Mental patients' rights: An empirical study of variation across the United States

Abstract

Numerous theoretical accounts have emerged in recent years to explain the changes that have occurred in the provision of services in the area of welfare and human services. In discussions of the deinstitutionalization of mental patients, for example (Brown, 1985); and the “decriminalization of public drunkenness” (Fagan & Mauss, 1978), rival accounts differ sharply: some see the changes coming about as the result of humanitarian concerns, while others believe that the changes result from institutional concerns with reducing the costs of providing welfare services. This divergence of opinion is also evident in different accounts of the development of mental patients’ rights. Many professionals and administrators in the mental health system, as well as a number of social science, psychiatric, and legal researchers, have interpreted the concern for patients’ rights as a humanitarian concern (Ennis & Emery, 1978). On the other hand, political and economic analysts tend to interpret patients’ rights either as a response to the “fiscal crisis” of the state (Scull, 1977), or to a combination of social, political, institutional, and economic forces (Brown, 1981; C. Smith, 1983). It is plausible, for example, that the provision of patients’ rights is simply a part of the overall logic and process of deinstitutionalization (Smith & Hanham, 1981). An alternative explanation is that provisions made for patients’ rights are related to the prevalence of social problems and each state’s commitment to social reform and the provision of welfare services. The existing research in this area can only provide the most general clues about why variations in patients’ rights might occur. Much of the research has been in the form of general theoretical statements, with some policy studies conducted in either individual states (Bardach, 1972; Warren, 1984) or one specific hospital (Zeigenfuss, 1983). Nationwide data on mental patients’ rights is available (Beis, 1983; Lyon, Levine, & Zusman, 1982) but beyond the simple enumeration of each state’s progress in moving toward patients’ rights, no