"The wrong handle": flawed fixes of medicolegal problems in psychiatry and the law.

The practice of psychiatry, the severity of some mental illnesses, the rights of mental patients, and the available resources for evaluation and treatment of mentally ill persons all pose significant challenges for the involved parties, including patients, practitioners, institutions, legislatures, and social systems. Making the system work at all inescapably creates many problems of access to and delivery of care, balancing needs for treatment, needs for autonomy, and so on. The legal system may be invoked to solve some of these problems that emerge from the complex interaction of several forces at multiple levels. Problems are best solved when they are approached from the most effective vantage point. The failure to accomplish this goal may be termed, “grabbing the problem by the wrong handle.” A number of legal approaches to problem-solving unfortunately fit this description. They have in common one or more of the following: a lack of clinical input, expert testimony, or consultation; a lack of due process and the failure to use the kinds of balancing tests that emerge from many courts; and the fact that most legislative initiatives are the product of compromise among interested parties, but not necessarily the best solution to the problem at hand. In other cases, judicially imposed standards are applied arbitrarily without necessary correlation with clinical realities, and committees spawn abstract statutes designed to remedy some perceived problem. Of course, all these forces are intensified by political pressures, imminence of elections, and other familiar factors. We will attempt to illustrate the secondary problems created by grabbing the original problems by the wrong handle, and to suggest solutions.