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The Death of the Least Restrictive Alternative

Dennis Feld, J.D. and Kim Darrow, J.D., Mental Hygiene Legal Services

Those who operate the psychiatric system have long paid lip service to the principle of "least restrictive alternative." But any pretense of actually putting that tenet into practice has been abandoned by the psychiatric establishment, which has embraced coercion with a vengeance. In New York, for example, open wards are a relic of the past and even "voluntary" patients are placed under lock and key. State hospitals now resemble medium security prisons. Exercising the "right" to refuse drugs or electroshock often sends hospital administrators scurrying to court requesting forced treatment orders. Outpatient commitment orders routinely give "mental health" bureaucrats pervasive control over most aspects of peoplešs lives, from housing to work to use of leisure time. In practice, the operative principle has become "most restrictive alternative." Nevertheless, the principle of the least restrictive alternative is still an important component of most areas of mental health law, and this workshop will explore strategies for reasserting this principle.