Legislative acts and psychiatric input--a New Jersey experience.

Organized psychiatry has not been very successful in communicating to government what it believes to be appropriate professional standards of psychiatric treatment or what it believes to be appropriate governmental policy to provide such care. Governmental mental health care is primarily a matter of state government, not federal government. Therefore, any attempt to influence social policy must most appropriately be made at that level. As we have been taught in our early school days, governmental authority in the United States stems from three sources judicial, executive, and legislative. In the last decade, judicial policy-making has been of extreme import. The American Psychiatric Association has responded by forming a commission on judicial action and has intervened in a number of lawsuits, usually with the preparation of an amicus curiae brief which sets forth the recommended position of a national body of psychiatrists and the rationale, medical and legal, for that position. The cases before the courts have had great effect because a federal court, in dealing with constitutional rights and state responsibilities, has the authority to force states to adopt certain policies and procedures. Organized psychiatry has taken the initiative in participating in selected lawsuits because early Significant suits did not allow psychiatrists to have input into the decision-making process, which resulted in policies thought detrimental to psychiatric treatment. Most of the suits have been individual or class action suits against state government hospitals or programs. Oearly the state governments themselves, often ill-defended, frequently did not have the capacity to formulate intelligently the need for appropriate professional input at the litigation level. Only recently have the states, with their service systems under attack and their authority vanishing, recognized the' appropriateness of professional medical input as well as adequate legal assistance. The judicial intervention into patient care has had both good and bad effects on care itself; its insistence on due process has ameliorated many past inequities while occasionally creating new ones.