What if you knew there were thousands of people with severe mental illness who couldn't get treatment unless a court ordered it?

Often those who oppose involuntary treatment argue that it violates the civil rights of people who have mental illness. But those who favor it make the argument that by not ordering involuntary commitments in some cases, the state is denying them their inalienable rights to life, liberty and pursuit of happiness. Proponents of involuntary commitments say the symptoms of mental illness can deprive some individuals the free will necessary to even enjoy such rights.

Of the estimated 50 million Americans with a mental disorder, about 5 percent suffer from severe illnesses. But nearly half of those individuals don't get help, often because of prevailing stigmas against people with mental illness, but also because of limited access to quality services. Many believe antiquated involuntary treatment laws are thwarting states' abilities to properly serve those most in need of treatment.

Some state legislators responsible for old laws limiting involuntary treatment regret the unintended consequences. For example, former Senator Frank Lanterman lamented the 1960s California legislation he helped pass, which aimed to correct a half-century of inappropriate lifetime commitments in state hospitals for people with mental illness. The Lanterman-Petris-Short Act established that only those perceived as a danger to themselves or others could be subjected to involuntary mental health treatment. Years later, however, some believe it kept many people with serious mental illness (but who didn't fit the law's criteria) from getting the care they needed.

"For nearly five years I have worked as a family advocate for a county department of mental health. The calls I get from family members go like this: 'My family member is ill but doesn't think she is. What can I do?' I have to tell them, essentially, unless they are violent, there is nothing. I hope you will interject some common sense into the involuntary commitment laws and put me out of a job." -- Camille Callahan, family advocate

"I wanted the LPS Act to help the mentally ill," said Lanterman, before his death in 1981. "I never meant for it to prevent those who need care from receiving it."

In the 1960s, Lanterman and other states' policy makers witnessed the release of thousands of mental health patients from state hospitals. As facilities began to empty out their populations, policy makers envisioned services in the community would replace what state-run hospitals had provided in an institutional setting. Yet most agree that those adequate community services never materialized and that in an attempt to protect the civil rights of people who have mental illness, the pendulum swung to the other extreme -- resulting in a generation in need of treatment neglected and ignored.

"In many ways, we've gone from the 'locked cage' to the 'revolving door,' still leaving the vulnerable of our society poorly served in any meaningful sense ... It's very frustrating. Then the family complains that the patient wasn't kept in the hospital long enough. They typically will make that complaint to me: 'You sent that patient over there and he wasn't kept but three days and he's back out and he's gonna be off his medications in a week. Why didn't you make him stay there longer?' Well, that is beyond my power under the law." -- Bibb County, Florida, Probate Judge Bill Self, quoted in the Macon Telegraph, Jan. 30 2002