Civil commitment reform: context and consequences

Laws and policies governing the care and treatment of the mentally ill are in part shaped by the sociopolitical climate in which they are formulated, and their outcomes are similarly shaped by the context in which they occur. Civil commitment laws were narrowed in a liberal era but later broadened in response both to the outcome of the initial reform and the trend toward social and fiscal conservatism which emerged in the late 1970s and 1980s. This study, which reports on the evolution of commitment law in the state of Washington, indicates that while recent changes in these laws mandate greater use of state hospitals, the retention of the procedural safeguards set in place by the initial reform coupled with limitations on resources available to state mental health systems will prevent a return to the state hospital as it appeared prior to the deinstitutionalization movement. These factors may promote the search for non-institutional alternatives, such as efforts underway in Washington and elsewhere to implement civil commitment of community-based services.