Liberty versus Need — Our Struggle to Care for People with Serious Mental Illness

Abstract

In 1985, when internist Jim O’Connell, cofounder of the Boston Health Care for the Homeless Program,¹ began doing outreach to homeless people, one of the toughest questions he faced was whether to commit someone to the hospital for involuntary psychiatric treatment. States vary in their criteria for involuntary commitment: some permit consideration of psychiatric need, whereas others allow such infringement of civil liberties only if one is believed to pose an immediate physical danger to self or others. Nevertheless, the application of legal criteria to the unique circumstances of someone’s life requires subjective interpretation. So despite 30 years of navigating this tension between liberty and need, O’Connell remains conflicted about when commitment is appropriate. “I’ve never found a comfort zone,” he explained to me. “I’ve only had experiences that are bad and experiences that are good.”