[Carrying out the compulsory orders in psychiatry].

The way a modern society frames its Mental Health Act, especially the clauses pertaining to the compulsory management of those suffering from mental illness, reflects the manner in which it resolves the inherent conflict between the individual's right for personal liberty and dignity and the society's right for safety. The authors review legislation regarding compulsory examination and involuntary hospitalization of individuals suffering from mental illness, of 8 Western countries. The review focuses on both the criteria allowing such compulsory management and the rules that determine how these laws are enforced. In Israel, a Mental Health Act was first enacted in 1955 and then revised in 1991. Both Acts contain clauses establishing the necessary and sufficient conditions for compulsory examination or involuntary hospitalization of persons under emergency or non-emergency circumstances. By requiring more stringent criteria for involuntary confinement, compared with the early Act of 1955, the 1991 Act begins a trend of favoring the individual's rights. Later, as the review reveals, judges in Israel have continued this trend by requiring greater proof of dangerousness and by allowing more room for appeals. To examine issues pertaining to the mechanisms by which compulsory management of persons under the Mental Health Act is carried out, the authors present a retrospective survey on 170 cases of compulsory management, both compulsory examination and involuntary hospitalization, in a three month period in 2005. The results indicate that in 48.3% of cases the orders were carried out after one visit, 71.7% of the cases ended in involuntary hospitalization. Regarding the individuals' response to involuntary confinement, the findings indicate that 43% willfully complied while 7.2% vigorously or violently objected requiring the intervention of the police.