Health Law Policy

Tennessee: The Next State to Require Involuntary Outpatient Commitment?

By Bryan Kozusko, JD (Expected graduation: May 2016) How will Tennessee address involuntary outpatient commitment hereon out? Currently, Tennessee is one of seven states that does not provide for direct involuntary outpatient commitment, pending a final disposition by a court with jurisdiction. According to general involuntary outpatient commitment law, whenever an individual is believed to…

By Bryan Kozusko, JD (Expected graduation: May 2016)

How will Tennessee address involuntary outpatient commitment hereon out? Currently, Tennessee is one of seven states that does not provide for direct involuntary outpatient commitment, pending a final disposition by a court with jurisdiction. According to general involuntary outpatient commitment law, whenever an individual is believed to require such commitment, a final hearing must be held allowing an adjudication on the merits and the establishment of grounds by clear and convincing evidence. The other states that do not allow for this process are Alaska, Connecticut, Kentucky, Maryland, Massachusetts, and New Mexico.

For six years Tennessee legislators have tried, but failed, to successfully implement a permanent statute authorizing direct involuntary outpatient commitment following the disposition of a final commitment hearing. In 2009, Bill H.R. 0297 of the 106th General Assembly passed through the Senate unanimously. Once received by the House, no further action was taken and the bill was never voted on. In 2012, the 107th General Assembly authorized the creation of an involuntary outpatient pilot program to operate two years in Knox County, Tennessee. In 2014, the 108th General Assembly amended their law to terminate the pilot program on June 30, 2015, citing the public welfare of their citizens.

Since the Tennessee amendment in 2014, the law authorizing the pilot program has expired, with no further evidence of discussion in the legislature. In order to better understand involuntary outpatient commitment and how to address its current legislative situation, Tennessee could use the pilot program as a test case. Examining resources from other states similar to Tennessee would also prove useful (Connecticut 1; Connecticut 2; Maryland 1; Maryland 2; New Mexico).

Content experts also provide useful suggestions for how the state government could proceed. The issue of involuntary outpatient commitment demonstrates two policies dictating commitment law: parens patriae and police powers. Parens patriae holds states responsible for providing care to the vulnerable, such as individuals with mental illness. Police powers allow states to protect citizens from imminent, substantial danger. Proponents of involuntary outpatient commitment support the parens patriae model, arguing that involuntary outpatient commitment would improve the everyday functioning of society, reduce the likelihood of victimization of individuals, reduce costs associated with alternative options such as inpatient care or jail, and provide a safer environment for citizens. Opponents of involuntary outpatient commitment support police powers. Because of the potential for imminent harm to self or other citizens, opponents believe the individual must not be allowed to remain in the community while receiving treatment.

Tennessee still remains silent on involuntary outpatient commitment. With their pilot program just ending, this may be the best opportunity to gather scientifically-based data and to provide a more clear and current, up-to-date view on how involuntary outpatient commitment could operate.

Bryan Kozusko is a student finishing his final year at Widener University School of Law: Delaware Campus. He is an intern at the Policy Surveillance Program at Temple University’s Center for Health Law, Policy and Practice.