The Mental Patient's Rights

Determined to do something about his weakness for vodka that had earned him a record of minor brushes with the law, Army Veteran Carl Holm, 28, voluntarily went to a veterans mental hospital in Sheridan, Wyo. When he was given town privileges, though, Holm wasted no time getting drunk and passing out on the hospital lawn. "It's my opinion," said a harried doctor after locking up the patient, "that you're a hopeless alcoholic and should spend the rest of your life in this ward."

The hospital duly went to court to ask Holm's involuntary commitment under a Wyoming law that aims to make such hearings easy on the patient. Like similar laws in a dozen other states, Wyoming's is based on a federally sponsored model code. To keep things informal, the code ironically says that a commitment hearing "shall not be bound by the rules of evidence"--the rules that bar hearsay or irrelevant testimony in any ordinary law court.

Old Liberty. After a jury ordered Holm back into the hospital last year, his young court-appointed Sheridan lawyer, James E. Birchby, appealed to the Wyoming Supreme Court on the grounds that the jury had been given hearsay evidence about Holm's mental condition. The law permitting this, he argued, denied the due process guaranteed by the 14th Amendment as well as the Wyoming constitution. Last month the court agreed and set Holm free. "It still remains the fundamental law of the land," said the court, "that a person cannot be deprived of his liberty--whether by involuntary hospitalization or some other kind of incarceration-without due process of law."

The Wyoming precedent reflects a new legal tension over the rights of the mentally ill. Of the roughly 300,000 Americans who will enter mental hos pitals this year, more than half will be committed against their will. While medicine seeks earlier and faster cures, the law's problem is to protect the patient's rights in the process.

New Safeguards. To meet the challenge, New York has adopted what is probably the most advanced mental-health code in the country. As a step toward reducing the state's high involuntary commitment rate (60%), the code obliges officials to stress voluntary treatment--for example, by voluntary hospitalization for a maximum 15 days. In addition, the code rings elaborate safeguards around involuntary commitments. Spouses, parents, children, relatives, friends, employers or the state itself may request involuntary commitment, but every request must be approved by two physicians and one staff psychiatrist. Full commitment does not take place until the patient has spent at least 60 days under observation in a psychiatric receiving center such as Manhattan's Bellevue Hospital.

Within five days after entering such a center, however, the patient and four of his relatives or friends must be in formed of his right to a jury hearing. Any one of them can then demand it. If the patient is committed, he need no longer fear being held indefinitely with no legal recourse except a writ of habeas corpus. Now his case must be reviewed by a court at intervals of six months, one year, and every two years thereafter. Moreover, the new law provides a fact-finding state mental-health service with trained lawyers and case workers, who will not only tell judges more about patients, but also keep better records for the use of patients themselves. The new setup takes long strides toward putting judges, doctors and patients on something like speaking terms.

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