Alternatives to Civil Commitment of the Mentally Ill: Practical Guides and Constitutional Imperatives

In 1930, Ford sold Fords only in black and states offered treatment for mental illness only in public mental hospitals. Today, new views of mental health care and mental health problems have begotten a galaxy of new treatment settings. Few cities can boast community-based programs sufficient to meet their needs, but almost all cities of any size rely increasingly on outpatient programs. The large public mental hospitals still stand, of course. Indeed, every year more people enter public hospitals than entered the year before. Over 400,000 Americans were admitted as inpatients to state and county mental hospitals last year.1 Partly because of the new outpatient services, patient stays tend to be shorter than they once were, but, short or long, a large portion of the 400,000 underwent anguish, terror, and embarrassment in the sudden separation from home and family and the sudden loss of privacy and self that accompanies confinement on a ward with fifty or a hundred strangers. Precisely what portion of these 400,000 were involuntarily committed is not known, but it is probably more than fifty per cent.2 What portion of the 400,000 could have been treated and protected as well or better outside the hospital is also unknown, but, as we shall see, the percentage also seems likely to have been high