Treatment Delayed is Treatment Denied

The past few decades have witnessed the steady development of a mental health jurisprudence dedicated to the preservation of human rights. Self-determination and personal autonomy are critical aspects of this perspective, pervading every facet of institutional psychiatric care. Of considerable concern, however, are those cases in which rote procedural approaches produce unintended consequences for the very persons such maneuvers were designed to protect. Delays-inherent in court-based procedures-may ironically lead to an acute illness becoming chronic, and to a single bout of inpatient services being transformed into a lifetime of revolving-door psychiatric admissions. This discussion is not about lawyers or lawyering; rather, it is about the proposition that a better system can and should be devised for advocates who must make do with the options they are dealt. A particularly problematic example is the "Rogers Guardianship" model currently prevalent in Massachusetts. Laws that effectively place on counsel and courts the challenge of second-guessing medical treatment decisions-with minimal latitude for counsel to exercise measured professional judgment-will inevitably generate, and empirically do generate, a degree of delay that ironically deprives patients of the liberation from illness that is the common goal of all stakeholders. Possible solutions to these difficulties are also suggested.