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Mental Health Commitment History

May 16, 1996
By: Angie Gaddy
State Capital Bureau
See the main story.

The problems which the McBride Commission recommendations seek to address have been building for the past years - since 1978.

Before 1978, people could be committed indefinitely by a judge with the signature of two doctors, says Lyn Turner, director of admissions, discharge and transfers for Missouri Department of Mental Health.

"The system had no due process," Turner says. "It was based on a need for treatment. There was no review board. Basically a person had no rights."

But with a flood of cases throughout the United States, civil commitment law began to change. A series of federal and district court cases began the wave of deinstutionalization and a change in civil commitment laws. Missouri followed the trend.

In a 1975 case, O'Connor vs. Donaldson, the Supreme Court ruled that states cannot constitutionally confine a person who is not dangerous and who can live on their own or with the help of others.

Missouri followed the national trend of treating people in what was known as "the least restrictive environment." That usually meant turning people away from hospitals and mental health facilities.

In 1978, Missouri law set up certain criteria to try to balance a person's rights with the ability to get services. Missouri lawmakers decided its courts couldn't commit someone just because they needed treatment. There had to be a physical threat or harm caused by mental illness before institutionalizing someone and there had to be a need for treatment.

Missouri's mental health law was tinkered with a bit in 1980. The Mental Health Department was given more authority and its powers were broadened. Since then, the laws on civilly committing someone haven't changed.

"In the state's eyes, there should be no reason for the state to take away a person's rights," Turner says. "If it's an illness, you can't take their rights away."

Medication developed in the 1950s had made it more practical to consider releasing patients who previously would have spent most their lives in institutions.

Drugs like Thorazine, which treated many schizophrenic symptoms, were hailed as miracle drugs that almost would make mental hospitals obsolete.

As result, institutions began dumping people who once had been determined unsavory back onto the streets.

But a major problem emerged. The serious sides of the drugs - lack of energy and muscle twitches - caused some to skip their drugs. For some, skipped medication led to renewed mental illness problems include paranoia about the medication itself.

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