Changes in North Carolina civil commitment statutes: the impact of attorneys.

Although authorized by statutes, involuntary civil commitment in this country was largely a clinical process until the 1960s. Patients were hospitalized on the statements of one or two physicians, without advice of counsel, opportunities to defend themselves in hearings, or any legal recourse save habeus corpus writs, which were seldom used and even less frequently successful. 1.2 When courts began to take an interest in commitment, they required due process protections for persons subject to commitment. 37 Civil libertarians argued that lack of adequate legal representation and the nearly complete concurrence between physician recommendations and commitment hearing outcomes demonstrated a usurpation of judicial authority by psychiatrists. 2.8-11 As a result, requirements for effective counsel for patients were enacted in a number of states;12 in those jurisdictions in which the statutes were taken seriously, concurrence rates with physician recommendations (and commitment rates) dropped significantly .13-20 While some authors saw this outcome as desirable,13-15 others pointed out that high concurrence rates do not automatically reflect undue judicial deference to psychiatrists.20.21 By contrast to the prevailing legal view that psychiatric authority is so great that providing attorneys for patients but not for the other side in commitment hearings will create an adequate balance, 22.23 the sharp drop in commitments was viewed by clinicians as evidence that psychiatric power evaporated in a legal setting when opposed by active adversarial counsel, and that the system had become unbalanced in the opposite direction. 23-27 North Carolina experienced this drop in commitments (up to 90 percent in one area) after the introduction of full-time patient attorneys at the four state mental hospitals (treating over 80 percent of the state's committed patients) in 1977. In reaction, a task force of the N.C. Division of Mental Health, Mental Retardation, and Substance Abuse Services (DMH) on which one of us (RM) served-and which included clinicians, patient attorneys, and Attorney General's staff-recommended several changes in the