Opening the Asylums

For nearly 15 years, Kenneth Donaldson had trouble sleeping. "There was the fear," he explains, "always the fear you have in your mind, I suppose, that when you go to sleep maybe someone will jump on you during the night. They never did. But you think about those things. It was a lunatic asylum." The Florida State Hospital was indeed an insane asylum, and Donaldson was committed there by his father as a "paranoid schizophrenic" in 1957. He was a college dropout and a divorced father of three; though he had held regular jobs, he had begun complaining that he was being harassed by unknown people. Since Donaldson was given virtually no psychiatric treatment, he repeatedly sued for his freedom. After his release in 1971, a federal court awarded him $38,500 in damages, and an appeals court unanimously upheld the decision.

Last week, at 67, Donaldson joined the ranks of those whose cases have prompted major Supreme Court decisions. The court unanimously ruled that every mental patient in the U.S. who is held involuntarily has the right to be either treated or released. "A finding of 'mental illness' alone cannot justify a state's locking a person up against his will and keeping him indefinitely in simple custodial confinement," wrote Justice Potter Stewart. The Constitution, he ruled, prohibits forced incarceration of untreated patients "if they are dangerous to no one and can live safely in freedom." In short, a state may not "fence in the harmless mentally ill solely to save its citizens from exposure to those whose ways are different."

What effect will the decision have?

The American Psychiatric Association has reported that "at least 90% of those in state and county mental hospitals are not dangerous to themselves or others." Bruce J. Ennis, a civil liberties lawyer who argued the Donaldson case, adds, "Most of them are just old. They are homeless, penniless, friendless and maybe not too smart." Many will not want to leave and will remain as voluntary patients. In other cases, authorities may now decree that patients are dangerous or simply unable to "live safely in freedom." Still, there will be new pressure to release large numbers, if only because better treatment will be required for those who are kept.

Local Centers. The mental-health system has long been moving toward the release of as many patients as possible. The population in U.S. mental institutions averaged 570,000 in 1957 when Donaldson was committed, but the number is now down to just over 200,000. One reason is the development of powerful tranquilizers like Thorazine, which make outpatient treatment more feasible. The second is an increasing belief that institutionalization is harmful to mental patients. The third is the soaring cost of medical care. Now, says Dr. Bertram Brown, director of the National Institute of Mental Health, "we are moving away from the large state or county facility and going to the concept of the community health center." With the help of federal funds, 500 such centers have been built in the last decade and another 100 privately supported ones have been funded. That is only about half the number needed, but it is a start. One major obstacle to this program: the prejudice in many communities against former asylum inmates.

For all the importance of the Donaldson decision, the court conceded that it was merely starting its work on the rights of mental patients. Left to future cases were such matters as what constitutes adequate treatment and what are fair standards for commitment. "Mainly," Kenneth Donaldson declared last week, "my disease was that I refused to admit that I was ill. From what I've seen and heard, that is the worst disease you can have--refusing to admit that you have a disease."

In its rush to close for the summer, the court last week also:

> Ruled unanimously that victims of discrimination in hiring or promotion can get back pay without proving bad faith on the part of the employer.

> Barred, 5 to 4, a suit attacking zoning in a suburb of Rochester, N.Y., for allegedly discriminating against the poor. The court ruled that none of the plaintiffs, including residents of the suburb and slum dwellers who claimed they had been excluded, had been sufficiently harmed to have standing to bring suit.

> Permitted, 6 to 3, drive-in theaters to show nonpornographic movies that include nudity, no matter what the distraction to drivers on nearby roads.

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