title: Legal issues in maximum security institutions for people with mental illness: liberty, security, and administrative discretion.
abstract: This article explores four legal issues relevant to the provision of care in secure hospitals. These include the current status of right to treatment litigation; the potential impact of the Americans with Disabilities Act; new developments in laws governing restraint and seclusion; and the need for uniform institutional policies on risk assessment. These issues illustrate the potential conflicts between individual autonomy and institutional control that have been at the heart of mental health law for three decades. The article suggests that because of the diminishing oversight provided by the federal judiciary, institutional custodians have a particular obligation to ensure that individual rights are not overwhelmed by concerns with security.
authors.affiliation: Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, FL 33617, USA. petrila@mirage.fmhi.usf.edu
authors.forename: John
authors.initials: J
authors.lastname: Petrila
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Douglas
mesh_terms: D004991:Ethics, Institutional; D005555:Forensic Psychiatry / Q000331:legislation & jurisprudence*; D005610:Freedom; D006778:Hospitals, Psychiatric / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation; D008605:Mental Health Services / Q000331:legislation & jurisprudence / Q000458:organization & administration; D028642:Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D028701:Patient Rights / Q000331:legislation & jurisprudence; D026684:Personal Autonomy; D011329:Prisoners / Q000331:legislation & jurisprudence / Q000523:psychology; D011330:Prisons / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D012149:Restraint, Physical / Q000331:legislation & jurisprudence; D012637:Security Measures / Q000331:legislation & jurisprudence; D014481:United States