91172.pdf

174 / Court and the Legal System—Civil Forensics

assumptions are employed when considering "restrictive" in individual cases. First,

that certain environments (e.g., hospital, halfway house, etc.) are inherently good

or bad regardless of the individual in question. Second, that there is a correlation

between the quality of restrictiveness and the class of the facility in question. The last

assumption identified by Bachrach and, perhaps more of a summary of the first two,

is that a continuum exists in which a hospital is the most restrictive environment

and living in the home would be the least restrictive. This final assumption places

importance on the type of facility rather than those within a specific type. In other

words, there is an assumption, for example, that all hospitals are more restrictive

than all halfway houses. According to Bachrach, this is a false assumption. In reality,

it is entirely possible that what is commonly regarded as a more restrictive type

of residential facility may, in fact, be less restrictive than a poorer quality facility

that is of a lesser presumed restrictiveness. Thus, the type of facility appears to

be of less significance than the individuals' needs and the quality of the particular

facility.

Several proposals have been made with regard to what determines the restrictive-

ness of a given residential facility. Perhaps the most informative is that of Carpenter

(1978), who notes that, in addition to the type of facility, we should consider the

location, staffing, specific programs, treatment provided, patient mix, emphasis on reha-

bilitation, degree of expectations of patients' performance, degree of autonomy granted

to patients, extraresidential programs for patients, limitations on length of stay, and the

facility's track record of success and its specified and unspecified goals. (Munetz & Geller,

199.3. p. 969).

With each of these variables, as well as others, equally contributing to the level of
restrictiveness, it is easy to understand how a given type of institution may be only
one consideration. Thus, a more restrictive type of facility (e.g., state hospital) that
ranks high on several of these variables, may in fact be less restrictive than a facility
that is presumed to be less restrictive (e.g., halfway house) that ranks low on many
of the aforementioned variables.
As mentioned earlier, one of the commonly used alternatives to hospitalization
is commitment to outpatient treatment. A considerable amount of clinical research
has addressed the issue of outpatient commitment since the late 1980s and sev-
eral attempts to establish clinical guidelines have followed (R. Miller, 1992). The
problem, however, is that no standard definition or consensus among states exist,
outlining what practices are consistent with involuntary outpatient commitment
(Arngo, 1993).
Proponents of involuntary outpatient commitment argue that mentally ill persons
benefit from such practices as their freedom and autonomy increase. For a majority
of the time, they are not subject to the impositions that may be present in hospitals.
At the same time, some structure remains. The mentally ill enjoy the benefits
of hospitalization (i.e., treatment, rehabilitation) while their lives are not being
governed to the extent that they would in an inpatient facility.