A new report from the Prison Policy Initiative argues that involuntary commitment—long framed as a public health intervention—is increasingly being used as a mechanism of social control, expanding the reach of the legal system over people experiencing mental illness, substance use disorders and homelessness rather than addressing the underlying causes of those crises.
The report, authored by Prison Policy Initiative researcher Emily Widra, contends that forced hospitalization has become another avenue through which vulnerable populations are swept into systems of confinement. Widra argues that what is often presented as treatment instead mirrors many of the inequities found throughout the criminal legal system.
Involuntary commitment, or forced hospitalization, refers to the legal process by which people are placed into psychiatric or substance use treatment without their consent. Widra identifies two categories of commitment: non-forensic hospitalization, which arises through the civil legal system, and forensic hospitalization, which occurs through the criminal legal system.
Non-forensic civil commitment can be imposed on individuals determined to be “a danger to themselves or others” or unable to meet their “basic needs,” Widra explains.
While “basic needs” have traditionally referred to “food, clothing and shelter,” Widra notes the definition has broadened significantly in recent years. In 2026, the Departments of Justice and Veterans Affairs began “seeking legal guardianship over ‘vulnerable’ veterans.” In 2025, an executive order issued by President Donald Trump explicitly sought to address homelessness through civil confinement. Since 2024, most states have expanded non-forensic hospitalization laws to include people with substance use disorders.
Widra argues these policies disproportionately affect “unhoused people, people in poverty and people of color, mirroring disparities within the criminal legal system.”
Although individuals subject to involuntary commitment are intended to receive treatment in state psychiatric facilities, many instead remain confined elsewhere while waiting for beds to become available. Widra points to Massachusetts, where people awaiting placement may be held in jails and prisons despite having no criminal charges or convictions.
The report also questions whether existing legal safeguards meaningfully limit involuntary confinement. Although many states impose statutory limits on commitment periods, courts can repeatedly renew those orders. Procedures and release standards vary by jurisdiction, but Widra notes that a single judge often has the authority to determine whether someone remains confined.
According to Widra, forensic forced hospitalization can occur at virtually any stage of the criminal legal process.
When the defense, prosecution or judge questions a defendant’s competency—or their “ability to participate in the trial […] unrelated to their mental state at the time of the alleged crime”—the court may order a competency evaluation to determine whether restoration services are necessary.
Widra reports that only about 20 percent of competency evaluations ultimately result in forced hospitalization. However, available research shows “a statistically significant relationship between incompetency findings and defendants identified as female, minority race or married,” with “non-white defendants 1.4 times more likely to be found incompetent.”
Competency evaluations and restoration proceedings also contribute to lengthy delays because of shortages of psychiatric hospital beds, extensive evaluation waitlists, delays in scheduling hearings and the need to restart criminal proceedings once competency is restored.
Even before conviction, defendants found incompetent may spend four times longer in custody than defendants found competent. “People who may be in psychological distress or in need of psychiatric treatment are left to languish in jails until a hospital bed becomes available,” Widra writes.
Following trial, verdicts of “not guilty by reason of insanity” (NGRI) and “guilty but mentally ill” (GBMI) can also result in involuntary treatment. NGRI verdicts automatically require hospitalization, while GBMI verdicts require defendants to serve their sentences while receiving treatment if it is available. In both situations, confinement is based on an individual’s mental state at the time of the offense, regardless of subsequent recovery.
Widra argues these legal processes rely on “inherently legal concepts, not medical or clinical concepts or diagnoses, and are not based on best practices regarding mental illness and treatment.”
“The expansion of carceral control over people who are not charged with criminal offenses and people who have already served their criminal sentences reveals yet another way the legal system seeks to criminalize mental illness and substance use,” Widra writes.
Rather than expanding involuntary commitment, Widra argues policymakers should invest in “community-based” mental health and substance use treatment, reducing reliance on detention facilities and overburdened psychiatric institutions while providing care outside the criminal legal system.
The report ultimately argues that treating forced hospitalization as a solution to crime expands the definition of who becomes subject to state confinement, extending carceral control beyond those accused or convicted of crimes to include people experiencing mental illness, substance use disorders and homelessness.
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