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The journal of behavioral health services & research
Mar 26, 2025;

"Involuntary" and "Voluntary" in Psychiatric, Behavioral, and Mental Health Services: A Scoping Review of Definitions.

Benjamin D Smart, Kritheeka Kalathil, William V McCall, Sahil Munjal, Haley Kirkendall, Madison Patel, Amy Taliaferro, Lauren H Yaeger, Ana S Iltis
Author Information
  1. Benjamin D Smart: Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Stockholm, 17165, Sweden. benjamin.smart@ki.se. ORCID
  2. Kritheeka Kalathil: Sandra and Leon Levine Psychiatry Residency Program, Carolinas Medical Center, 501 Billingsley Rd, Charlotte, NC, 28211, USA.
  3. William V McCall: Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA.
  4. Sahil Munjal: Wake Forest School of Medicine, Department of Psychiatry and Behavioral Medicine, 791 Jonestown Road, Winston-Salem, NC, 27103, USA.
  5. Haley Kirkendall: Wake Forest Psychiatry and Behavioral Medicine Residency Program, Atrium Health Wake Forest Baptist, 791 Jonestown Road, Winston-Salem, NC, 27103, USA.
  6. Madison Patel: Wake Forest University, 1834 Wake Forest Rd., Winston-Salem, NC, 27106, USA.
  7. Amy Taliaferro: Wake Forest University School of Law, 1834 Wake Forest Rd, Winston-Salem, NC, 27109, USA.
  8. Lauren H Yaeger: Becker Medical Library, Washington University School of Medicine, Campus Box 8132, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
  9. Ana S Iltis: Wake Forest University Center for Bioethics, Health and Society, Wake Forest University, 1834 Wake Forest Rd., Winston-Salem, NC, 27106, USA.
PMID: 40140169 DOI: 10.1007/s11414-025-09940-8

Abstract

The meaning of (in)voluntary in the context of psychiatric, behavioral, and mental health services in the United States lacks shared understanding despite widespread use, such as in "involuntary treatment," "involuntary hospitalization," and "voluntary patient." A pre-registered scoping review was conducted to describe how U.S.-based healthcare professionals explicitly define (in)voluntary when referring to psychiatric, behavioral, and mental health concepts. Nine databases and nine organization/government websites were searched. Eligibility criteria included English availability, U.S.-based healthcare author(s), and an explicit definition of (in)voluntary. Extracted data included study characteristics and (in)voluntary term(s) with definitions. Open coding was used for the (in)voluntary-associated definition. Meaning categories were created by grouping codes. A total of 29,313 citations were screened for a final 162 sources, containing 203 definitions. Evidence sources (years 1966-2023) were most frequently research articles (33%), review articles (24%), and books (20%) with authorship including persons with an M.D./D.O. (70%) and/or Ph.D. (51%). The most common definition words were order, coercion, against/opposed to a patient's will/wishes, consent, force, and adhere. Meaning categories were external pressure, civil rights, individual agency, competence and capacity, and ethics. Involuntary definitions more commonly characterized the patient as actively against an intervention (23%), rather than without active agreement (11%). Some definitions included a legal (62%) and/or ethical dimension (33%). Two-thirds of sources used at least one additional (in)voluntary term in the publication without defining it. Because there exists a range of competing definitions for the term (in)voluntary, authors who use this descriptor clearly are recommended to explain their meaning.

Keywords

Civil commitment Ethics Health services Involuntary Psychiatry Voluntary

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