The "least restrictive environment": from rhetoric to practice.

During the past 10 years, more and more general hospitals have opened psychiatric units, many of which represent the best of modern hospital psychiatry. Therapeutic success on these units is based on control of admissions as well as on clinical programs. Pressure from the State to admit involuntary patients, recently justified by the doctrine of the "least restrictive environment," threatens to erode the quality of treatment now being provided. The concept of "least restrictive environment" is ambiguous and sometimes misleading. The treatment of involuntary psychiatric patients in general hospitals, in order to be safe and effective, requires the resolution of legal, clinical, financial, and architectural issues, as well as problems in the relationship between psychiatric units and other areas of the general hospital.