Safety first. Recovery next. Relationship always. Involuntary Commitment for Treatment of Substance Use Disorders and Mental Illness
The Crossroads
It starts with a phone call at midnight. Your heart jumps before you even look at the screen — because when your loved one is in active addiction and/or struggling with a mental illness, every ring feels like a warning. On the other end is someone telling you they’ve found your loved one — disoriented, maybe arrested, maybe overdosed — and now you’re faced with the question that haunts so many families:
Do I step in and force help, or do I wait until they decide they’re ready?
You love them. You’re terrified for them. You’ve begged, pleaded, promised, prayed. But love, fear, and urgency can pull in three different directions.
One instinct says: “Do Something. Demand that they get the help they need - before it’s too late.” Another instinct says: “Don’t push too hard or you’ll lose them.” And finally another instinct says: “Protect them from the consequences of this moment. Rush in and get them out. Make sure others don’t find out.”
This is the crossroads where many families find themselves when they start to ask about involuntary commitment - a legal process that involves asking a judge to require your loved one to get help.
But before legal options become your last hope, it’s important to understand what it actually means — and what it doesn’t. Involuntary commitment isn’t a punishment, and it isn’t a magic fix. It’s a legal process meant to protect someone whose substance use or mental health concerns have reached a point where they can no longer protect themselves. They may have even become a threat to others as well. It can save a life — but it can also change the nature of your relationship, and once the legal system is involved, families lose much of their control over what happens next.
So when families stand at this intersection, the question isn’t only “Can I force them into treatment?” — it’s “How do I protect their safety, preserve a chance for recovery, and still hold on to our relationship?” Because in the end, that’s the true hierarchy of priorities: Safety first. Recovery next. Relationship always.
What are your options when a loved one is struggling and you believe their life or health is in danger?
A short mental health hold—often lasting up to 72 hours—is an emergency measure used when someone is believed to be an immediate danger to themselves or others, or unable to care for their basic needs due to a mental health crisis. Its purpose is stabilization, not punishment or long-term treatment, and during this time clinicians assess safety, provide immediate care, and determine next steps.
In contrast, involuntary commitment for a mental health condition or substance use disorder is a more formal legal process that occurs only after evaluation and due process, and it can result in longer treatment requirements. This type of commitment is typically reserved for situations where there is an ongoing, serious risk and evidence that voluntary treatment has been refused or unsuccessful. While both involve temporary loss of personal choice, a 72-hour hold is designed to pause a crisis, whereas involuntary commitment is intended to address a sustained threat through structured treatment.
How do you pursue one of these options for your loved one?
For families, the steps look very different depending on the situation. A 72-hour mental health hold usually happens in the moment, during a crisis. Families often don’t “apply” for it so much as raise concern—by calling 911, taking their loved one to an emergency room, or contacting a local crisis line when there’s immediate danger. From there, medical professionals or law enforcement decide whether a short hold is necessary to keep everyone safe.
Involuntary commitment, by contrast, is something families may actively pursue when problems have been ongoing and safety concerns keep coming up. This process typically involves filing paperwork through the court, documenting behaviors or incidents, and sometimes attending a hearing where a judge determines whether longer-term, court-ordered treatment is needed. In short, a 72-hour hold is about responding to an emergency right now, while involuntary commitment is about taking formal steps when a pattern of risk makes intervention unavoidable.
What are some of the factors to consider whether it’s time to seek an Involuntary Commitment?
When you have tried to engage your loved one into voluntarily getting help, but they refuse.
When risk to life (self or others) or public safety is imminent.
When the person’s capacity to make decisions is clearly impaired by substance use and/or mental health concerns.
How to Initiate the Process for Involuntary Commitment
Families can sometimes initiate a civil (involuntary) commitment request, but the process—and how much they can do on their own—varies by state. In some places, a family member may file a petition or sworn statement with the court outlining specific safety concerns, while in others they must go through law enforcement, a mobile crisis team, or a local mental health authority. If you are unsure of where to start, you can contact the court in your county for information. If possible, work with a family attorney who is familiar with involuntary commitment and can guide you in the process. Legal aid may also be available to assist you with low or no cost legal services in your area if needed.
Regardless of how the process starts, families are rarely the ones who make the final decision. Courts and licensed clinicians are required to evaluate the situation to determine whether the legal threshold for commitment is met, which helps protect individual rights while addressing serious risk. Families are typically advised to document concrete behaviors—such as threats of harm, repeated overdoses, severe mental health symptoms, or inability to care for basic needs. While the process can feel overwhelming and emotionally heavy, it’s important to recognize that you are not “doing this to your loved one”. Instead, you are starting what may be a life-saving intervention that will ultimately be decided upon by professionals.
Understanding the Involuntary Commitment Process
Once initiated, a court-ordered commitment for treatment requires an evaluation of the individual and a court proceeding. If the court determines that the individual should be mandated to treatment, it will typically mandate a person to treatment for a specific time period that is also subject to periodic review. This treatment can be inpatient (where they will live at the facility during the treatment) or outpatient (where they will live at home or another safe environment while attending treatment groups, sessions, and appointments). Sometimes, while a person is being evaluated by the court, they may be held in a facility for crisis stabilization until the court makes a determination about the case.
