Treatment Goals, Interventions, and Institutional Language in Civil Commitment Plans for Individuals with Intellectual and Developmental Disabilities: A Content and Critical Discourse Analysis

Abstract

Introduction: Individuals with intellectual and developmental disabilities (IDD) are overrepresented in both the criminal legal system and within institutions. These individuals face compounding marginalizations in housing, healthcare, and education access. Individuals with IDD who end up in the criminal legal system but are found not competent and not restorable to competency to stand trial can be placed on long term involuntary civil commitments. Involuntary commitments can continue indefinitely until individuals are deemed ready for discharge. To date, no research has examined the treatment goals and interventions prescribed to individuals with IDD who reside on civil commitments to meet their discharge criteria. Research has also not yet examined characteristics of the language used to construct treatment plans and how that may be informed by perception of disability and simultaneously shape future perceptions of the individuals. Methods: A conventional content analysis and a critical discourse analysis were conducted on fifteen treatment plans for individuals with IDD who were civilly committed in Washington State in 2024. Nine of the individuals resided on a ward specifically housing patients with IDD, the habilitative mental health unit (HMH), and six individuals with IDD resided on a ward with a mixed milieu (C-wards). The content analysis examined goals and interventions prescribed to facilitate discharge, and the critical discourse analysis examined the use of institutional language and whether it varied by race, activities of daily living, or commitment history. Results: Goals and interventions focused on the replacement of aggressive or challenging behaviors. Social determinants, environmental factors, and personal goals were not regularly considered in treatment or discharge planning. Individuals who reside on the IDD-specific ward received recreational and vocational interventions, especially janitorial work, as a part of their treatment, but do not frequently receive formal group or individual therapy. Individuals who resided on C-wards with a general civil commitment milieu did not receive treatment involving recreation or work but did receive formal therapies. Individuals’ disabilities were often cited as the driving force for the behavioral challenges. This attribution of disability as a causal force driving behavioral challenge was frequently paired with statements regarding an individual’s inability to understand their treatment issues and recommendations for 24/7 community supervision. Individuals with multiple commitments, people of color, and those who needed support with daily living activities receive more negative or deficit-based descriptions in their treatment plans. Conclusion: There is limited evidence for the employment of evidence-based, person-centered, or strengths-based clinical care for individuals with IDD on civil commitments. Interventions and discharge recommendations appear to be generalized based on ward rather than person-level or tailored treatment. In combination, the emphasis on individual deficits, the lack of therapeutic intervention, the attribution of behavior to disability, and the reliance on community supervision in discharge planning suggest that the perception and treatment of individuals with IDD on civil commitments is grounded in an ableist system and clinical viewpoint.