In the US, people can't be forced into treatment just because they don't want to do it; one or more of the following three things must be true:
Parents can commit their children against their will without these necessarily being true if the children are still minors; if the children are over the age of 18, the parents cannot do this. People refuse treatments for reasons other than the three above, and legally they have the right to do that. Because people with serious disorders (schizophrenia and sometimes bipolar disorder) often lack insight into how sick they are , that means many go untreated despite relatives' best efforts.
Schizophrenia.com has some great resources on why we hospitalize, what it's like to be a family member who needs to hospitalize someone, and how those people feel about their hospitalizations.
One area that still needs serious work in the US is the treatment of cultural minorities. Different groups' traditions and problems can be misinterpreted by therapists trained in white, mainstream psychology.
The European Union takes a less consistent and more liberal approach to involuntary hospitalization, which is called sectioning under the Mental Health Act of 1983.
People can be sectioned if they have a "mental illness," "psychopathic disease," or "severe mental impairment," all broad terms, especially because the Act says, "Mental illness itself is not defined by the Act, but is a matter of clinical judgement." Along the same lines, people can be sectioned because someone perceives them to be dangerous. Usually "someone" means two doctors, social workers, or a close relative with a doctor or social worker.
Opponents argue that in their search for people who have the potential to be violent and therefore dangerous to society, the Home Office (responsible for the prison system) and the Department of Health are identifying too many false positives.
According to the MHA,
To be compulsorily admitted under the provisions of the Mental Health Act 1983, a person must be diagnosed as suffering from a mental disorder as defined by Section 1 of the Act. Mental illness itself is not defined by the Act, but is a matter of clinical judgement.
The Department of Health has suggested one or more of the following to define the term "mental illness":
- more than temporary impairment of intellectual functions shown by a failure of memory, orientation, comprehension or learning capacity;
- more than temporary alteration of mood of such degree as to give rise to the patient having a delusional appraisal of his situation, his past or his future, or that of others or to the lack of any appraisal;
- delusional beliefs, persecutory, jealous or grandiose;
- abnormal perceptions associated with delusional misinterpretation of events;
- thinking so disordered as to prevent the patient making a reasonable appraisal of his situation or having reasonable communication with others.
The terms "mental disorder," "severe mental impairment," "mental impairment," and "psychopathic disorder" are defined in Section 1. (Note that this definition of psychopathic is very different than that in the US, where the term "psychopathic" usually refers to someone with Antisocial Personality Disorder.)
Mental disorder: means mental illness, arrested or incomplete development of mind, psychopathic disorder or any other disorder or disability of mind.
Severe mental impairment: means a state of arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned.
Mental impairment: means a state of arrested or incomplete development of mind (not amounting to severe mental impairment) which includes significant impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned.
Psychopathic disorder: means a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned.
A person may not be regarded as suffering from mental disorder by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs.
When sectioning occurs on an emergency basis, patients are said to be detained under section four of the Mental Health Act. (The 2002 BBC article below mentions lobotomies, which have essentially been outlawed in the US and other parts of the world—to my understanding, they've just about disappeared in the EU, too.)
Minors have fewer rights.
The following people may be admitted without any legal formalities:
- any person who has attained the age of 16 years and who requests admission
- any person under the age of 16 years whose parent or guardian gives consent
- any person to whom it is suggested that admission is advisable, who is capable of understanding the implications of the suggestion and who does not refuse. These patients can discharge themselves at any time unless the doctor in charge decides that if discharged they would endanger their own health and safety or that of other
In places like the People's Republic of China, South Africa during aparthied, and the former Soviet Union, "psychiatric" facilities have been misused to "treat" people society deems undesirable, most notably political dissidents. Fortunately, a 2005 article suggests that this is changing.
Back in the US -- Though hospitals are often portrayed as horrific places (and although some, especially state institutions that receive very little money, really are rather unpleasant), most are not, and my experience has been that most people who are hospitalized have been helped a great deal by it. Are there people who are involuntarily committed when they shouldn't have been? Of course there are, but many mental health advocates argue that the same laws that allow people to be unfairly involuntarily committed (usually those who are inaccurately perceived as dangerous because they're "different") are also the ones that mean that the people who need to be involuntarily committed aren't.
You can read more about the assessment process for involuntary commitment in America in Suicide Emergencies in Fiction: From Safety Plans to Voluntary and Involuntary Hospitalizations.