger to himself or others.
To be sufficient to justify confinement, the medical examination must be performed
or supervised by a doctor or nurse practitioner who has been approved to perform
such examinations. It also must occur within 3 days of the request to confine
Once the initial medical determination is properly certified, a person
may be confined for up to 10 days, not including weekends. This is known as an involuntary
or IEA. The IEA authorizes a police officer to transport the person to
Hampshire Hospital or other “designated receiving facility.” Currently,
designated receiving facilities are the Elliott Hospital
in Manchester and the Cypress Center in Manchester.
Although the doctor’s certification is enough to trigger confinement, a
district court judge must review the IEA within 3 days, excluding Sundays and holidays. The person who requested
the IEA (“the petitioner”) must present enough information to the
judge to show that “probable cause” supports the IEA. The probable
cause standard is fairly lenient; it is the same standard used to determine
if there is enough reason to arrest someone for a crime, for example. The person being confined will have an attorney appointed for representation at the IEA hearing.
If a judge determines that probable cause exists, the person’s confinement
can continue beyond the initial 3 days. From that point, one of 3 things
- A request for longer commitment may be filed in the probate court,
in which case the person may be held while that court considers the
- A second IEA may be put into place, but must be based on a
new dangerous act by the person during the initial IEA. Another ten
day period would
a new probable cause determination would have to be made by a district
- The person is discharged from the IEA, either because the hospital
determines that they are no longer mentally ill and dangerous, or because
ten day period expires.
What is the process for forcing someone to stay at the New Hampshire
Hospital for longer than ten days?
The probate court handles requests for longer-term confinement and
forced treatment. Typically, petitions are brought concerning people
confined under an IEA, or due to criminal prosecution, or due to
a previous commitment.
To begin the process, a formal petition must be filed which includes
- A description of specific acts that show that the person is in a
dangerous condition due to mental illness. The danger alleged in the
may be either to self
or to others;
- A certification from an approved physician who has
examined the person and agrees that the person is dangerous due to
- A list of witnesses who can testify to the contents
of the petition.
The court must hold a hearing on the petition within 15 workdays. A
lawyer is appointed to represent the person, and a psychiatric examination
ordered. If the person is in custody due to an IEA, then that custody can continue
the probate court considers the petition.
The psychiatrist files a report with the court and a copy is given
to the lawyer for the person. The report is required to address
whether the person is dangerous,
the appropriate treatment for the person and whether hospitalization
is necessary for that treatment. The psychiatrist should provide
of the length
of treatment needed and include in appropriate cases a period of
conditional discharge during which the person would be required
to follow treatment
conditions following release from the hospital.
Can the psychiatrist’s opinions be challenged?
Yes. At the probate court hearing, the attorney may cross-examine
the psychiatrist and present other evidence to attempt to challenge
conclusions. Other psychiatrists could be called to testify, but
it is unusual for there to
be more than one psychiatric examination in a case.
What rights does one have while involuntarily committed?
New Hampshire’s commitment law specifically states that admission to the
mental health services system does not in and of itself affect such civil liberties
as the right to vote, to enter into contracts, to marry or divorce, or to hold
motor vehicle or professional licenses. It is important to know, however, that
the probate court in a guardianship proceeding can take away certain rights.
Commitment proceedings can be accompanied by guardianship proceedings, or the
New Hampshire Hospital can petition the probate court during the period of commitment
to appoint a guardian. The New Hampshire Hospital may initiate guardianship proceedings
due to a belief that medications should be administered despite the patient’s
Can a person who has been committed be forced to take medication against their
Neither an IEA nor a probate commitment is enough to force the committed
person to take medication. Forced treatment of committed persons
can only be given
in three circumstances:
- If there is an emergency situation where
a physician determines that serious physical harm would be inflicted
if treatment were not given
immediately, a person
can be given medication without their consent. However, they
cannot be subjected to psychosurgery, electro convulsive therapy, sterilization,
treatment of any kind.
- If the person is considered incapable of
making an informed decision, and there is an urgent need for medical
or psychiatric treatment,
such treatment can be
authorized, but only after a lawyer is provided to the person
and a hearing is held by the Department of Health and Human Services.
- If a guardian
is appointed by the probate court, the guardian can authorize treatment
even if the committed person objects.
Who can find out that a person has been involuntarily committed?
In general, there is a right to keep information
confidential about any hospitalization, and this applies to involuntary hospitalizations.
are circumstances where
the information could become known, however. For example,
information regarding treatment following an IEA or probate
commitment can be given
to persons living with or providing care to persons who were
subject to such commitments.
The patient, however, must be told about the intended release
of information and the reasons for it. Some professional
that may require disclosure of information about prior
commitments. Some inquiries about mental illnesses have been
found to be in
with Disabilities Act because they may screen out people
with disabilities that are
How long can someone be held at the New Hampshire Hospital involuntarily?
The initial IEA expires after ten days. If someone is subject
to a probate commitment, the commitment order can last
for as long
as 5 years, and
can be renewed. The
court should tailor the commitment period to the treatment
needs in the case. If the staff at the New Hampshire Hospital
a person may be released before the end of the commitment
period ordered by the court.
What is a conditional discharge?
A person who has been committed to the New Hampshire Hospital
can be released under either a conditional or absolute
that inpatient treatment is no longer necessary but that
conditions of treatment are needed to prevent a recurrence
of a dangerous
condition, the patient may
be required to comply with those treatment conditions. Patients released on a conditional discharge are required to receive treatment from a community mental health center. An absolute discharge means the patient has no conditions placed on their release.
What happens if the conditions of the discharge are violated?
The person may be returned to the New Hampshire Hospital
if it is shown that the conditions were violated. That
be shown to actually be a danger to self or others, but
there are specific procedures
that must be followed both before and after the return
to the hospital. The person is entitled to a lawyer to
assist in the
can challenge the
of the conditional discharge.
Under what circumstances can a commitment be renewed?
The probate court can renew a commitment if the
person is, at the time of the recommitment, dangerous to themselves or others.
A person can also be recommitted to force them to remain on a conditional
discharge if treatment is necessary to prevent the recurrence of the
circumstances which led to the dangerousness. The person is entitled
to the same safeguards as in the original commitment.
August 16, 2013
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