The involuntary civil commitment of mentally ill persons in the United States and Romania: a comparative analysis

The law and policy relating to the civil commitment of mentally ill persons in the United States and Romania are currently undergoing significant changes. While many jurisdictions in the United States are moving towards increasing emphasis on various forms of outpatient civil commitment, Romania is contemplating a restructuring of its commitment procedures to conform to international principles of human rights and to resemble more closely the United States model of commitment and care. A comparison of the procedures and standards for the involuntary civil commitment of mentally ill persons under each system is, consequently, timely. This article begins with a discussion of how mental illness is defined and identified clinically in a cross-cultural context. The article then examines the legal meaning of mental illness in the civil context in the United States and Romania, focusing on the implications of these meanings for the civil commitment of persons deemed to be mentally ill. Current models, standards, and procedures for the civil commitment of persons deemed to be mentally ill are described, using schizophrenia as a case example. The article concludes with an analysis of the strengths and weaknesses of each system and the arguments that provide the basis for the current reform efforts.