Effects of a new involuntary commitment law: expectations and reality.

During the last decade, there has been almost constant upheaval in the field of psychiatry ,as the courts have examined and found inadequate many of its procedures and institutions. Formerly, it seemed the legal system did not realize that psychiatry existed, now it appears the psychiatrist must be prepared to defend in court everything he or she does or does not do. Court cases concerning civil commitment,l.~ right to treatment,:! right to refuse treatment, 4 and least restrictive alternatives'; have dictated major changes in psychiatric procedures and practice. Ii •7 In civil commitment, courts have supported a replacement of the medical model by the legal model and an emphasis on a state's police powers instead ofitsparefls patriae authority,ll with commensurate attention to due process procedures and protection of patients' rights. In response to this legal activity, a number of authors have presented recommendations for civil commitment statuteso.ll . IO that attempt to strike a . balance between protecting patients' rights and ensuring adequate treatment. Many state legislatures also have been busy rewriting commitment statutes to bring them in line with court decisions. The results of all this activity have left many psychiatrists feeling frustrated, helpless, and fearful that many mental patients will now have the privilege to "die with their rights on."11 Despite this controversy, there have been few reports in the literature about the effects of new civil commitment laws on mental health systems. Table 1 summarizes the effects described in several states. As can be seen, the reports are contradictoryY·I:! Generally, it is claimed that the numbers of court hearings have decreased,14.1;, the percentage of involuntary civil commitments has declined,B.lli the length of stay has "declined dramati-