What Is Mandated Treatment and When Does It Apply?

Lawyer sits across the desk with a client, explaining a court order

When mental health conditions contribute to violent or dangerous behavior, affect the way a person treats their children, or increase the risk of recidivism, a court may order treatment. A court may also compel treatment if a person is deemed a risk to themselves or others. State laws governing court-mandated treatment vary, as do the programs a person might complete as part of court-ordered treatment.

Research on the value of court-ordered treatment is mixed. Mandated treatment offers access to mental health care that a person might not otherwise have. Some studies suggest that people pursuing court-ordered treatment may be less motivated in treatment or less likely to be honest with clinicians. Because treatment is mandatory, however, court-mandated treatments improve treatment completion rates.

The benefits and risks of court-ordered treatment depend on the type of treatment, the client’s commitment to treatment, the skill of the treating clinician, and numerous other factors.

The benefits and risks of court-ordered treatment depend on the type of treatment, the client’s commitment to treatment, the skill of the treating clinician, and numerous other factors.

What Is Mandated Treatment?

Mandated treatment is treatment ordered by a court. A person might have to undergo treatment for a set period of time, receive an evaluation from an approved mental health expert, pursue treatment at a specific facility, or agree to treatment as a condition of probation or parole. A person might also have to receive treatment before receiving visitation with or custody of their child.

Some examples of mandated treatment include:

Emergency mental health holds

When a person is a danger to themselves or to others, a therapist, doctor, or other clinician may pursue an emergency hold. These emergency holds require a person to seek evaluation at a mental health facility—usually a psychiatric hospital. In most cases, the hold lasts 72 hours. After the initial hold period, state laws vary. States generally have some form of judicial oversight, which means that a judge must approve the hold after a set period of time. A person can also fight a mental health hold, usually by filing an emergency petition with the assistance of a lawyer. A person cannot be indefinitely held against their will without a court order.

Treatment in lieu of incarceration

In some states, a person who is found not guilty by reason of mental disease or defect may be ordered to stay in a psychiatric hospital. In this scenario, the person cannot leave until they have either stayed for a period predetermined by the court or the facility has determined the person may be released.

Drug and mental health courts

Many states now offer diversion programs through drug and mental health courts. These programs require a person to complete treatment and other requirements. Those who finish the program can avoid jail or prison time. In many of these programs, jail time is used as a way to induce treatment compliance. For example, a drug court participant who doesn’t show up for a treatment session or who is accused of drinking might be forced to spend a weekend in jail before continuing the program.

Mental health treatment as a condition of some other benefit

Courts often make mental health treatment a precondition to receiving some other benefit. For example, a person being released early from prison via parole may have to seek treatment to avoid being re-incarcerated. Likewise, probation agreements that keep people out of prison sometimes require specific treatment. In these scenarios, a person typically meets with a probation or parole officer on a regular basis to show they are meeting court-ordered treatment requirements.

A person might also have to seek treatment to gain custody of their children. For example, if child protective services removes a child from a parent’s home because of the parent’s addiction, the parent may have to seek treatment and remain sober for a set period of time before regaining custody.

Legal principles of informed consent and informed refusal mean that a person cannot be forced into treatment without a court order. Some states offer a brief exception for 72 hour evaluation holds. In this scenario, however, a mental health professional must believe the person is a threat to themselves or others.

A therapist cannot force a client to stay in therapy or demand that a client undergo certain treatment. Even when a person receives court-mandated treatment, they retain basic rights such as the right to be free of physical abuse. People who have been ordered to undergo treatment may want to consult a lawyer. A lawyer can offer advice about your state’s laws as well as your specific rights.

History of Mandated Treatment for Mental Health

Mandated treatment allows clinicians, judicial systems, and treatment facilities significant control over a client’s life. Historically, mandated treatment was rife with abuse. People sent to mental health facilities might spend years in those facilities, receiving a wide range of unsupported and potentially traumatic treatments. Patients might be forced to undergo electroconvulsive therapy, be restrained for hours or days, or be subjected to violent abuse.

