The criteria for emergency evaluation are similar from state to state, although there is some variation in how they are interpreted.  It is not the role of the police officer to make the sole determination that a person should be committed.  However, being familiar with the criteria will help officers decide whether to detain the person and transport him or her for an emergency mental evaluation.  This is not an arrest.  Officers should be alert to the behaviors, actions, and speech of the person so that they can determine whether specific indicators of the criteria apply.  Officers should also familiarize themselves with state law concerning emergency evaluation.

Most patients who receive inpatient or outpatient services for mental illness do so voluntarily. That is, when presented with their options - including the possibility of involuntary commitment - they choose to enter a hospital or to follow a course of outpatient treatment suggested by treatment professionals. In fact, in some states you cannot commit someone who is willing to admit him- or herself voluntarily. For a significant minority, however, there are times when involuntary commitment becomes the only available avenue to services and the surest way to ensure the safety of the person involved. Involuntary commitment involves deprivation of personal freedom and can be an indignity to the person being committed. In addition, it requires the participation of numerous professionals (including the certifying doctor, attorneys representing both the accepting facility and the patient, and a judge).  For these reasons and the simple reality that commitment takes considerable time, in the majority of cases most clinicians will seek to offer voluntary admission to services before considering involuntary commitment.

Every state has a law that provides a clear path for those cases in which a person must be involuntarily committed to treatment. While the laws vary to some degree, they all attempt to define circumstances under which a person's unsupervised presence in the community poses a risk by reason of his or her mental illness. In almost all cases, it is the likelihood of a person's dangerousness to self or to others that is the primary trigger for involuntary commitment. In several states, the mental health law also includes language defining what is broadly known as the "gravely disabled" criterion, which is meant to cover instances in which a person's well-being is threatened by inattention to personal safety, failure to eat, exposure to extreme or dangerous conditions, or other evidence that he or she is in imminent danger if left untreated. Some state statutes also note a "need for treatment" or likelihood that a person will benefit from treatment as one of many criteria for commitment. Additionally, the laws covering involuntary commitment are subject to interpretation and, it should be noted, continued debate within the mental health community.

Traditionally, the treatment to which a person is involuntarily committed is provided in a secure inpatient facility. State law generally charges the department of mental health or its equivalent with regulating facilities to which involuntary commitment is possible. Not all hospitals are licensed to receive involuntary patients (although this does not always restrict their ability to conduct emergency evaluations). In addition, reimbursement issues may limit admission to some hospitals.  It is important for law enforcement officers and others who might become involved in involuntary commitment proceedings to know which facilities are able to admit involuntary patients.

In some states, involuntary commitment to outpatient services is also possible under the law. As with involuntary inpatient commitment, there is considerable controversy within the mental health community with regard to the acceptable purposes and uses of this option. There is also considerable variability in the manner in which outpatient commitment is utilized. Not only do states have different standards in the law, but judges and doctors can and do differ widely in their understanding and use of discretion regarding the appropriateness of invoking outpatient commitment provisions.

To avoid the adversarial dynamics of involuntary commitment, in some instances crisis teams may consider the use of alternative dispute resolution (ADR). Crisis teams should consider including personnel trained in ADR techniques who can attempt to resolve conflicts short of involuntary intervention.

Many people with mental illness today have some broad understanding of involuntary commitment laws and of the rights they have under those laws. More broadly, many who have been in treatment have learned to understand their illness, to monitor their symptoms, and, ideally, to manage their condition. Patient education is a significant component of treatment in some mental health agencies. Some consumers have arranged to provide information to emergency responders (e.g., through wallet cards) on whom to contact in the event of a crisis. Officers should be aware that someone with a mental illness who is expressing a preference for particular actions, medications, or modes of treatment may be speaking from experience. The person's requests should be relayed to any treatment professional called to the scene or consulted in follow-up to an incident.

"Advance directives" are legal mechanisms by which a patient's preference for particular medications or treatment alternatives can be expressed prior to a crisis, much as many in the general population execute "living wills" or other legal documents outlining their wishes should medical crises leave them unable to express themselves in this way. Officers should be familiar with this mechanism and should be aware of the possibility that a person with mental illness may wish to follow the steps outlined in his or her advance directive. In cases where the advance directive is followed, the person with mental illness may more readily agree to become engaged in services, thereby eliminating the need for involuntary commitment.