Mental Illness & Legal Remedies

To his co-workers at a Los Angeles aerospace plant, Herbert Hill seemed odder and odder. The angry exmarine, a purchasing expediter, refused to speak, neglected his work, shoved his chair at passersby, rejected all psychiatric help. Last month Hill's boss ap pealed to a special psychiatric court in the county general hospital. Hill was arrested, examined by two court psychiatrists, and diagnosed as a potentially dangerous schizophrenic. After an informal hearing, at which he was rep resented by a public defender, the court sent Hill to Camarillo State Hospital and scheduled a jury trial to review his commitment. But Hill responded so well to treatment that in a few weeks the hospital advised the court to release him. Now he is getting private medical care, and has a fair chance of recovery.

At some point in their lives, roughly 10% of Americans will probably wind up in mental hospitals -- a statistic that poses hard questions of civil liberty and medical necessity. Though critics decry the use of police to "arrest" mental patients, Hill's rights were well guarded by California's relatively enlightened rules. But what of others in Hill's position throughout the country?

No Railroading. The ancients had legal sanctions to exorcise demons by crushing or cutting open the bodies of the afflicted. The Middle Ages permit ted even worse therapeutic tortures.

Colonial Americans whipped the mentally deficient. But in 1773 Virginia opened the country's first state mental hospital, and the law soon honed the classic standard that involuntary commitment is justified for persons "dangerous to themselves or others."

It was so easy to pin this label on enemies or unwanted wives, however, that in the 1870's reformers pushed through strict judicial safeguards against railroading. Since mental hospitals were then regarded as fearful places, the law's chief aim was to make sure that only the truly ill were committed. Today's most advanced screening procedures require careful precommitment medical examination, legal notice, and informal hearings before special courts. Some judges follow up with personal bedside visits; the patient's legal remedies range from jury trial to writs of habeas corpus. Says one Chicago judge: "It would take a massive conspiracy to railroad anyone."

No Restraint. But a new legal problem has arisen as a result of the mid-1950s' introduction of tranquilizers that ease savage symptoms. Bars, screams, straitjackets--all signs of restraint are disappearing from mental hospitals as new remedies make mental illness more tractable. The law's new problem is how far to liberalize involuntary commitment procedures at a time when psychiatrists argue for earlier admission (leading to earlier discharge), long before patients become "dangerous."

Some doctors now argue that admission should be governed entirely by medical boards, without interference from lay judges and juries. But lawyers fear that even harmless neurotics might wind up in institutions that are still primarily geared to restraint. The consensus is that involuntary admission should be extended to nondangerous persons only where hospitals are fully equipped to treat early symptoms. On the other hand, state hospitals are allowed to discharge patients without court intervention. In many places, nondangerous patients who succeed in going over the hill and staying free for a year are considered discharged, on the theory that they must have come to terms with society.

In such advanced states as Illinois and New York, the admission trend is nonetheless toward maximum medical control. Hospital judges in Illinois now work so closely with medical advisers that, in general, they decide only whether a committal involves bias or unethical conduct. Boasts one Chicago judge: "This is the only court where the defendant always wins. If he is released, it means he is well. If he is committed, it is for his own good."

Earlier & Faster. New York will probably lead all states next year when it puts into effect a new mental-health code based on careful bar studies and long experience with the psychiatric division of Manhattan's Bellevue Hospital, the world's biggest psychiatric admission center (18,000 cases a year).

Bellevue's mental patients may be held for observation against their will for up to 60 days. In deciding whether they should go on to state hospitals, the judges manning Bellevue's 7th-floor courtroom are amply served by psychiatric advice, but they need far more information about the patients' families and financial backgrounds.

The new law thus provides a fact-finding state mental-health service with trained case workers who will not only tell judges more about patients, but also keep better case records for the information of friends, relatives and patients themselves. While retaining such remedies as habeas corpus, the new law will put medical and legal interests in better perspective. Involuntary admission will be by application of relatives, friends or public officers, plus a certificate signed by two psychiatrists. Within five days of admission notice must be given to the patient and three relatives or friends. Though hospitals will still be able to hold patients for 60 days, they must then get court permission and court review after six months, one year, and every two years thereafter.

All this aims to get patients in earlier and out faster. If it works, New York may take credit for a major step toward putting admission to mental hospitals on virtually the same medical basis as admission to other hospitals--while safeguarding civil liberties for citizens who must be denied some freedom in order to handle full freedom later on.

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