The civil commitment hearing, accompanied by the panoply of due process rights, is important. However, it is what happens when an individual first enters the mental health delivery system that is of fundamental significance. It is then that decisions on hospitalization, treatment, and disposition are made. The commitment hearing represents not the beginning of a process but, rather, the middle stage or the final chapter. This essay reports the results of an observational study of the functioning of nine emergency rooms or crisis units, with particular emphasis on implications for the civil commitment process.

Every U.S. statute concerning commitment, as well as the English and Canadian statutes I have reviewed, reads as though the individual being considered for commitment is at liberty pending a hearing. Each jurisdiction also has a statute to take care of emergency situations.