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PubMed1976

The case for involuntary hospitalization of the mentally ill.

The author examines three points of view on the question of society's right to involuntarily hospitalize a mentally ill individual. The "abolitionists" oppose involuntary hospitalization entirely; the medical model psychiatrists support the need for commitment under certain circumstances and so do the civil liberties lawyers, but by different standards. The author believes that with the current overreliance on the dangerousness standard, we are witnessing a pendular swing in which the rights of the mentally ill to be treated and protected are being set aside in the rush to give them their freedom. He favors a return to the use of medical criteria by psychiatrists, albeit with constructive legal safeguards.

Adult↗
PubMed1977

Children's rights on entering therapeutic institutions.

The authors delineate aspects of adolescent psychological development that should be considered in decisions regarding psychiatric residential treatment, reviewing the issue of consent to treatment in the context of developmental psychology. They state that rather than jettisoning the whole system of placing treatable disturbed young people in residential facilities without their explicit consent, the court should take as its proper role to ensure that adolescents placed in residential psychiatric facilities receive adequate treatment.

Adolescent↗
PubMed1977

Recent mental health litigation: a critical perspective.

The author considers the effect of recent mental health litigation involving involuntary confinement, the right to refuse treatment, the least restrictive alternative, and the right to treatment on the role of the psychiatrist and the provision of mental health care. His thesis is that the implicit analogies between psychiatrists and agents of the criminal justice system and between patients and criminal defendants are misleading and that the recent changes in the law based on these analogies adversely affect the provision of mental health care.

Civil Rights↗
PubMed1977

Toward a model of the legal doctrine of informed consent.

The authors draw together the disparate scholarly and judicial commentaries on consent to medical treatment to develop a model of the components in the decision-making process regarding consent to or refusal of psychiatric treatment. The components consist of the precondition of voluntariness, the provision of information, the patient's competency and understanding, and, finally, consent or refusal. They offer two models of valid consent: the objective model, which focuses on the congruence or lack of it between the patient and a "reasonable" person, and the subjective model, which focuses entirely on the patient's actual understanding.

Civil Rights↗
PubMed1977

Changing law and clinical dilemmas.

The author describes a case in which a severely depressed suicidal patient was treated with ECT despite her refusal to grant permission while involuntary commitment procedures were pending. He discusses the professional dilemmas caused by new, and sometimes conflicting, legal principles such as the right to treatment and the right to refuse treatment and suggests that psychiatrists work to clarify these principles while saftguarding themselves with the aid of appropriate legal counsel.

Adult↗
PubMed1977

Regulating psychiatric practice.

The trend toward increased regulation of psychiatry and medicine may alleviate some problems but increase others. Some models of practice may achieve monolithic dominance, and maldistribution of practitioners may increase. Covert fantasies about authority, leadership, and peer relations should be borne in mind in the attempt to create an informed, improved regulation of medical practice.

Civil Rights↗
PubMed1978

The process of criminal commitment for pretrial psychiatric examination: an evaluation.

The authors examined the records for 1975 of 87 pretrial commitments to Worcester State Hospital under a 1971 revision of the Massachusetts law regarding such commitments. They also compiled statistics on all admissions to the hospital for 1966-1975. They found that only 2 of the 87 pretrial commitments resulted in a final court disposition of commitment and that pretrial commitments increased during 1972-1975 in contrast to a decrease in other kinds of admissions. On the basis of these findings the authors suggest that serious attention be paid to arguments that pretrial commitment serves to control and sequester deviants. Dr. Alan A. Stone comments on the authors' presentation.

Adolescent↗
PubMed1981

Legislating social control of the mentally ill in California.

The Lanterman-Petris-Short Act in California has been acclaimed for protecting the civil rights of the mentally ill and curbing unnecessary involuntary psychiatric hospitalization. Its passage, however, has not prevented an increase in the rate of involuntary admissions to state hospitals and a marked decrease in the rate of voluntary admissions. This has greatly changed the functions and problems of state hospitals. In local as well as state hospitals large numbers of people continue to become involuntary psychiatric patients. In many cases this results from gaps between the law and its implementation. It appears that professionals, the courts, families, and society generally feel a continuing need for social control of the mentally ill.

California↗
PubMed1985

Miranda comes to the hospital: the right to remain silent in civil commitment.

One procedural protection that has not generally made the transition from the criminal justice system to involuntary civil commitment is the Fifth Amendment protection against self-incrimination. The authors present the results of a study of the implementation of the right to remain silent, which demonstrate that warning patients that anything they say may be used against them in the commitment hearing has little impact on their willingness to talk to staff or to cooperate with treatment. The authors discuss the possible reasons for their findings.

Adult↗