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A review of major implications of the O'Connor v. Donaldson decision.

Although the Supreme Court's decision in O'Connor v. Donaldson is narrow from the legal perspective, it will have wide clinical applications for psychiatry if it reflects a trend in future court decisions. The author assesses the impact of this decision on the mental health profession in terms of the issue of dangerousness as grounds for involuntary commitment for psychiatric treatment, the principle of least restrictive alternative to hospitalization, the question of adequacy of treatment in light of the absence of nationally defined standards, and the personal liability of physicians for their professional actions.

Aged↗

O'Connor v. Donaldson: retelling a classic and finding some revisionist history.

This article discusses the 1975 Supreme Court opinion O'Connor v. Donaldson. The article first examines the due process clause of the Fourteenth Amendment, the basis for the O'Connor ruling. It then looks carefully at the Court's conclusions, with particular attention to the Court's reasoning and analysis. The article goes on to look at how the Supreme Court has interpreted O'Connor on subsequent occasions and suggests that the Court has often misconstrued its own decision. The article concludes by offering thoughts and commentary on the O'Connor opinion and its progeny.

Civil Rights↗

Donaldson revisited: is dangerousness a constitutional requirement for civil commitment?

The Supreme Court decision O'Connor v. Donaldson (1975) has been widely interpreted to assert that dangerousness is a constitutional requirement for civil commitment. This interpretation is a misreading of the decision, which actually addressed the conditions disallowing indefinite, involuntary custodial confinement and not the requirements for an initial commitment. An excessive reliance on dangerousness narrowly construed as a restrictive requirement for civil commitment has distorted the commitment process by emphasizing the state's police power in protecting the public at the expense of its parens patriae responsibility to provide care and treatment for the severely mentally ill. In reality, the Court has been remarkably cautious in addressing the justifications for civil commitment and has allowed room for a broader interpretation of legitimate justifications that would permit greater latitude in the treatment of the severely mentally ill.

Adult↗

Health sciences librarians and mental health laws.

Two U.S. Supreme Court decisions, O'Connor v. Donaldson and Bounds v. Smith, hold important implications for health sciences librarians serving in mental health facilities. The first, O'Connor, with its many ancillary holdings, puts mental health personnel on notice that patients have certain basic rights, which courts all over the country will now be required to enforce. In Bounds the court has ruled that prison authorities must assist prison inmates in preparing and filing legal papers. The ruling will most likely benefit all mentally disabled prisoners, and future litigation may expand this category to include: (1) persons committed under the criminal code, (2) persons under involuntary commitment not related to the criminal code, and (3) persons voluntarily committed. A selective annotated bibliography, consisting of background readings in mental health and the law, basic rights, law library materials, and mental health legal services, has been compiled to help librarians establish and develop legal collections in anticipation of court decisions that will expand the conditions of Bounds to include all mentally disabled patients.

Bibliographies as Topic↗

Evaluations of dangerousness.

The Supreme Court decided in O'Connor v. Donaldson that mentally ill people who were not dangerous and who could survive safely in the community could not be kept in a mental hospital against their will. In 1976, a project evaluated the legality of the commitments of 107 patients in a State mental hospital. The review was conducted by three panels, each composed of a law student, a resident psychiatrist, and a social worker. Evaluations of a patient's dangerousness were made on the basis of information from the patient's hospital records, an interview with the patient's primary therapist at the hospital, and interviews with the patient. Analysis of project recommendations revealed that commitment decisions were more related to the clinical outlook of the evaluators than to the patient's behavior.

Aggression↗

Rights of the mentally ill: the gulf between theory and reality.

Within the last few years several lawsuits have significantly increased both the procedural and the substantive rights of mental patients; among them are Lessard v. Schmidt, in which the court held that persons facing involuntary civil commitment are entiltled to dueprocess safeguards, and Wyatt v. Stickney and Donaldson v. O'Connor, concerned with the right ot adequate treatment. The author draws on the problems of implementing the landmark decree of Miranda v. Arizona, guaranteeing the rights of criminal suspects, in discussing the difficulties of translating rights promulgated in the courts into reality. He believes that enofrcement of patients' rights depends not on the law alone but also on the sensitivity and good faith of mental health workers.

Attitude of Health Personnel↗

Mental health commitment: the state of the debate, 1980.

This overview of recent mental health commitment litigation and statutes begins with the 1972 decision by a federal district court in Wisconsin that the state's procedures for commitment were constitutionally defective; the case, Lessard v. Schmidt, was a bellwether for the decade. By 1979 three major mental health cases concerning civil commitment reached and were decided by the U.S. Supreme Court--O'Connor v. Donaldson, Addington v. Texas, and Parbam v. J. R. The author reviews the impact of changing standards and procedures on commitment and discusses in some detail the Addington and Parbam cases. He feels that one lesson of those cases is that the positions of the main disputants in the commitment controversy--legal advocates and beleaguered professional--must be compromised. He also discusses the logical culmination of the continuing controversy between law and psychiatry about civil commitment: the committed patient's right to refuse customary treatment.

Commitment of Persons with Psychiatric Disorders↗

Implications of the Donaldson decision: a model for periodic review of committed patients.

In 1976 the Connecticut Valley Hospital, the Yale University School of Law, and the department of psychiatry of the Yale School of Medicine, undertook a project in which all involuntary patients at the hospital, a total of 107, were reviewed by three interdisciplinary panels, each composed of a law student, a psychiatric resident, and a hospital social worker. The major purposes of the project were to identify those patients entitled to release under the Donaldson criteria, to develop a model review procedure, and to assess the need for alternative placements. The panels found no patients resembling Kenneth Donaldson, but they did find 53 per cent of the patients inappropriately detained on involuntary status. However, in most cases the recommendation was transfer to a nursing home because of the patient's high degree of disability. The authors emphaxize the importance of periodic external reviews of commitment status.

Activities of Daily Living↗

The Supreme Court looks at psychiatry.

An analysis of the attitudes of the U.S. Supreme Court toward psychiatry, as expressed in the Court's major opinions on mental health law from 1975 to 1983, reveals significant discrepancies from case to case. The explanation for these puzzling shifts in attitude lies outside the realm of mental health law, in the justices ' aversion to judicial involvement in professional decision making. A close examination of the cases demonstrates the Court's willingness to alter its rhetoric about psychiatry to support this overriding end. Psychiatrists' understanding of the Court and advocacy for their own and their patients' interests must take this broader issue into account.

Adult↗

Supreme Court decisions on mental health: a review.

Since the late 1960s mental health advocates have filed numerous lawsuits against mental health institutions in an effort to narrow the standards for civil commitment, improve the care of patients, and define patients' rights. While many of the lawsuits were successful in attaining these goals at the district and appellate court levels, review by the Supreme Court generally has resulted in decisions blunting the lower court rulings. The high court has rejected broadly worded lower court decisions on commitment laws, standards of proof in commitment hearings, and patients' rights. The court also has upheld the traditional reliance on decision-making by medical professionals. The author describes a number of these cases and their decisions and concludes that cases now before the Supreme Court very likely will result in decisions that strike a balance between the needs of the patients and those of treatment staff.

Adult↗

Right to treatment.

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Compensation and Redress↗