Attitudes towards the rights of mental patients : A national survey in the United States

Recent changes in mental health policy and treatment have largely been attributed to a professional concern for patients' rights. This view is challenged by patients' rights organizations and their allies, such as legal advocacy groups. These parties argue that psychiatric planners and providers are trying to coopt a popular movement and to use patients' rights as a convenient explanation for the mental health system's limited self-reform and fiscal limitations. A key issue here is the gap between planned policy and implemented practice. Patients' rights activists maintain that rights are only very sparsely implemented, while the mental health system believes that it has progressed quite far. A study of patients' rights attitudes held by the various involved forces can illuminate the conflicts in patients' rights policy and provide understanding of the potential for resolving these conflicts. Such an analysis also touches on some general themes concerning the relationships between health providers and social movements in the health field. This paper examines attitudes towards mental patients' rights on the part of mental patients rights groups, state departments of mental health, state hospitals and statewide mental health associations. One hypothesis was borne out: that patients' rights groups do not believe as much as does the mental health establishment that concern for patients' rights has played a large role in mental health policy. Further, the activist groups are more favorable than are the other respondents to abolition or sharp curtailment of intrusive psychiatric treatments. And, mental health officials and their lay supporters are less prone to accept patients' rights groups' initiative in reform efforts. The second main hypothesis, that the mental health establishment would be more antagonistic to patients' rights in states where patients rights groups existed, was not supported. One possible explanation for this is that patients' rights groups have had a nationwide impact, and that mental health officials face common problems throughout the country. Alternatively, or in conjunction, an antecedent variable of political liberalism may operate in sone states, creating both activist groups and more liberal psychiatric professionals. The significance of these findings is discussed and suggestions are offered for future research in this area.