A bill to streamline the involuntary commitment process for people with severe mental illness passed its first vote in the D.C. Council on Dec. 3, following revisions to address community concerns. While supporters and councilmembers argue the changes will lead to better care, the bill’s detractors feel streamlining the process could make it easier to criminalize people with mental illnesses, especially Black people.
Through involuntary commitment, health care professionals can detain someone with severe mental illness they judge may be a danger to themselves or others and send them to a psychiatric hospital for care. The Enhancing Mental Health Crisis Support and Hospitalization Amendment Act of 2024, proposed in February by At-Large D.C. Councilmember Christina Henderson, removes barriers for health care providers attempting to involuntarily commit someone, a process also known as an FD-12.
The bill permits psychiatric-mental health nurse practitioners to initiate the involuntary commitment process, requires the Department of Behavioral Health to develop online resources for health care providers about the commitment process, and requires remote court hearings for individuals in involuntary commitment to reduce delays in patient care and health care providers’ response time.
“Recognizing the importance of equipping providers with the tools needed to deliver effective care, [the bill] seeks to address systemic gaps that complicate timely and appropriate responses,” a spokesperson from Henderson’s office wrote in an email.
Involuntary commitment has also been used across the county to respond to rising homelessness. A 2023 Department of Housing and Urban Development report showed 31% of people experiencing homelessness on a given night reported facing serious mental illness. Mental health advocates say the District often initiates the involuntary commitment process on people experiencing homelessness who refuse treatment, and encampment residents have been threatened with involuntary commitment for refusing to move. D.C. does not publish the number of individuals who are involuntarily committed, but the Office of the Attorney General said 2,930 emergency petitions to commit residents had been filed in 2023.
Ward 5 Councilmember Zachary Parker, who co-introduced the legislation, said at the Dec. 3 legislative meeting, when the council first passed the bill, that while the legislation addresses shortcomings in involuntary commitment processes, this process has historically targeted Black communities and contributed to the criminalization of mental illness.
The act was sparked by an incident in Ward 5. In October 2023, a man experiencing homelessness attacked two early childhood educators in front of a daycare. Parker said the man has since been released but was deemed unfit to stand trial, which left the community without “many forms of recourse” to address their ongoing concerns.
“We saw very quickly that there were clear loopholes in our FD-12 policies and how we involuntarily commit someone,” Parker said.
The legislation faced initial backlash from community members for a clause that proposed extending the emergency observation and diagnosis period from seven to 15 days. The Washington Legal Clinic for the Homeless spoke out against the clause, stating that “increasing the duration of detention only inflicts additional and avoidable trauma.”
Kathryn Baselice, who identified herself as a forensic psychiatrist, said at a public hearing in July that extending the mandatory stay to 15 days could “worsen anxiety” and “induce behavioral problems” for people with mental illnesses.
“Treatment teams know their patients and their needs. For some patients, a mandatory additional 15-day stay may pose an undue risk,” Baselice said.
Henderson removed the clause from the final draft of the legislation. Over the last nine months, Henderson’s office evaluated feedback and testimony from behavioral health providers, advocates, hospitals, government agencies, and community members, which led to “significant revisions” to the bill’s final version, a spokesperson wrote. They wrote the office worked to craft legislation that balances patient and community safety with timely care.
During the public hearing, Emily Bell, a nurse practitioner, proposed the committee amend the legislation to include psychiatric-mental health nurse practitioners as qualified to administer an emergency psychiatric examination alongside physicians and qualified psychologists. She said not being able to initiate the evaluation process has “dire consequences” for these health care workers, who can’t act as quickly to address mental health crises.
“When starting this position, I was quite shocked to learn that psychiatric-mental health nurse practitioners had no ability to initiate a psychiatric hold for emergency examination despite having full practice authority in the District of Columbia,” Bell said. The legislation now grants psychiatric-mental health nurse practitioners the ability to conduct an emergency psychiatric evaluation.
The U.S. Attorney’s Office testified in support of the act at the public hearing, saying it will grant health care providers more tools to assist people with mental illnesses while “protecting the community.”
“This bill is a crucial tool that will help to address the overlap between mental health, civil commitment processes, and criminal justice,” Elana Suttenberg, the U.S. Attorney’s Office Special Counsel for Policy and Legislative Affairs, said.
Invisible Prophet, a Street Sense vendor who has published opinion pieces relaying concerns the act would promote unjust treatment of people who have mental illnesses and are experiencing homelessness, said the legislation will further harm people with trauma and criminalize people whose trauma can prevent them from regulating their emotions.
They worried the act would promote a culture where some health care staff believe people with mental illnesses “are not human beings,” and staff are not held accountable for treating patients poorly.
“This legislation is careless for anyone’s ability to create mental health advocacy,” Invisible Prophet wrote in an email to Street Sense.
A spokesperson from Henderson’s office said the act is “one piece of the puzzle” that will help combat challenges faced by physicians trying to keep patients and the community safe.
“A comprehensive mental health crisis response system must not only stabilize individuals at the moment but also ensure access to high-quality, person-centered care that fosters recovery and long-term well-being,” the spokesperson wrote. “Significant work remains to achieve this vision.”
