involuntary commitment by country involuntary commitment by country involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital (inpatient) or in the community (outpatient). criteria for civil commitment are established by laws, which vary between nations. united nations united nations general assembly (resolution 46/119 of 1991), "principles for the protection of persons with mental illness and the improvement of mental health care" is a non-binding resolution advocating certain broadly-drawn procedures for the carrying out of involuntary commitment. these principles have been used in many countries where local laws have been revised or new ones implemented. the un runs programs in some countries to assist in this process. australia in australia, court hearings are not required for involuntary commitment. mental health law is constitutionally under the state powers. each state thus has different laws, many of which have been updated in recent years. referral for service the usual requirement is that a police officer or a physician determine that a person requires a psychiatric examination, usually through a psychiatric hospital. if the person is detained in the hospital, they usually must be seen by an authorized psychiatrist within a set period of time. in some states, after a further set period or at the request of the person or their representative, a tribunal hearing is held to determine whether the person should continue to be detained. in states where tribunals are not instituted, there is another form of appeal. some australian states require that the person is a danger to the society or themselves; other states only require that the person be suffering from a mental illness that requires treatment. the victorian mental health act (1986) specifies in part that: "(1) a person may be admitted to and detained in an approved mental health service as an involuntary patient in accordance with the procedures specified in this act only if— (a) the person appears to be mentally ill; and (b) the person's mental illness requires immediate treatment and that treatment can be obtained by admission to and detention in an approved mental health service; and (c) because of the person's mental illness, the person should be admitted and detained for treatment as an involuntary patient for his or her health or safety (whether to prevent a deterioration in the person's physical or mental condition or otherwise) or for the protection of members of the public; and (d) the person has refused or is unable to consent to the necessary treatment for the mental illness; and (e) the person cannot receive adequate treatment for the mental illness in a manner less restrictive of that person's freedom of decision and action. there are additional qualifications and restrictions but the effect of these provisions is that people who are assessed by doctors as being in need of treatment may be admitted involuntarily without the need of demonstrating a risk of danger. this overcomes the pressure described above to exaggerate issues of violence, or to verbal statements, to obtain an admission. treatment in general, once the person is under involuntary commitment, treatment may be instituted without further requirements. some treatments, such as electroconvulsive therapy (ect), often require further procedures to comply with the law before they may be administered involuntarily. community treatment orders can be used in the first instance or after a period of admission to hospital as a voluntary/involuntary patient. with the trend towards deinstitutionalization, this situation is becoming increasingly frequent, and hospital admission is restricted to people with severe mental illnesses. finland involuntary commitment requires three criteria: 1) severe mental illness with impaired insight; 2) that a lack of treatment would worsen the condition or endanger the safety or security of the patient or others; 3) and other treatments or services are insufficient or inapplicable. if found insane, criminal offenders may not be sentenced. instead, they must be referred to thl (national institute for health and welfare) for involuntary treatment. niuvanniemi hospital specializes in involuntary commitment of criminal patients. france about 24 % of patients in french psychiatric wards are committed involuntarily. a person may be committed if they are an imminent danger or at the request of either a third party, usually a family member, one or two physicians or a representative of the state. classic admission: to involuntarily commit a person, are needed: a handwritten request from a third party with a relationship to the person (e.g. a member of the patient's family or a care giver), excluding care givers working in the institution caring for the sick person, two supporting medical certificates, at least one of which is drawn up by a doctor outside of the institution giving care to the person. admission in case of imminent danger: a single medical certificate drawn up by a doctor who is not part of any establishment caring for the person, suffices to involuntarily commit a person. this practice has led to abusive banalisation according to a report by the health ministry. admission in case of emergency: a handwritten request from a third party and a medical certificate suffice to involuntarily commit a person. from an admission at the request of a representative the state to occur, the mentally ill person must a danger to themselves or others, or cause a serious breach of public order, in which case the mayor (temporarily and only when there is a danger to the safety of persons) or the prefect, may issue a decree in support of a medical certificate issued by a doctor outside the receiving institution to admit that person. germany in germany, there is a growing tendency to use the law on legal guardianship instead of mental health law for justification of involuntary commitment or treatment. the ward's legal guardian decides that he/she must go into mental hospital for treatment, and the police then acts on this decision. this is simpler for the government and family members than the formal process for commitment under mental health laws. in german criminal law, a person who was convicted of certain crimes can also be sentenced to be kept in preventive detention; see article on preventive