State licensing boards now regulate mental health facilities and prosecute abuse. Abuse can and does still happen. In 2009, a report detailed numerous abuses at Kings County Hospital Center’s psychiatric unit. New stories often feature tales of abuse in prison psychiatric facilities.

People undergoing mandated treatment should review all of their options, especially if they are permitted to choose among several therapists or facilities. When court-mandated treatment requires a person to seek treatment from a specific person or organization, advocates such as lawyers and family members can be key. Loved ones and paid advocates should educate themselves about the reputation of the treatment facility and remain in communication with the person undergoing treatment.

Common Reasons for Court-Ordered Therapy

Some of the most common reasons a court might order treatment include:

  • The person has been convicted of a sex crime. Some states’ sex offender registries require participation in sex offender treatment.
  • The person has lost custody of their child because of abuse, neglect, or addiction.
  • The person is involved in a child custody dispute, and the court thinks one or both parents need either a psychiatric evaluation or mental health treatment.
  • The person has a mental health condition or addiction and the court offers treatment as an alternative to jail or prison time.
  • The person is incarcerated, and the parole board offers treatment as a condition of early release.
  • The person is a threat to themselves or others. A person with intense suicidal ideation may be ordered to get a psychiatric evaluation or be held in a mental health facility for a set period of time. People with homicidal or violent thoughts may also undergo coerced treatment.

Does Court-Mandated Treatment Work?

Like any other treatment, the effectiveness of court-mandated treatment depends on several factors, including the skill of the clinician and the willingness of the client to actively engage in the treatment process. Court-mandated treatment can and does work.

Drug courts, for example, may lower recidivism. One study found that, over 2 years, drug court participation was correlated with a drop in recidivism from 40% to 12%.

Court-mandated treatment may also offer indirect mental health benefits. Researchers have repeatedly documented the harmful effects of incarceration on mental health. When court-mandated treatment helps a person avoid jail or prison time, it may prevent their mental health from deteriorating.

Mandated programs also have some shortcomings. When clients sign confidentiality waivers, they may be less likely to share openly with their providers. When a provider has the power to incarcerate a client by reporting noncompliance to the court, this can compromise the integrity of the therapeutic alliance.

Mandated treatment can feel scary and intimidating, especially if you have never sought mental health treatment before. Mental health workers offering court-mandated treatment are licensed professionals just like any other mental health worker. They have a duty to protect their clients and to offer compassionate care.

In many cases, a person compelled to undergo mental health treatment can still choose their own clinician. Click here for help finding the right mental health professional and here to find a treatment center near you.

References:

  1. Coviello, D. M., Zanis, D. A., Wesnoski, S. A., Palman, N., Gur, A., Lynch, K. G., & Mckay, J. R. (2013). Does mandating offenders to treatment improve completion rates? Journal of Substance Abuse Treatment, 44(4), 417-425. doi: 10.1016/j.jsat.2012.10.003
  2. Do drug courts work? Findings from drug court research. (2018, May 1). Retrieved from https://www.nij.gov/topics/courts/drug-courts/pages/work.aspx
  3. Hartocollis, A. (2009, February 06). Abuse is found at a psychiatric unit run by the city. The New York Times. Retrieved from https://www.nytimes.com/2009/02/06/nyregion/06kings.html
  4. Hedman, L. C., Petrila, J., Fisher, W. H., Swanson, J. W., Dingman, D. A., & Burris, S. (2016). State laws on emergency holds for mental health stabilization. Psychiatric Services, 67(5), 529-535. Retrieved from https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201500205
  5. Yasgur, B. (2018, May 29). Court-mandated substance abuse treatment: Exploring the ethics and efficacy. Retrieved from https://www.psychiatryadvisor.com/home/topics/addiction/court-mandated-substance-abuse-treatment-exploring-the-ethics-and-efficacy

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