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Notes -
I will freely admit that sometimes places are a little "soft" with commitment (or lazy) but in general (and uniformly in busier places because resources are scarce) systems are very good at following the law, which varies by state by state.
In essence though the idea is the person needs to be a danger to themselves or others. The way that works out in practice is significant, imminent danger. You might say you have suicidal thoughts, but unless you have a plan and a situation which makes implementing that plan easy and likely then you'll get sent home.
When it comes to homicidal thought content its not "i'm going to kill my wife" its "I went out an bought a gun because I want to kill my wife because she is cheating on me" (and she is not in fact cheating, that's a delusion).
Putting aside the suicide end of things, you basically have to be having something (psychiatric) going on in your life that makes you likely to kill somebody. That gets taken seriously because a lot of these people don't get caught and end up murder suiciding, killing people, and doing things that end up in the news. Getting treatment on board or removing guns from the equation when they present themselves is huge.
The best predictor of future behavior is past behavior. Even with that in mind some people do get discharged from the (medical) hospital after a suicide attempt. When done properly (which is admittedly sticky) the burden for commitment is high. On the homicidal end of things you can credibly be planning to shoot up a school but if it's not psychiatric in nature...off you go (although some will make exceptions for this for the obvious reasons).
Inability to care for oneself is part of the assessment but that almost only comes up with people like chronic schizophrenics who can't feed themselves and so on.
Basically the idea is that (like with a felony) you've had an event that's so bad that it greatly contorts your actuarial risk of bad behavior such that abridgment of your personal rights is appropriate in order to protect others. That's fundamentally what a commitment IS, so taking away guns is not far off from a commitment itself.
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