Doubts about the reality of mental illness and the benefits of psychiatric treatment helped foment a revolution in the law's attitude toward mental disorders over the last 25 years. Legal reformers pushed for laws to make it more difficult to hospitalize and treat people with mental illness, and easier to punish them when they committed criminal acts. Advocates of reform promised vast changes in how our society deals with the mentally ill; opponents warily predicted chaos and mass suffering. Now, with the tide of reform ebbing, Paul Appelbaum examines what these changes have wrought. The message emerging from his careful review is a surprising one: less has changed than almost anyone predicted. When the law gets in the way of commonsense beliefs about the need to treat serious mental illness, it is often put aside. Judges, lawyers, mental health professionals, family members, and the general public collaborate in fashioning an extra-legal process to accomplish what they think is fair for persons with mental illness. Appelbaum demonstrates this thesis in analyses of four of the most important reforms in mental health law over the past two decades: involuntary hospitalization, liability of professionals for violent acts committed by their patients, the right to refuse treatment, and the insanity defense. This timely and important work will inform and enlighten the debate about mental health law and its implications and consequences. The book will be essential for psychiatrists and other mental health professionals, lawyers, and all those concerned with our policies toward people with mental illness.

1. Setting the Stage for Reform 2. Involuntary Commitment of the Mentally Ill: Civil Liberties and Common Sense 3. Duty to Protect Potential Victims of Patients' Violence: Public Peril vs. Protective Privilege 4. Right to Refuse Treatment with Medication: Consent, Coercion, and the Courts 5. The Insanity Defense: Moral Blameworthiness and Criminal Punishment 6. The Consequences of Reform in Mental Health Law

Paul S. AppelbaumArnold Frank Zeleznik Distinguished Professor and Chair, Department of Psychiatry; and Director, Law and Psychiatry Program, University of Massachusetts Medical Center

"I have always thought of Dr. Appelbaum as a scholar and a wise man. His latest contribution only reinforces my opinion. To understand and explain the past 25 years of mental health law, the author has reviewed the revolution in the field from the perspective of research studies and on the basis of his own practical knowledge gleaned from working at the interface between the clinic and the court. He has brought to this knowledge his own marvelous capacity to place things into perspective....As usual, Dr. Appelbaum's thinking, writing, and logic are remarkably consistent and lead clearly to his conclusions....I commend him and recommend this book to anyone interested in this cross-disciplinary field. I am sure I will use this book repeatedly in my teaching and practice over the years and will loan it to students and colleagues; I only hope they remember to return it."--The New England Journal of Medicine |k No