"Involuntary commitment is a legal institution designed to
facilitate psychiatric treatment."  Lidz, Commitment, *Am J
Psychiatry*, 146:2, February, 1989, p 180

         To me, the spin of shifting the focus from
         medicine to law is an startling way of avoiding
         the discussion of medical ethics.  I hear foot
         soldiers repeating, "Just doing my job."  S.

Conditions Conducive to Perceived Coercion in Mental
Hospital Admission

1.  Patient's belief that he or she is not mentally ill
2.  Motives of others suspect
3.  Force used or threats made
4.  Admission resembles criminal arrest (e.g., handcuffs)
5.  No opportunity to have voice in admission decision
6.  Not treated with respect in admission process
7.  dealt with in bad faith (e.g., deceived)
8.  Inadequate information provided
9.  Decisionmaking seen as unfair
10. Treatment is unsuccessful

John Monahan, Steven K Hoge, Coercion and Commitment:
Understanding Involuntary Mental Hospital Admission,
International Journal of Law and Psychiatry, in press, 
Table 1.

     "Patients tend to employ heavily moralized theories of
coercion.  Patients believe that they should be included as
much as they wish to be in the process of determining
whether they will be admitted to the hospital.  They believe
that those involved in the admission process should be
motivated by an appropriate degree of concern for their
well-being, and they evaluate the legitimacy of involved
persons' actions in light of the motivations they attribute
to them.  Finally, patients believe that others should act
toward them in good faith.  The others should be personally
or professionally qualified to participate in the admission
process, should act without deceit, and should treat the
patient with equality and respect.
     "When the admission process violates these moral norms-
-when the patient is excluded from participation in the
decision about whether he or she should be hospitalized,
when the actions of others appear to be selfishly motivated,
or when others lack the personal or professional
qualifications to intervene, or lie to or disrespect the
patient==coercion may be more likely to be perceived,and
resented.  When these moral norms are adhered to, may
apparently coercive acts seem to be accepted by the patient
as morally legitimate."

Bennet, Inclusion, Motivation, and Good Faith, *Behavioral
Sciences and the Law, Vol. 11, p 305 (1993).

"The most reasonable position appears to be an open
recognition that there are serious threats to civil
liberties posed by a policy of involuntary outpatient
commitment but that little positive treatment can be done
for the casualties of deinstitutionalization without
accepting some element of coercion in the policy strategy. 
In the end, outpatient commitment is worth attempting
because it is a possible way to get us out of the present
quandary of having to decide between the inhumaneness of
institutions and the neglect involved in dumping mental
patients in the community.  The use of an element of
coercion should make us wary of the dangers of this
approach, but the unsuitability of our present options
should push us to design a system that is sensitive to both
the needs and the rights of mental patients."

Mulvey, The Promise and Peril of Involuntary Outpatient
Commitment, *American Psychologist*, June 1987, p 582

Thanks to William Gardner, PhD, Associate Professor of
Psychiatry, for the reprints.