and a court order must be received for more than very short term treatment or hospitalization (typically no longer than 72 hours). this ruling has severely limited involuntary treatment and hospitalization in the u.s. in the u.s. the specifics of the relevant statutes vary from state to state. in 1979, addington v. texas set the bar for involuntary commitment for treatment by raising the burden of proof required to commit persons from the usual civil burden of proof of "preponderance of the evidence" to the higher standard of "clear and convincing evidence". an example of involuntary commitment procedures is the baker act used in florida. under this law, a person may be committed only if they present a danger to themselves or others. a police officer, doctor, nurse or licensed mental health professional may initiate an involuntary examination that lasts for up to 72 hours. within this time, two psychiatrists may ask a judge to extend the commitment and order involuntary treatment. the baker act also requires that all commitment orders be reviewed every six months in addition to ensuring certain rights to the committed including the right to contact outsiders. also, a person under an involuntary commitment order has a right to counsel and a right to have the state provide a public defender if they cannot afford a lawyer. while the florida law allows police to initiate the examination, it is the recommendations of two psychiatrists that guide the decisions of the court. in the 1990s, involuntary commitment laws were extended under various state laws commonly recognized under the umbrella term, svp laws, to hold some convicted sex offenders in psychiatric facilities after their prison terms were completed. (this is generally referred to as "civil commitment," not "involuntary commitment," since involuntary commitment can be criminal or civil). this matter has been the subject of a number of cases before the supreme court, most notably kansas v. hendricks and united states v. comstock in regard to the adam walsh child protection and safety act, which does not require a conviction on sex offenses, but only that the person be in federal custody and be deemed a "sexually dangerous person". specific requirements by state in arizona, the government can mandate inpatient treatment for anyone determined to be "persistently or acutely disabled." virtually anyone who suspects that someone has mental problems and needs help could file an application to a state-licensed healthcare agency for a court-ordered evaluation. in connecticut, individuals committed must possess "psychiatric disabilities and is dangerous to himself or herself or others or gravely disabled". "gravely disabled" has usually been interpreted to mean that the person is unable on their own to obtain adequate food, shelter and clothing. in iowa, any "interested person" may begin commitment proceedings by submitting a written statement to the court. if the court finds that the respondent is "seriously mentally impaired," the respondent will be placed in a psychiatric hospital for further evaluation and possibly treatment. further hearings are required at specific intervals for as long as the person is being involuntarily held. the michigan mental health code provides that a person "whose judgment is so impaired that he or she is unable to understand his or her need for treatment and whose continued behavior as the result of this mental illness can reasonably be expected, on the basis of competent clinical opinion, to result in significant physical harm to himself or herself or others" may be subjected to involuntary commitment, a provision paralleled in the laws of many other jurisdictions. the michigan mental health code allows for one to petition a court to order assisted outpatient treatment for patients with such impaired judgment, which compels them to comply with treatment to avoid relapses. one can petition for assisted outpatient treatment along with, or instead of, hospitalization. in nevada, prior to confining someone, the state must demonstrate that the person "is mentally ill and, because of that illness, is likely to harm himself or others if allowed his liberty." in oregon, the standard that the allegedly mentally ill person "peter as been committed and hospitalized twice in the last three years, is showing symptoms or behavior similar to those that preceded and led to a prior hospitalization and, unless treated, will continue, to a reasonable medical probability, to deteriorate to become a danger to self or others or unable to provide for basic needs" may be substituted for the danger to self or others standard. in texas, the standard is that, in the judgment of the person seeking involuntary commitment, 1) the person is mentally ill, and 2) because of that mental illness "there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained". the utah standard is that the proposed patient has a mental illness that poses a substantial danger. "substantial danger" means the person, by his or her behavior, due to mental illness: (a) is at serious risk to: (i) commit suicide, (ii) inflict serious bodily injury on himself or herself; or (iii) because of his or her actions or inaction, suffer serious bodily injury because he or she is incapable of providing the basic necessities of life, such as food, clothing, and shelter; (b) is at serious risk to cause or attempt to cause serious bodily injury; or (c) has inflicted or attempted to inflict serious bodily injury on another. in wisconsin, the district ii wisconsin court of appeals ruled in 2011 that patients with alzheimer's disease cannot be involuntary committed under chapter 51 and can only be involuntarily committed for residential care and custody under chapter 55. the court left open whether this applies also to persons with a dual diagnosis. controversy about liberty the impact of involuntary commitment on the right of self-determination has been a cause of concern. critics of involuntary commitment have advocated that "the due process protections... provided to criminal defendants" be extended to them. the libertarian party opposes the practice in its platform. thomas szasz and the anti-psychiatry movement have also been prominent in challenging involuntary commitment. the american association for the abolition of involuntary mental hospitalization (aaaimh) was