Involuntary medication and the case of Joyce Brown

In October 1987, Joyce Brown became the first homeless person removed from New York City's streets and hospitalized under a city initiative that authorized evaluation of "gravely disabled" homeless persons for admission to inpatient psychiatric treatment. Miss Brown's highly publicized and ultimately successful court battle to prevent a course of forced medication is described. Her refusal of medication was upheld based on her capacity to understand the proposed treatment and to express a partially rational opinion about it. The author, who served as independent psychiatric consultant to the court on the decision about Miss Brown's involuntary medication, uses the case to illustrate some of the problems of involuntary psychiatric intervention, including the commitment of competent patients and the lack of a coherent approach to persistent treatment refusal.