Opinion ID: 110113
Heading Depth: 1
Heading Rank: 1

Heading: rights of children committed to mental institutions

Text: Commitment to a mental institution necessarily entails a massive curtailment of liberty, Humphrey v. Cady, 405 U. S. 504, 509 (1972), and inevitably affects fundamental rights. Baxstrom v. Herald, 383 U. S. 107, 113 (1966). Persons incarcerated in mental hospitals are not only deprived of their physical liberty, they are also deprived of friends, family, and community. Institutionalized mental patients must live in unnatural surroundings under the continuous and detailed control of strangers. They are subject to intrusive treatment which, especially if unwarranted, may violate their right to bodily integrity. Such treatment modalities may include forced administration of psychotropic medication, [1] aversive conditioning, [2] convulsive therapy, [3] and even psychosurgery. [4] Furthermore, as the Court recognizes, see ante, at 600, persons confined in mental institutions are stigmatized as sick and abnormal during confinement and, in some cases, even after release. [5] Because of these considerations, our cases have made clear that commitment to a mental hospital is a deprivation of liberty which the State cannot accomplish without due process of law. O'Connor v. Donaldson, 422 U. S. 563, 580 (1975) (BURGER, C. J., concurring). See, e. g., McNeil v. Director, Patuxent Institution, 407 U. S. 245 (1972) (defective delinquent commitment following expiration of prison term); Specht v. Patterson, 386 U. S. 605 (1967) (sex offender commitment following criminal conviction); Chaloner v. Sherman, 242 U. S. 455, 461 (1917) (incompetence inquiry). In the absence of a voluntary, knowing, and intelligent waiver, adults facing commitment to mental institutions are entitled to full and fair adversary hearings in which the necessity for their commitment is established to the satisfaction of a neutral tribunal. At such hearings they must be accorded the right to be present with counsel, have an opportunity to be heard, be confronted with witnesses against [them], have the right to cross-examine, and to offer evidence of [their] own. Specht v. Patterson, supra, at 610. These principles also govern the commitment of children. Constitutional rights do not mature and come into being magically only when one attains the state-defined age of majority. Minors, as well as adults, are protected by the Constitution and possess constitutional rights. See, e. g., Breed v. Jones, 421 U. S. 519 (1975); Goss v. Lopez, 419 U. S. 565 (1975); Tinker v. Des Moines School Dist., 393 U. S. 503 (1969); In re Gault, 387 U. S. 1 (1967). Planned Parenthood of Central Missouri v. Danforth, 428 U. S. 52, 74 (1976). Indeed, it may well be argued that children are entitled to more protection than are adults. The consequences of an erroneous commitment decision are more tragic where children are involved. Children, on the average, are confined for longer periods than are adults. [6] Moreover, childhood is a particularly vulnerable time of life [7] and children erroneously institutionalized during their formative years may bear the scars for the rest of their lives. [8] Furthermore, the provision of satisfactory institutionalized mental care for children generally requires a substantial financial commitment [9] that too often has not been forthcoming. [10] Decisions of the lower courts have chronicled the inadequacies of existing mental health facilities for children. See, e. g., New York State Assn. for Retarded Children v. Rockefeller, 357 F. Supp. 752, 756 (EDNY 1973) (conditions at Willowbrook School for the Mentally Retarded are inhumane, involving failure to protect the physical safety of [the] children, substantial personnel shortage, and poor and hazardous conditions); Wyatt v. Stickney, 344 F. Supp. 387, 391 (MD Ala. 1972), aff'd sub nom. Wyatt v. Aderholt, 503 F. 2d 1305 (CA5 1974) (grossly substandard conditions at Partlow School for the Mentally Retarded lead to hazardous and deplorable inadequacies in the institution's operation). [11] In addition, the chances of an erroneous commitment decision are particularly great where children are involved. Even under the best of circumstances psychiatric diagnosis and therapy decisions are fraught with uncertainties. See O'Connor v. Donaldson, supra, at 584 (BURGER, C. J., concurring). These uncertainties are aggravated when, as under the Georgia practice, the psychiatrist interviews the child during a period of abnormal stress in connection with the commitment, and without adequate time or opportunity to become acquainted with the patient. [12] These uncertainties may be further aggravated when economic and social class separate doctor and child, thereby frustrating the accurate diagnosis of pathology. [13] These compounded uncertainties often lead to erroneous commitments since psychiatrists tend to err on the side of medical caution and therefore hospitalize patients for whom other dispositions would be more beneficial. [14] The National Institute of Mental Health recently found that only 36% of patients below age 20 who were confined at St. Elizabeths Hospital actually required such hospitalization. [15] Of particular relevance to this case, a Georgia study Commission on Mental Health Services for Children and Youth concluded that more than half of the State's institutionalized children were not in need of confinement if other forms of care were made available or used. Cited in J. L. v. Parham, 412 F. Supp. 112, 122 (MD Ga. 1976).