Abstract

England’s New Commitment LawPaul S. Appelbaum,steadfasdy clung to a system based on treatment needs-rather than on dangerousness-that continuesto iodge substantial discretion in family members and psychiatrists. The 1983 act permits involuntary. hospitalization on the applicatior, tive of the patient’s or an approved Commitment nearest relasocial workerM.D.laws gov-In the last 1 5 years, erning commitmentof the mental-ly ill in the United States have been based on two bedrock principies: involuntary hospitalizationpeal their commitments to informal mental health review tribunals, but unless the patient took the initiative, indefinite commitment was possible simply on medical authorization. Patients had no right to representation at hearings andno possibility of further appeal.and the authorizationcians.for the purposeof two physican be either of assessment, fora maximum of 28 days, or of treatmerit, for a maximum of six months. Emergency commitment for up to 72 hours is available inshould be limited to patients who are dangerous to themselves or others, and procedural safeguards in the commitment process shouldresemble as closely as possibleof “tirgentnecessity.”meet two criteriathose found in criminal law (1). Neither differences among the states in application of nor occasional efforts to liberalize commitment criteria and procedures (2) have seriously challenged the dominance of these guiding principles.Inpatients