The opposition to involuntary committal and treatment betrays a profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness—free them from the Bastille of their psychoses—and restore their dignity, their free will and the meaningful exercise of their liberties.
But as a result of our current restrictive commitment procedures, persons with mental illness kill 1,000 individuals annually, roughly 10% of all homicides. The most likely victims are family members, police, and sheriffs. Take the parents of mentally ill Eric Bellucci in Staten Island. They were so fearful of their son, who had been hospitalized and involuntarily committed multiple times, that they locked him out of the house. So he camped in their yard. They begged to have him civilly committed, but the law required Eric to first become "dangerous." So he did. On October 13, 2010 he stabbed both his parents. They are dead and Eric will be permanently incarcerated. Hardly a victory for individual liberties.
Untreated schizophrenia and untreated bipolar disorder are two of the disorders most likely to be represented among civilly committed populations. I’ll limit this discussion to schizophrenia.
John Stuart Mill's introduction to On Liberty stated, “It is, perhaps, hardly necessary to say that this doctrine is meant to apply only to human beings in the “maturity of their faculties.” He was wrong. Some libertarians need reminding.
Nowhere is the debate over civil commitment less informed than when it comes to answering the question “Are people with mental illness more violent than others?” It is largely irrelevant, because civil commitment is not aimed at the 25-40% of Americans some claim have a "diagnosable mental disorder"—your friends on Prozac.
By reducing hallucinations and delusions, and by restoring “maturity of faculties,” medication reduces violence. This should be readily apparent because almost everyone civilly committed because they were dangerous is eventually released—because they are no longer dangerous. The difference between their pre-commitment state and post-commitment state was the administration of medicines.
Individuals with mental illness are allowed to refuse treatment and cannot be treated in the community system unless they volunteer. For the most seriously ill, this is often an insurmountable hurdle because of their anosognosia, neurocognitive dysfunction, hallucinations, and delusions. Individuals who need the community mental health system the most cannot get in. They are allowed to deteriorate to dangerousness and then become subject to the involuntary commitment system.
From a libertarian’s perspective, successful civil commitment reform would use commitment less, use it only when needed, steer individuals away from the most restrictive forms of commitment to less restrictive forms, and place greater reliance on the systems that require the least amount of government. We know how to do that.
Preventing the mass civil commitment and incarceration of people with mental illness requires lowering the commitment hurdle to something below imminently, provably dangerous.
Once we understand that treatment can prevent violence in those prone to it and that the "choice" to go off medications is not being made of free will but because the brain is impaired, the libertarian objective should be to restore free will, not stand back so violence can occur.
Some alternatives to inpatient commitment, in order from most restrictive to least restrictive, are guardianship, parole or conditional discharge from hospital after involuntary commitment, and Assisted Outpatient Treatment (AOT).
Current civil commitment practices fail to result in the libertarian objective of having fewer individuals incarcerated, public safety protected, and government growth restrained. Using lower commitment standards combined with less restrictive treatment venues can reduce the number incarcerated, shorten length of commitments, improve safety of the citizenry, and reduce the size of government. Reforming civil commitment practices can free people with serious mental illness "from the Bastille of their psychoses—and restore their dignity, their free will and the meaningful exercise of their liberties."
Mental Illness Policy Org
 Hardin, Herschel. “Uncivil Liberties” Vancouver Sun. July 22, 1993.
 Of spouses killed by a spouse, 12.3 percent of defendants had a history of untreated mental illness; of children killed by a parent, 15.8 percent of defendants had a history of untreated mental illness; of parents killed by children, 25.1 percent of defendants had a history of untreated mental illness; and of siblings killed by sibling, 17.3 percent of defendants had a history of untreated mental illness. 1994 Department of Justice Statistics Special Report, "Murder in Families.”
 The Treatment Advocacy Center runs a fascinating online database called “Preventable Tragedies” that documents mentally ill who have been shot by police or become violent to others.
 See this research on officers shooting persons with mental illness.
 Here is a summary of studies of incarcerated mentally ill.
 Michael C. Biasotti, VP, New York State Chiefs of Police “Management of the Severely Mentally Ill and its Effects on Homeland Security” Naval Postgraduate School. 2011.
 Department of Justice Source Book on Criminal Justice Statistics (1996). $15 billion is based on an estimated cost of $50,000 per ill inmate per year, and 300,000 individuals with serious mental illness incarcerated.
 Van Horn, J.D., and McManus, I.C. (1992). "Ventricular Enlargement in Schizophrenia. A Meta-Analysis of Studies of the Ventricle:Brain Ratio (VBR)." British Journal of Psychiatry160, 687–97; Soares, J.C., and Mann, J.J. (1997). "The Anatomy of Mood Disorders: Review of Structural Neuroimaging Studies." Biological Psychiatry 41, 86–106; Elkis, H., Friedman, L., Wise, A. et. al. (1995) "Meta-Analyses of Studies of Ventricular Enlargement and Cortical Sulcal Prominence in Mood Disorders. Comparisons with Controls or Patients with Schizophrenia." Archives of General Psychiatry52, 735–46.
 Lawrie, S.M, and Abukmeil, S.S. (1998) "Brain Abnormality in Schizophrenia: A Systematic and Quantitative Review of Volumetric Magnetic Resonance Imaging Studies."British Journal of Psychiatry 172, 110–20.
 Schroder, J. et. al. (1992). "Neurological Soft Signs in Schizophrenia." Schizophrenia Research 6, 25–30.
