Incompetence, Treatment Refusal, and Hospitalization

Psychiatrists have proposed broadened commitment statutes based on need for care and treatment, and under which judges have no role in deciding cases of treatment refusal. The mental health bar has consistently opposed these proposals on constitutional and common law grounds. The authors propose new commitment criteria based on incompetency to decide about hospitalization, and inability to live safely in freedom. The proposed standards would meet the Constitutional require-ments, and would permit hospitalization and/or treatment for many persons who are in need but who now go without. The authors recognize that new commitment law without adequate clinical resources will not greatly improve patient care. Under current commitment and right to refuse treatment laws, many persons with chronic, severe mental disorders cannot be hospitalized or treated. There-fore, many psychiatrists favor broaden-ing commitment laws, with clinical rather than judicial resolution of cases of treatment refusal. The psychotic homeless are a particular concern, and Lamb ' has argued that society should provide services for them, voluntarily if possible but involuntarily if not. Many within the mental health bar have vigorously opposed proposals to broaden commitment laws. They argue that public mental hospital treatment is often inadequate, and that involuntary civil commitment violates the constitu-tional right to liberty and self-determi