Least Restrictive Alternative Doctrine 173Literature Review
The legal basis for the LRA doctrine is rooted in First Amendment rights. The First
Amendment states that the state may only impose on individual liberty to the extent
that it is necessary to ensure state interests (Melton et al., 1987). Thus, since civilly
committing individuals is a significant imposition on individual liberty, the argument
posed by the LRA doctrine is that the state may only commit persons to the extent
that it is absolutely necessary to protect the individual, the community, and provide
treatment (Melton et al., 1987), Therefore, if release to the care of family or friends,
community outpatient services, or a stay in a supervised community facility are
all that is necessary to effectively treat an individual and protect state interests, this
form of release becomes a less restrictive alternative than hospitalization, and is in
the best interest of individual liberty. In such cases, commitment to a state hospital
would arguably be unconstitutional.
The first case to apply the LRA concept to mental health (the commitment
process) was Lake v, Cameron (1966). In this case an elderly demented woman op-
posed her commitment to a hospital. Though disoriented and prone to wandering,
her danger was not significant enough that it demanded confinement in a locked
psychiatric facility. Thus, while supervision may have been necessary for Ms, Lake,
involuntary confinement in a hospital was clearly unnecessary (Munetz & Geller,
1993). Judge Bazelon wrote that "deprivations of liberty solely because of dan-
gers to the ill persons themselves should not go beyond what is necessary for their
protection" and that ".. .an earnest effort should be made to review and exhaust
available resources of the community in order to provide care reasonably suited to
[Ms. Lake's] needs" (Lake v. Cameron, 1966, p. 657). Such efforts are the duty of the
court when deprivation of liberty is at stake. The court implied this by staring that it
had an "affirmative duty to explore alternatives to hospitalization before committing
Lake to an institution" (Melton et al., 1987, p. 224). Thus, the concept of "least
restrictive alternative" should be employed in situations involving commitment for
mental health reasons.
After the Lake v. Cameron decision, a number of states began to implement the
concept of Least Restrictive Alternative into their commitment laws. By 1977,
two-thirds of the states incorporated it, in some way, into their laws (Hoffman &
Faust, 1977). Shortly after the Hoffman and Faust study, the President's Commission
on Mental Health (1978) stated that the concept of LRA concerns the "objective of
maintaining the greatest degree of freedom, self-determination, autonomy, dignity,
and integrity of body, mind, and spirit for the individual while he or she participates
in treatment or receives services" (Munetz & Geller, 1993, p. 967). Thus, by the
late 1970s the LRA was a significant national concern. And by the early 1990s, the
mental health laws and policies of nearly every state included the concept (Munetz
and Geller. 1993).
Perhaps the most fundamental and disputed matter with regard to LRA centers
upon the question "what is restrictive?" According to Bachrach (1980). several