 Torrey, E.F. et. al. (1994). Schizophrenia and Manic-Depressive Disorder. New York: Basic Books: 127, 176-7 (1994); Goldberg, T.E., and Gold, J.M. (1995) "Neurocognitive Functioning in Patients with Schizophrenia: an Overview." In: Bloom, F.E. and Kupfer, D.J. (eds). Psychopharmacology: The Fourth Generation of Progress. New York: Raven Press; Hoff, A.L., Shukla, S., Aronson, T. et. al. (1990). "Failure to Differentiate Bipolar Disorder from Schizophrenia on Measures of Neuropsychological Function." Schizophrenia Research 3, 253–60; Morice, R. (1990). "Cognitive Inflexibility and Pre-Frontal Dysfunction in Schizophrenia and Mania." British Journal of Psychiatry 157, 50–4; Berman, K.F., and Weinberger, D.F. (1991). "Functional Localization in the Brain in Schizophrenia." In: Tasman, A. and Goldfinger, S. (eds.).Review of Psychiatry vol. 10. Washington, D.C.: American Psychiatric Press, 24–59.
 Andreasen, N.C., et. al. (1992). "Hypofrontality in Neuroleptic-Naive Patients and in Patients with Chronic Schizophrenia." Archives of General Psychiatry 49, 943–58.
 Goldberg TE, Ragland JD, Torrey EF et al. "Neuropsychological Assessment of Monozygotic Twins Discordant for Schizophrenia." Archives of General Psychiatry47 (1990): 1066-1072; Goldberg TE, Gold JM. "Neurocognitive Functioning in Patients with Schizophrenia: an Overview." In FE Bloom and DJ Kupfer (eds.), Psychopharmacology: The Fourth Generation of Progress, New York: Raven Press, 1995, pp. 1245-1257; Gourovitch M, Goldberg TE. "Cognitive Deficits in Schizophrenia: Attention, Executive Function, Memory and Language Processing." In C. Pantelis, H. E. Nelson, and T. R. E. Barnes (eds.), Schizophrenia: A Neuropsychological Perspective, New York: John Wiley, 1996;
 “What are the symptoms of Schizophrenia,” National Institute of Mental Health.
 Torrey, Fuller, MD. “Bazelon Center is Wrong – Weston and Goldstein Refused Treatment and Services.”
 A collection of anosognosia research at MentalIllnessPolicy.org.
 A summary of some of the research on involuntary medication and Assisted Outpatient Treatment at MentalIllnessPolicy.org.
 Satel, S. and Jaffe, DJ, “Violent Fantasies” National Review July 20, 1998, pp. 36-37.
 National Institute of Mental Health.
 A two summaries of the research can be found at MentalIllnessPolicy.org.
 Interestingly, from a libertarian perspective, this means the mental health system is treating all others. It prioritizes the least ill and sends the most seriously ill to jails, prisons, shelters, and morgues. This has caused a giant and wasteful mental health industry that rather than serving a core state function of helping those who can’t help themselves, is instead, helping all others. See DJ Jaffe, “Mental Health Kills Mentally Ill,” Huffington Post, January 10, 2010.
 O’Connor v. Donaldson, 422 U.S. 563 (1975) and others.
 Admittedly, some may be what libertarians call ‘victimless’ crimes like possession of narcotics, prohibited pornography, soliciting a prostitute and others.
 John Stuart Mill. On Liberty, 1859.
 Testimony given at meeting of West Virginia Subcommittee C of the Joint Judiciary Committee August 13, 2012.
 There have been at least ten studies on delayed treatment leading to poorer prognosis.
 All treatments have side effects. All decisions involving treatment, voluntary or not, should balance these side-effects against the efficacy of the treatment.
 When Nevada County, CA recently introduced Assisted Outpatient Treatment, they found “County counsel cost is minimal…. Public Defender cost varies, but there would likely be few new or additional costs, because these same individuals would need representation in Criminal Court, Mental Health Court, or Adult Drug Court, if not being dealt with in (outpatient commitment) Court. (Michael Heggarty, Nevada County Behavioral Health, Carol Stanchfield, Turning Point Providence Center, Honorable Judge Thomas Anderson, Nevada County Superior Court. “Assisted Outpatient Treatment in California: Funding Strategies” February 7, 2012.
 1995 Wisconsin Act 292 51.15 (1) (a) (5).
 See NYS Mental Hygiene Law § 9.60 (c); CA WIC, Article 9 5346(a) or Treatment Advocacy Center model law.
 Many people have questions about how monitoring is accomplished. We already monitor those in the parole system and those with TB living in the community. Likewise we have teams of social workers who monitor the non dangerous mentally ill. There are many feasible existing ways to accomplish monitoring. At minimum, a family member or significant other, or community member could report the reemergence of symptoms to a doctor, social worker, psychiatric nurse, law enforcement officer or other person who could determine if the person needs to be brought to a hospital for evaluation. Assertive Community Treatment (ACT) teams can also be used.
 A summary of studies on Kendra’s Law.
 Michael Heggarty, Behavioral Health Director, Nevada County. “The Nevada County Experience,” Nov. 15, 2011; County of Los Angeles. “Outpatient Treatment Program Outcomes Report" April 1, 2010 – December 31, 2010.
 Phelan JC, Sinkewicz M, Castille DM, Huz S, Muenzenmaier K, Link BG. "Effectiveness and Outcomes of Assisted Outpatient Treatment in New York State." Psychiatric Services 61. No 5 February 2010.
 Bruce G. Link, Ph.D., et. al. "Arrest Outcomes Associated With Outpatient Commitment in New York State." Psychiatric Services. May 2011.
 Savings calculation at KendrasLaw.org.