detention. israel the mental health care act of 1991 regulates the rights of the mentally ill in israel and defines the conditions under which the patient's freedom of choice can be restricted. the law replaced the mental health law of 1955. italy in italy the physician giorgio antonucci, in his work at the hospitals of gorizia, cividale del friuli and imola since the late 1960s, has avoided involuntary hospitalisation and any kind of coercion, rejecting the diagnosis as psychiatric prejudice. during the years 1973-1996 he worked on the dismantling of the psychiatric hospitals osservanza and luigi lolli in imola. he currently collaborates with the italian branch of the citizens commission on human rights. ireland further information: mental health in ireland japan in japan, the law on mental health and welfare for the mentally disabled (japanese: 精神保健及び精神障害者福祉に関する法律) establishes the legal framework for involuntary commitment. netherlands in dutch criminal law, a convict can be sentenced to involuntary psychiatric treatment in a special institute called a ''tbs'' clinic. tbs is an abbreviation for ter beschikkingstelling, literally meaning "being placed at disposal" (of the state). legally, such a sentence is not regarded as punishment like a prison sentence, but as a special measure. often, when a convict is sentenced to tbs, they first serve a prison sentence. the convict will then be placed in a clinic after serving time in prison (usually two-thirds of the original prison sentence, although this practice is under discussion). according to dutch law, meeting three conditions is required for a convict to be sentenced to tbs. these conditions are: the crime committed must have been directly related to a psychiatric disorder, recidivism must be likely, and the convict can not, or only partially, be held accountable for the crime. to determine if these conditions are met, the suspect is observed in a forensic psychiatric detention center, the pieter baan centre. neither the prosecution or the defense can effectively challenge the pieter baan centre's report, since it is the only institution that can conduct such investigations. fatal mistakes have occurred, for instance, when a child molester regarded by the pieter baan center as "not dangerous" killed a child after the molester was released. the conclusions in the centre's report are not binding; the judge can decide to ignore, or only partially accept them. every convict detained in a tbs clinic may get temporary leave after serving a certain time or after some progress in treatment. this is regarded as an essential part of treatment, as the convict will be gradually re-entering society this way. at first the convict will be escorted by a therapist, and will be allowed outside the clinic for only a few hours. after evaluation, time and freedom of movement will be expanded until the convict can move freely outside the clinic without escort (usually for one day at a time). at that time, the convict will find work or follow an education. generally, the convict is released after being in this situation for one or two years without incident. the time to be served in tbs can be indefinite, and it may be used as a form of preventive detention. evaluation by the court will occur every one or two years. during these evaluations the court determines if any progress is made in treatment of the convict, and if it will be safe to release the convict into society. in general, the court will follow conclusions made by the tbs clinic. average time served in a tbs clinic by a convict is slightly over eight years. dutch tbs clinics in the netherlands there are currently 12 institutions regarded as tbs clinics: inforsa/arkin, amsterdam dr. henri van der hoevenstichting, utrecht dr. s. van mesdagkliniek, groningen hoeve boschoord, boschoord fpc veldzicht, balkbrug pompestichting, nijmegen oostvaarderskliniek, almere de kijvelanden/fpc tweelanden, poortugaal fpc oldenkotte, rekken (closed on 4 september 2014) fpc de rooyse wissel, venray ggz drenthe, assen ggz eindhoven/de woenselse poort, eindhoven these institutions combined currently are holding about 1840 convicts. by the end of the 20th century, it was concluded that some convicts could not be treated and therefore could not be safely released into society. for these convicts, tbs clinics formed special wards, called "long-stay wards". transfer to such a ward means that the convict will no longer be actively treated, but merely detained. this is regarded as more cost-effective. in general, the convicts in these wards will be incarcerated for the rest of their lives, although their detention is eligible for regular review by the court. controversy since the latter half of the 1990s, considerable controversy has grown in dutch society, about the tbs system. this controversy has two main areas. the first level of controversy resulted from the media increasingly reporting cases of convicts committing crimes while still in, or after, treatment in a tbs clinic. some examples of these cases are: during 1992, a truck driver was convicted of raping and murdering three young children. eight years earlier he was released from a tbs clinic after being treated for child molestation. a convict, about to be released from a tbs clinic, murdered the owner of a garage in 1996 while under the influence of drugs. an ex-convict, treated in a tbs clinic, murdered two women in 1994 and 1997. a convict, still being treated by a tbs-clinic, randomly killed a man in the city of groningen in 1999. between 2000 and 2004, an ex-convict tortured several animals and killed a homeless man. he had been treated in a tbs clinic. in 2002 an ex-convict was sentenced for triple murder. he also had been released earlier by tbs. in 2005 a convict escaped his escort during leave. he was arrested several days later after killing a man. political and social attention increased, and debate started about the effectiveness of the tbs system and whether convicts should be granted leave from tbs clinics. especially right-wing politicians suggested the tbs system be discarded altogether. numerous articles in newspapers, magazines, television and radio programs and a revealing book written by an ex-convict (which for the first time openly questioned the effectiveness of the tbs-system) boosted discussion. prior to that,