an organization founded in 1970 by thomas szasz, george alexander, and erving goffman for the purpose of abolishing involuntary psychiatric intervention, particularly involuntary commitment, against individuals. the founding of the aaaimh was announced by szasz in 1971 in the american journal of public health and american journal of psychiatry. the association provided legal help to psychiatric patients and published a journal, the abolitionist. the organization was dissolved in 1980. a small number of individuals in the u.s. have opposed involuntary commitment in those cases in which the diagnosis forming the justification for the involuntary commitment rests, or the individuals say it rests, on the speech or writings of the person committed, saying that to deprive the person of liberty based in whole or part on such speech and writings violates the first amendment. other individuals have opposed involuntary commitment on the basis that they claim (despite the amendment generally being held to apply only to criminal cases) it violates the fifth amendment in a number of ways, particularly its privilege against self-incrimination, as the psychiatrically examined individual may not be free to remain silent, and such silence may actually be used as "proof" of his "mental illness". although patients involuntarily committed theoretically have a legal right to refuse treatment, refusal to take medications or participate in other treatments is noted by hospital staff. court reviews usually are heavily weighted toward the hospital staff, with the patient input during such hearings minimal. in kansas v. hendricks, the u.s. supreme court found that civil commitment is constitutional regardless of whether any treatment is provided. alternatives accompanying deinstitutionalization was the development of laws expanding the power of courts to order people to take psychiatric medication on an outpatient basis. though the practice had occasionally occurred earlier, outpatient commitment was used for many people who would otherwise have been involuntarily committed. the court orders often specified that a person who violated the court order and refused to take the medication would be subject to involuntary commitment. involuntary commitment is distinguished from conservatorship and guardianship. the intent of conservatorship or guardianship is to protect those not mentally able to handle their affairs from the effects of their bad decisions, particularly with respect to financial dealings. for example, a conservatorship might be used to take control of the finances of a person with dementia, so that the person's assets and income are used to meet their basic needs, e.g., by paying rent and utility bills. advance psychiatric directives may have a bearing on involuntary commitment. us military the service member can be held under the so-called boxer law (dod directive 6490.04). california further information: 5150 (involuntary psychiatric hold) district of columbia in the district of columbia, any police officer, physician, or mental health professional can request to have an individual evaluated at st. elizabeths hospital, where they may be detained for up to 48 hours at the direction of the physician on duty. a family member or concerned citizen can also petition the department of mental health, but the claim will be evaluated prior to the police acting upon it. to be held further requires that a request be filed with the department of mental health. however, this only can keep the patient involuntary admitted for up to seven days. for further commitment, the patient is evaluated by a mental health court, part of family court, for which the public defender assists the patient. this can result in the patient being held up to one year at which point the patient returns to mental health court. this is different for someone first admitted to st. elizabeths hospital due to criminal charges. if found to not ever become competent for trial, they will be evaluated via a jackson hearing for possible continued commitment to protect the public. if they have been found not guilty by reason of insanity, their dangerousness is evaluated at a bolton hearing. florida further information: florida mental health act maryland in maryland, any person may request, via an emergency evaluation form, that another individual be evaluated against their will by an emergency room physician for involuntary admission. if the judge concurs, he will direct the police to escort the individual to the hospital. a licensed physician, psychologist, social worker, or nurse practitioner who has examined the patient or a police officer may bring a potential patient to the emergency room for forced evaluation without approval from a judge. the patient may be kept in the hospital for up to thirty hours. if by then two physicians, or one physician and one psychologist then decide that the patient meets the maryland criteria for an involuntary psychiatric admission, then he or she may be kept inpatient involuntarily for up to ten days. during this time, an administrative law judge determines if the following criteria for longer civil commitment are met: a person has a mental illness; a person needs inpatient care or treatment; a person presents a danger to themselves or to others; a person is unable or unwilling to be admitted voluntarily; there is no available, less restrictive form of care or treatment to meet the person's needs. texas in texas a person may be subject to involuntary commitment by: a peace officer, without a warrant, if a) the officer believes that 1) the person is mentally ill, 2) because of that mental illness "there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained", and b) the officer also believes that there is insufficient time to obtain a warrant. a guardian of the person of a ward under the age of 18, if the guardian believes that 1) the ward is mentally ill, 2) because of that mental illness "there is a substantial risk of serious harm to the ward or to others unless the ward is immediately restrained". an adult may file an application for emergency detention of another person; the application must meet seven outlined items which indicate that, in the applicant's belief, that the person to be detained is mentally ill and poses a threat to the person or to others, why the person considers this