The rising tide of patients' rights advocacy.

Abstract

Mental health professionals appear to be on the verge of having to cope with the introduction of an- other set ofparticipants in the din- ical decision-making process. The patients' rights advocate, hereto- fore an inconsistent feature of the mental health system, may soon become as common a fixture in inpatient settings as any current member of the clinical treatment team. Regardless of one's views of the desirability of such a step, seri- ous thought must be given to the effects of an increasing number of patients' rights advocates in the mental health arena. Advocacy programs, of course, states may soon have mandatory programs for patients' rights advo- cacy established independently of the mental health system. These mandatory programs will replace the voluntary, often internally di- rected programs some states or facilities have today. Second, the current fragmented system of advocacy programs promises to become generalized to entire states and to span both the public and the private sectors. Two arms of government-the judicial and the legislative branches-are pushing in the direction of ubiqui- tous advocacy programs. The ef- forts of the judiciary pose more interesting questions of constitu- tional theory, but Congress has the potential for greater ultimate im- pact on the system. The role that the courts may play in bringing about advocacy systems is demonstrated by the situation in a Maryland case as of this writing. The plaintiffs in the case, Coe v. Hughes (4), sued the state in 1983, alleging that the rights of hospitalized patients were being infringed because of the unavailability of legal services for those who could not afford private attorneys. Legal precedent for this claim derived primarily from the criminal sphere-the U.S. Su- preme Court had required prison authorities to provide inmates with legal assistance sufficient to permit the preparation of court papers related to inmates' assertions of fundamental constitutional rights