Book – Civil Commitment: A Therapeutic Jurisprudence Model

Table of Contents
Reviews
The civil commitment of people with mental illness has had a long history. We originally followed a medical model of civil commitment, in which the commitment decision was left largely in the discretion of physicians, with little scrutiny by the courts. Starting in the 1960′s, however, in response to the excesses of the medical model, a paradigm shift occurred in which the medical model was replaced by a legal model of civil commitment that was much more protective of the legal rights of patients. The legal model, however, has raised new difficulties, sometimes elevating protection of legal rights over the clinical needs of patients. A new model of commitment therefore is needed that strikes an appropriate balance between the protection of legal rights and the achievement of clinical needs. This book offers such a new model — a therapeutic jurisprudence model of civil commitment.

The book uses therapeutic jurisprudence to examine a variety of issues relating to civil commitment and to propose how legal practices may be restructured so as to increase the efficacy of hospitalization. It analyzes the key issues in civil commitment and makes concrete proposals concerning how commitment laws and the ways in which they are applied can be restructured to bring about better therapeutic outcomes. The issues explored include the tension between coercion and autonomy reflected in commitment laws and how the balance should be struck between these competing values, the standards for commitment, the commitment hearing and how lawyers, judges, and expert witnesses should play their roles, voluntary hospitalization and its application, rights within the institution and the standards governing their exercise or waiver, outpatient commitment, including its newest version, preventive outpatient commitment, and how international human rights limitations on commitment should be construed. The book concludes with a chapter analyzing therapeutic jurisprudence’s challenge to civil commitment law and practice.

Book Blurbs:

“Bruce Winick kicks Therapeutuc Jurisprudence up several notches in this remarkable new book. With uncommon erudition and in precise, elegant prose, he demonstrates how coercion to mental health treatment — in both its institutional and community forms — can be seen more clearly through the lens of a theory that takes seriously the therapeutic potential of law.”
John Monahan , Ph.D., Doherty Professor of Law, University of Virginia

“ Bruce Winick ’s work on therapeutic jurisprudence has long been a beacon for anyone involved or interested in mental health law. This newest effort on his part will be another crucial reference point for mental health professionals, scholars, lawyers, judges and consumers of psychiatric treatment. Winick masterfully weaves together legal doctrine and empirical research into a practical guide for dealing with a wide range of issues concerning civil commitment, including the use of coercion by the state, the doctor-patient relationship, the definition of competency to make treatment decisions, and outpatient interventions. Winick deftly demonstrates that, through the prism of therapeutic jurisprudence, civil commitment can be viewed as a cooperative health-enhancing process, rather than a zero-sum battle between autonomy principles and treatment goals.”
Christopher Slobogin, Stephen C. O’Connell Professor of Law, University of Florida Fredric G. Levin College of Law

“ Bruce Winick ‘s new volume on civil commitment is the most important book-length work on that topic that has been published in my 35 years as a lawyer. It examines virtually every question raised by the commitment process, and rigorously analyzes each issue through the lens of therapeutic jurisprudence. By way of one example, his chapter on international human rights law will immediately restructure how we think about the relationship between that body of law and all of mental disability law. This book is, to be concise, superb.”
Michael L. Perlin, Professor of Law, New York Law School

“ Bruce Winick has done it again. ‘Civil Commitment: A Therapeutic Jurisprudence Model’ uses TJ comprehensively to challenge and provoke those who wish to do mental health law business as usual. It is required reading for mental health lawyers, advocates, and anyone interested in the intersection of mental health, law and social policy.”
Stephen J. Morse, J.D., Ph.D., Ferdinand Wakeman Hubbell, Professor of Law & Professor of Psychology and Law in Psychiatry,
University of Pennsylvania

“Why be concerned about involuntary civil commitment in an era when it is difficult to get approval to admit even very disturbed psychiatric patients? In the first few pages of this important book, Winick makes the point that many patients continue to confront the reality of involuntary commitment. Then, using clear and graceful prose, he launches into an encyclopedic analysis of the historical, legal, clinical, and ethical issues surrounding involuntary commitment. Combining legal scholarship with clinical insights, Winick establishes a roster of challenging questions that provides a valuable guide for the theoretical and empirical work of those interested in mental health law and the treatment of the mentally ill.”
J. Richard Ciccone, M.D., Professor of Psychiatry, Director, Psychiatry and Law Program, University of Rochester School of Medicine