Treatment refusal in a forensic hospital: ill-use of the lasting right.

A forensic hospital patient's persistent treatment refusal-his or her last recourse and lasting right-virtually ensnarls our social system legally, clinically, and economically. 1 Meanwhile, the right to be mentally ill and the illness gather momentum. It has been recommended that dangerous patients, whose treatment refusal is upheld by the law, be diverted to the criminal justice system for disposition. 2 In practice, however, it is not the detention center that accommodates such assignments. Forensic hospital patients remain in large part unattended by the legal system beyond commitment for designated "clinical" purposes. Based on information derived from first-hand clinical experience, this article raises questions about clinical, legal, economic, and social implications of forensic hospital treatment refusal and highlights the paradoxical nature of clinical management of involuntary, violence-prone patients in a closed (maximum security) system. Material is drawn from a 12-month experience as part-time staff psychiatrist for a 16-bed treatment ward at the Dayton (Ohio) Mental Health Center Forensic Unit, one of the regional forensic hospitals built in response to the Davis v. Watkins decision that provided federally mandated treatment for forensic patients in Ohio.:1 The hospital staffs mechanism for managing treatment refusal is the application of individualized clinical judgment in emergency and nonemergency situations.