that those involuntarily institutionalized because of
mental illness should enjoy no fewer rights. Before
this, the courts had taken essentially a hands-off
approach to the plight of mental patients. Indeed, the
law can be seen as having applied a medical model to
civil commitment and other issues involving people
with mental illness. These issues were seen as medical
in nature and beyond the ken of the courts.
After the 1960s, this medical model was replaced
by a constitutionally based legal model that focused
on expanding and protecting patients’ rights. Modern
mental health law has been transformed by this legal
model. For many, this was a welcome change indeed.
The medical model granted excessive deference to
physicians, which produced arbitrary and sometimes
unnecessary deprivations of liberty. Mental hospitals
at this time often were little more than human ware-
houses in which treatment was scant or nonexistent.
The legal model of mental health law ushered in
significant reforms. The court severely restricted
the standards for civil and criminal commitment,
expanded procedural due process hearing rights, and
recognized new constitutional rights for patients
involved in various aspects of the mental health and
criminal justice systems.Limits on Civil and
Criminal Commitment
In a 1972 case, the Court found unconstitutional the
indefinite commitment of a mentally retarded criminal
defendant who was incompetent to stand trial. The
Court held that, at a minimum, due process requires
that the nature and duration of an individual’s confine-
ment to a mental hospital must bear a reasonable rela-
tion to the purposes of such commitment. When it is
clear that a criminal defendant committed on the basis
of his incompetence to stand trial will not regain com-
petence in the foreseeable future, his continued com-
mitment on this basis would be impermissible. The
Court also found that the defendant was denied equal
protection because he was subjected to a more lenient
commitment standard and to a more stringent standard
of release than civil patients. Soon thereafter, the
Court extended these rights to those committed fol-
lowing an adjudication of not guilty by reason of
insanity and then to patients subjected to civil com-
mitment. Courts soon used substantive due process to
limit the standards that would justify commitment—
and procedural due process to require greater hearingrights—including the right to counsel and the require-
ment that the state bear the burden of proof by clear
and convincing evidence.Rights Following Commitment
Because mental hospitals were chronically understaffed
and underfunded, mental health lawyers challenged
these institutions as denying patients a constitutional
right to treatment. Some lower courts recognized such a
right to treatment and specified detailed standards and
conditions that hospitals must comply with. The
Supreme Court, however, avoided deciding the issue,
instead recognizing that a patient committed for many
years without treatment was deprived of his constitu-
tional right to liberty. The Court subsequently held that
an individual committed to a mental retardation facility
has a constitutional right to safe conditions of confine-
ment, freedom from unreasonable physical restraint,
and minimally adequate habilitation.The Right to Refuse Treatment
A frequently litigated issue has been the asserted right
of mental patients and prisoners to refuse medication
and other forms of intrusive mental health treatment.
In 1990, the Supreme Court upheld the involuntary
administration of antipsychotic medication to a men-
tally ill prisoner who is dangerous to other inmates and
staff. The Court recognized that the prisoner had a sig-
nificant liberty interest in refusing forced medication
but recognized that the prison’s interest in its adminis-
tration outweighed this liberty interest. The right to
refuse intrusive treatment was given wider scope in
contexts not involving the prison. In cases involving
pretrial detainees rather than sentenced prisoners, the
Court applied a more stringent standard, requiring that
unwanted medication must be justified as medically
appropriate and the least restrictive alternative way of
achieving a compelling governmental interest, such as
the protection of other inmates or staff and the need to
restore a criminal defendant to competence for trial.Constitutional Limits in
the Criminal Process
The Supreme Court has determined that a criminal
defendant may not waive counsel, plead guilty, or
be tried, while incompetent due process requires
determination of the competence question and placesMental Health Law——— 491M-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 491