[The involuntary hospitalized psychiatric patient, present-but-missing].

The Israeli Treatment of Mental Patient Law of 1991 reflects an innovative approach which promotes the use of compelled treatment order in the community as the least restrictive environment alternative for involuntary psychiatric hospitalization. This law grants the Regional Psychiatric Committees with authorities regarding the involuntary placement of such patients by court. The proportion of court order induced involuntary psychiatric hospitalizations among the total psychiatric hospitalizations is increasing with time. The 2004 Correction to the Act, clause 29a, states that a psychiatric patient may be represented in the Regional Psychiatric Committee by a legal advocate, and settles the options to materialize this right. The 2004 Correction is not yet applied in all regions in Israel. The Committees do not usually promote compelled treatment in outpatient clinics as a follow-up or an alternative for involuntary psychiatric hospitalizations. Involuntary hospitalizations by court order bear no time limits despite a former decision of the Israeli High Court of Justice. The lack of an obligatory legal representation for the psychiatric patient further ensures that the option of compelled treatment in outpatient clinics is not satisfactorily considered. In our opinion, the current reality of involuntary hospitalization orders that bear no time limits; the underuse of the compelled out patient clinic treatment option; and the lack of obligatory legal representation for the patients, results in an inappropriate application of the treatment policy of least restrictive environment. The patient is often regarded as present-but-missing. The awareness to patients' human rights in the Israeli psychiatric system must be emphasized, and suitable resources should be allocated to promote the option of treatment and rehabilitation in the community as the least restrictive option. However, if patients' rights are not appropriately kept, public safety may well be compromised, as well as patients' rights.