Understanding U.S. Debates Surrounding Standards in Involuntary Inpatient Psychiatric Commitment Through the Maryland Experience

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Involuntary psychiatric commitment procedures are being reconsidered across the United States in highly contentious debates as policymakers, consumers, families, and mental health professionals struggle to balance competing values. Social workers are well-positioned to inform this debate, but to do so must be knowledgeable of the issues and perspectives. This study analyzed legislative testimony regarding proposed changes to Maryland standards (N = 42) together with data from a statewide survey of mental health care professionals conducted by the National Alliance on Mental Illness–Maryland in order to inform their stance on the debate (N = 208). Although we found disagreement on how to balance paternalism and care for safety with the autonomy and dignity of the individual, there was widespread consensus regarding the lack of appropriate treatment options as a source of crisis. Our data also indicate a need for training, irrespective of any legislative changes. On the whole, our findings indicate that a narrow focus on the standard for involuntary civil commitment should not divert attention from the larger issues that frame and contribute to what has been called a crisis in mental health services by proponents as well as opponents of changes to the standards for involuntary psychiatric commitment.