“Involuntary commitment” means a person can be legally ordered into treatment when their substance use or mental illness has reached a point where they can’t keep themselves—or others—safe. This process happens through the civil system, not the criminal one, and is meant to provide medical stabilization rather than punishment.
Here are a few additional facts:
State-by-state differences: Every state is different. For example, only about 35+ states allow involuntary commitment specifically for addiction. State laws set forth criteria for commitment while duration and procedures differ.
Does it matter if a person is being committed for addiction-related reasons or mental-health related reasons?: Yes, there are several differences between the two situations, including but not limited to, different procedures and different community-based resources available to treat your loved one. Typically, substance use commitment is longer than mental health commitment and involves residential treatment. If both are present, you should consult local legal counsel to determine which pathway is best.
Who can file: Family, individuals with first hand knowledge, physicians, law enforcement, or designated mental health professionals are usually the ones who file. But this is largely dependent on the state in which you are filing.
Legal threshold: Generally speaking, courts must enter a finding that the person is “a danger to self or others,” or “grave disability,” or “impaired judgment resulting in risk of serious harm” in order to involuntarily commit someone to addiction or mental health treatment.
Due process rights: Under the 14th Amendment of the US Constitution, a person has the right to liberty. When a person is involuntarily committed, the court is essentially removing their right of liberty by confining them for a period of time. For this reason, courts want to ensure that the time period is limited to only the time necessary. And courts must provide the person of concern with sufficient notice, set a court hearing, and allow the person to be represented. In other words, it is procedurally like other cases that come before the court with witnesses, evidence, and findings.
Outcomes of the court order: Possible hospitalization, detox, or mandatory treatment (inpatient or outpatient) are possible outcomes.
Who pays for treatment services if my loved one is mandated to treatment? If the person has insurance coverage, or financial means to pay for treatment, they can do so and will have more choice as to where they or their loved one will go to treatment. If the person does not have insurance coverage or financial means to pay for treatment, they will be remanded to a state-subsidized treatment facility.
What Happens if my Loved One Leaves Court-Ordered Treatment?
This is a really important question because families often worry about what will happen if their loved one leaves treatment. In states that allow involuntary commitment for addiction, if the person leaves treatment early, the facility must notify the court or law enforcement that the individual is noncompliant. Law enforcement can return them to treatment under court order. If the person continues to refuse treatment, the court may dismiss the order, issue a contempt citation, or reassess the danger to self/others. The facility does not have authority to restrain a person from leaving.
If a person is involuntarily committed for mental health reasons, the facility may have more authority. For example, a “locked” facility can detain a person if the court order grants them authority. The family cannot legally restrain or force the person to stay — only the court or law enforcement can.
What should families know about their participation in an involuntary commitment proceeding?
The first thing families need to know is that it is likely you will have to testify. Your testimony may be required to establish danger/neglect or need for treatment. You may be subpoenaed. Civil commitment is a legal proceeding, and immunity is not automatic — get legal advice before testifying. Testimony becomes part of the public/official record. Once in state custody, families lose influence over treatment plans, medication or discharge. Families will only receive information about their treatment if their loved one has signed a release of information allowing them access. Finally, there is an emotional component to giving testimony in court. It can feel like betrayal, and families often report guilt, relief, or ambivalence. Prepare emotionally and get support (therapist, family counselor). Balance this reality with your stated goal: safety first.
Practical tip: Document objective facts (dates, behaviors, hospitalizations, threats) rather than moral judgments. Attorneys can help frame testimony to achieve safety without unnecessarily harming relationships.
Relationship Always
If families find themselves needing to consider involuntary commitment, how they begin the process can make a real difference in preserving trust and connection. Starting with professional guidance—such as a crisis line, mobile crisis team, physician, or mental health provider—helps shift the focus away from blame and toward safety and care. Being honest, calm, and specific about concerns, while avoiding threats or ultimatums, can reduce feelings of betrayal and fear. When possible, families are encouraged to communicate that the goal is protection and support, not punishment or control, and to stay involved during treatment through appropriate channels. While this decision is not an easy one, approaching it with transparency, compassion, and respect gives relationships the best chance to heal once the immediate crisis has passed.
While involuntary commitment is often one of the hardest decisions a family can face, research consistently shows that family involvement matters. Studies have found that when loved ones stay engaged—by advocating for care, participating in treatment planning, and maintaining connection—individuals are more likely to remain in treatment longer, experience fewer repeat crises, and connect to ongoing support after discharge. For many families, involuntary commitment becomes a turning point rather than an ending: a moment that interrupts a dangerous cycle and opens the door to stability, recovery, and renewed communication. It’s not a guarantee, but it is a meaningful step—and one that data and experience both suggest can save lives and strengthen long-term outcomes.
It’s important for families to be informed about involuntary commitment and understand that there’s no single “right” way to handle a loved one’s crisis. Every situation is unique, and families often wrestle with guilt, fear, and uncertainty. While voluntary treatment is always preferred, there are times when repeated efforts to get help haven’t worked and the individual faces a serious risk of harm to themselves or others. In these situations, involuntary commitment can be considered as a necessary step to ensure safety and connect the person to care. Knowing the options, the process, and what to expect helps families make thoughtful decisions while maintaining support and compassion for their loved one.
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