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In December 2024, in Portland, Oregon, a twenty-eight-year-old man was found guilty except for insanity for the murder of his mother by manual strangulation. The judge held that the defendant lacked the capacity to understand the criminality of his conduct because of a mental illness that caused him to believe, delusionally, that his mother was poisoning him. In August 2024, a twenty-nine-year-old Portland woman was found guilty except for insanity for arson. She had set fire to a 118-year-old church that served as a gathering place for the city’s Korean American community. Her action was prompted by auditory hallucinations that threatened her with mutilation unless she followed their command to ignite the blaze.
These cases are tragedies, but they are also evidence of significant failures in law and judicial policy. Specifically, appellate case law in Oregon has become so rigid that it is easier to pass a camel through the eye of a needle than to judicially compel a person to accept treatment for psychiatric illness.
The mental health of the young man who killed his mother had been in serious decline for the previous five years. Throughout this time, his concerned family had attempted to obtain psychiatric treatment for him without success. Despite being awarded medical guardianship shortly before her death, his mother was unable to compel treatment because Oregon sets the legal bar for involuntary commitment so high. State law provides that “a person can be committed if the judge finds by clear and convincing evidence that the person has a mental disorder and, because of that mental disorder, is dangerous to self or others, or unable to provide for basic personal needs like health and safety.” But meeting the “clear and convincing evidence” bar prospectively has become virtually impossible. In practice, immediate danger can only be proven in retrospect—which in most tragic cases is postmortem.
Many groups advocating for the mentally ill have supported this stringent approach to involuntary commitment on the grounds that it protects personal autonomy. I think they are misguided for two reasons. First, they treat personal autonomy as an idol, without considering the broader context of human well-being. Mentally ill people who live on the streets—unprotected from the elements, surrounded by used needles, marinating in their own excrement—are not striking a blow for personal choice. They are living lives of isolation and suffering.
Second, the practical effect of idolizing autonomy is the criminalization of serious mental illness. Statistics show that people with mental illness are far more likely to be victims than perpetrators of crime. Yet in Oregon, the only path to treatment for far too many people is through the criminal-justice system. The Oregon State Hospital, originally intended to provide long-term care for seriously ill patients who have been civilly committed, is now, for all practical purposes, a forensics hospital. It houses those found unable to assist in their own defense against criminal charges and ordered to receive treatment so they can understand the charges against them, participate in court proceedings, and work with their attorneys. There is virtually no room to treat anyone else.
How do we reform a system that treats serious mental illness only when it is intertwined with a criminal charge? Catholic social thought provides a helpful lens for analyzing the problem. The conviction that every human being is made in God’s image and likeness is foundational to the Catholic understanding of creation. The right to autonomy, expressed in the power to accept or decline treatment for both physical and mental illness, is rooted in the recognition of the inherent dignity of all people. But in three respects, it does not exhaust that recognition.
First, identifying truly autonomous choices made by seriously mentally ill persons is a difficult task. Serious mental illness can compromise a person’s reasoning and judgment, turning their apparent autonomy into an unreliable and even dangerous guide to the best interests of the whole person. For example, some people who are mentally ill suffer from anosognosia, which is a neuropsychiatric condition causing someone to be unable to recognize that they have an illness even when informed otherwise by a qualified health-care practitioner. It is nonsensical to expect someone with anosognosia to give or withhold an effective consent to treatment.
Second, while autonomous choice is one component of personal well-being, it is not the only one. Other factors must be taken into account, including functionality, which we now know is likely to diminish with repeated and protracted psychotic episodes. The degree to which a person with psychosis is suffering—physically, emotionally, and spiritually—must also be considered. Finally, those with mental illness often suffer from delusions—fixed beliefs that remain intractable despite all evidence to the contrary. The psychic experience of a man absolutely convinced his mother is poisoning him or a woman certain that she will be physically mutilated if she doesn’t set fire to a church can only be understood as a form of agony. And, of course, reckoning with the behaviors undertaken during a psychotic episode after the episode subsides can be even more agonizing.
Third, the obligation to care for all of one’s neighbors, who are also created in God’s image and likeness, requires equal consideration. According to Catholic teaching, human beings are not isolated monads. They are essentially social, with rights and duties to be understood in the context of the broader community. The decision to compel treatment must therefore involve the interests of people affected by the patient’s mental illness, quite often their family members who love and care for them. It is one thing to say that involuntary commitment should be a last resort, to be used only after less intense treatment plans have proven ineffective. But it is another to ignore the interests, concerns, experience, and efforts of family members to obtain help for their mentally ill family member.
Thankfully, this issue is getting renewed attention in Oregon and other places. In August 2025, Gov. Tina Kotek signed House Bill 2005 into law. It allows judges in civil-commitment courts to consider events and behaviors occurring in the previous thirty days when deciding whether a person poses a danger to themselves or others and should be committed to the Oregon Health Authority for mental-health treatment. This explicit authorization for contextualized assessment of risk means judges don’t have to be fortune tellers predicting dangerous behavior prospectively.
Civil commitment is, of course, one piece in a larger mental-health puzzle. Oregon has one of the highest rates of mental illness in the United States but has consistently ranked among the lowest in terms of access to mental-health treatment. A robust system of care—including long-term, acute, and subacute residential treatment; residential and outpatient substance-use treatment; supported housing; and outpatient, community-based mental-health treatment engaging the whole person—is essential. Hopefully, with systems like this in place both in Oregon and throughout the country, compelled mental-health treatment will become a rarely used option, needed only to stop the criminalization of mental illness and, most importantly, to alleviate suffering.
This article was published alongside two others in a symposium about the Church and mental illness. The other contributions can be found here:
“The Vision of Baptism” by Peter K. Fay
“Just Policing” by Tobias Winright
