[Involuntary hospitalization and treatment: the interface between psychiatry and law].

Involuntary or compulsory hospitalization and treatment of mentally ill patients is one of the most distressing societal needs. The decision to hospitalize or treat an individual involuntarily must balance between three ethical issues: the patient's right to receive medical care, the patient's personal rights to liberty and dignity, and the protection of the public. The psychiatrist is concerned with the need for medical treatment, while the courts follow the letter of the law in order to ensure protection of the individual's rights, as well as those of the public. The interaction between the psychiatric (or medical) discipline and the judicial discipline comprises inherent difficulties, due to these differences in focus of concern and due to the differences in the language they use. In the civil compulsory hospitalization, it is the definition and prediction of dangerousness that comprises a potential discourse and misunderstanding between the psychiatric and the judicial system. It seems that both systems, as well as the patients, may benefit if the initial decision to hospitalize involuntarily is taken by the medical representatives (the District Psychiatrist, Hospital Director, three physicians, etc.) as an emergency procedure. The decision to continue the involuntary hospitalization should be taken by a judicial representative (or a committee), based on the psychiatric evaluation, within 72 hours instead of the 14 days as is currently stated in the Mental Health Law. The less restrictive alternative to hospitalization, compulsory outpatient treatment, is still controversial. This is an order "with no bite" and its implementation is determined, in effect, by the patient's goodwill and cooperation. There are no legal or other consequences for patients who do not comply with the outpatient treatment order. This is true for both civil and criminal outpatient orders. Without legal sanctions this model of outpatient treatment is not really "compulsory" and does not achieve its preventive goals.