The state hospital for treating the mentally-ill and confining the criminally-insane is located in the town where I practiced law for over twenty years. During that time, I represented hundreds of persons caught up in civil commitment proceedings. It was a dynamic time in the commitment arena. My state like many at the time had enacted new civil commitment laws. It took a lawsuit brought by mental health advocates to bring about the changes needed to bring my state into compliance with the new requirements.
One of the first people I represented at the state hospital had been “guested” to the Special Treatment Ward (STW). Those guested to STW had gotten into trouble or otherwise were considered dangerous. The STW was on the highest floor of a four story building. The only aisle to get from the front to the back of the ward was directly below the peak of the building’s roof. Those guested were in barred jail cells with ceilings that slanted towards the back as the roof did.
There were no windows. Ventilation was poor. The ward was dimly lit by light bulbs dangling from the ceiling. The smell of sweat, urine and feces permeated the whole floor. In my experience, one or two staffed the ward. The patients talked to themselves, argued with others and yelled for attention. Frequently the staff told patients to shut up.
The client I was representing was naked. Earlier, he had torn apart his mattress with his hands. He had been such a problem he had not been allowed out of his cell to shower for several days. He was a big man and he was mad.
Staff told my client I was there to see him. He moved from the cell door so I could enter and I was locked in the cell with him. He covered himself with sheet. Since the cell was an absolute mess, we stood next to each other. I started trying to get some information from him. He said nothing for awhile. Then he asked me if I was afraid of him. I said, “No.” He said, “You should be.” Nonetheless, he started answering questions and shook my hand when I left.
I was one of the commitment lawyers that did all that I could to get a patient out. That STW client was ordered back to the state hospital despite my efforts. Even so, he shook my hand again and thanked me for trying to help. He had been in the system for awhile and eventually figured out he had to be in compliance to get out.
Being a hard-nosed advocate had its interesting moments. Sometimes relatives would call me upset when they found out I had talked to a patient who they thought needed to remain hospitalized. Several times, representatives from the state hospital would get angry with me for getting a patient released. I would tell them they needed to do a better job.
Perhaps the oddest case is one where I got a patient released and he got mad at me. He wondered what he was going to do now? He had no place to go. So, he got into the state hospital vehicle, went back to the hospital and voluntarily committed himself.
As this thread affirms, dealing with those who do not think they need treatment is no simple matter. A lot of people have worked hard to address the concerns about involuntary treatment and right to be free. Here is one state's version of the rights of patients:
Quote:
25-03.1-40. Rights of patients. Each patient of a treatment facility retains the following rights, subject only to the limitations and restrictions authorized by section 25-03.1-41. A patient has the right:
1. To receive appropriate treatment for mental and physical ailments and for the
prevention of illness or disability.
2. To the least restrictive conditions necessary to achieve the purposes of treatment.
3. To be treated with dignity and respect.
4. To be free from unnecessary restraint and isolation.
5. To visitation and telephone communications.
6. To send and receive sealed mail.
7. To keep and use personal clothing and possessions.
8. To regular opportunities for outdoor physical exercise.
9. To be free to exercise religious faith of choice.
10. To be free from unnecessary medication.
11. To exercise all civil rights, including the right of habeas corpus.
12. Not to be subjected to experimental research without the express and informed
written consent of the patient or of the patient's guardian.
13. Not to be subjected to psychosurgery, electroconvulsive treatment, or aversive
reinforcement conditioning, without the express and informed written consent of the
patient or of the patient's guardian.
14. In a manner appropriate to the patient's capabilities, to ongoing participation in the
planning of services.
15. Not to be required to participate in the development of an individual treatment plan.
25-03.1-41. Limitations and restrictions of patient's rights. The rights enumerated in subsections 5, 6, 7, and 8 of section 25-03.1-40 may be limited or restricted by the treating physician, psychiatrist, or psychologist trained in a clinical program, if in that person's professional judgment to do so would be in the best interests of the patient and the rights are restricted or limited in the manner authorized by the rules adopted pursuant to section.
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http://www.legis.nd.gov/cencode/t25c031.pdf If you have time to read it and are curious, this link is to my state's current commitment chapter.
This article talks about the sexual predator law:
http://www.nytimes.com/2010/05/18/us...offenders.html
It is unlikely there will ever be a civil commitment process that does not raise the ire of someone. That said, requiring the least restrictive alternative for one who needs some help has proved beneficial. Those with capacity may refuse treatment. Most professionals try to have the patient involved in the treatment plan. The process certainly is better than when people were being guested to STW.
You make valid points, Can't Stop Crying. What happened to you is criminal.