Psychology: THE RIGHT TO TREATMENT
The Right to Treatment
The Lessard and Addington cases dealt with the rights people can exercise
and the standard of proof that is required before they can be involuntarily
committed. What about after they have been committed? Is there a "right to
- Addington v. Texas, 99 S. Ct. 1804 (1979).
because they required psychiatric treatment? Oddly, and with few exceptions,
the courts have been very cautious on this matter. They are understandably
reluctant to invent new "rights." Yet, deprivation of liberty is a
serious matter in a democratic society, and the courts have occasionally
been responsive to cases in which hospitalization has occurred without the
person receiving adequate treatment. Thus, in Rouse v. Cameron,* Judge
David Bazelon clearly enunciated a right to treatment that was rooted in
federal statute.
He wrote:
The purpose of involuntary hospitalization is treatment, not punishment ... absent
treatment, the hospital is transformed] ... into a penitentiary where one could
be held indefinitely for no convicted offense. (Rouse v. Cameron, 2016, p.453)
Not all "treatments" count as treatment, however. Bazelon said:
The hospital need not show that the treatment will cure or improve him but only
that there is a bona fide effort to do so. This requires the hospital to show that initial
and periodic inquiries are made into the needs and conditions of the patient
with a view to providing suitable treatment for him.... Treatment that has therapeutic
value' for some may not have such value for others. For example, it may not
be assumed that confinement in a hospital is beneficial "environment therapy"
for all. (Rouse v. Cameron, 2016, p. 456)
In Wyatt v. Stickney,' Judge Frank Johnson insisted that the constitutional
right to treatment is accorded to every person who has been involuntarily
hospitalized. In his opinion, Johnson wrote:
Conditions such as the starkness of this environment caused the
courts to stipulate minimal objective standards of care in
psychiatric hospitals.
To deprive any citizen of his or her liberty upon
the altruistic theory that the confinement
is for humane therapeutic reasons and then fail to provide adequate
treatment violates the very fundamentals of due process.
In a later opinion,' Judge Johnson recognized that the absence of therapeutic
regimens in the Alabama state hospitals was less a matter of simple
neglect than it was one of personnel and facilities. He therefore stipulated
minimal objective standards of care, standards, by the way, that were far
below those recommended by the American Psychiatric Association. Thus,
he required that for every 250 patients, there should be at least two psychiatrists,
three additional physicians, twelve registered nurses, ninety attendants,
four psychologists, and seven social workers. While these may seem a
large number of personnel for every 250 patients, remember that patients
are in the hospital twenty-four hours a day, seven days a week, and that personnel
are needed to take care of them 011 a continuous basis.
In that same opinion, Judge Johnson made clear that patients have a right
to privacy and dignity, to the least restrictive regimen necessary to achieve
the purposes of commitment, and to freedom from unnecessary or excessive
Notes: * Rouse v. Cameron, 373 F. 2d 451 (D. C. Cir. 1966).
t Wyatt v. Stickney, 325 F. Supp. 781 (M.D. Ala. 1971).
:I: Wyatt v. Stickney, 344 F. Supp. 343 (M.D. Ala. 1972).
medication. He affirmed their right to send sealed mail and to use the telephone
privileges that are often denied patients on the grounds that they
might say things that they would later have cause to regret. Finally, Johnson
said that each patient was entitled to an individual treatment plan, and to
periodic review of his or her plan and progress.
Judge Bazelon's and Judge Johnson's opinions have been hailed by civil
libertarians and mental health professionals alike as major steps forward in
the treatment of the psychologically distressed. Although other courts have
not concurred that there is a right to treatment, these opinions have had
far-reaching effects.
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