O'Connor v. Donaldson, 422 U.S. 563 (1975)
Key Issue: "capable of surviving safely in freedom"
In terms of impact, O'Connor v. Donaldson, 422 U.S. 563 (1975) is probably the single most important decision in mental health law. It has been used by opponents of involuntary commitment (like the ACLU) to argue that it is unconstitutional to commit an individual involuntarily who is not (imminently) dangerous to himself or others.
Kenneth Donaldson was 34, married with three children, and working in a General Electric defense plant when he had his first episode in 1943. Hospitalized at Marcy State Hospital, he was given 23 electro-shock treatments and resumed normal life. In the mid-1950s he developed paranoid delusions that he was being poisoned. At his parents' instigation, he was committed to Florida's Chattahoochee State Hospital in 1956. He remained there for fifteen years. Donaldson lacked insight (i.e., suffered anosognosia), and steadfastly denying he was ill, refused all treatment once he was hospitalized. He had a high degree of motivation, persistence and intelligence, and through the years persistently petitioned the courts for his release.
While he was in Chattahoochee, there were repeated offers - both from a halfway house in Minneapolis and a friend of Donaldson's in Syracuse - to provide a home and supervision for him.
Donaldson's own (probably correct) view was that the hospital's doctors would not release him because he refused to play what he called "the game" of thanking the doctors for making him better. Instead, he adamantly denied he was or ever had been ill.
The Supreme Court said the case raised "a single, relatively simple, but nonetheless important question concerning every man's constitutional right to liberty."
The key paragraph in the decision reads: "A finding of 'mental illness' alone cannot justify a State's locking a person up against his will and keeping him indefinitely in simple custodial confinement… In short, a state cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends."
The mental health bar, spearheaded by the ACLU, has interpreted this decision to mean that it is unconstitutional to commit for treatment an individual who is not (imminently) dangerous, and have maintained the individual must be considered "capable of surviving safely in freedom" if his life is not in immediate danger. This interpretation has been important in hampering efforts to implement changes in civil commitment law. In a number of states where the law has been broadened to include some variation of a "need for treatment" standard, those implementing the law for the most part still insist the individual meet the "dangerousness" standard. An important reason is that they accept the ACLU's interpretation of the Donaldson case.
The Donaldson case is also significant because of its role in determining the outcome of another key case, Wyatt v. Stickney (described elsewhere). This is because, in the lower courts, Donaldson was argued and decided as a "right to treatment" case. Donaldson's attorney, lawyer-physician-reformer Morton Birnbaum, had taken the case as part of his campaign to win court recognition of a "right to treatment," a concept Birnbaum pioneered, believing it would improve the state hospital system. At the trial level, the judge accepted the "right to treatment" argument (although at this point there was no such thing in law as a right to treatment). The judge instructed the jury it should rule for Donaldson (who was now free but suing two of his doctors) if it found he was not given such "treatment as will give him a realistic opportunity to be cured or to improve his mental condition."
The lower court decision in favor of Donaldson was then appealed to the U.S. District Court of Appeals, which upheld it, the "patient had constitutional right to such treatment as would help him to be cured or to improve his mental condition." That same court had been sitting on Alabama's appeal of the trial judge's decision in Wyatt v. Stickney for two years. It now affirmed the Wyatt decision – which would precipitate massive deinstitutionalization -- on the basis of Donaldson.
In O'Connor v. Donaldson, the Supreme Court, however, deliberately steered clear of the issue of a right to treatment. Chief Justice Burger objected that "to condition a State's power to protect the mentally ill upon providing of 'such treatment as will give a realistic opportunity to be cured'" would: make commitment too difficult (what if the individual was incurable?), or too easy (if he were treatable but functioned well in society without treatment).
The Supreme Court decision in Donaldson was a reasonable one, which has been interpreted unreasonably. The Supreme Court had Kenneth Donaldson in mind when it ruled that an individual who was "capable of surviving safely in freedom" by himself or with the help of others could not be confined. Donaldson was fully capable of living independently, had people who were willing to support him if necessary, and posed no danger to himself or others.
The mental health bar argues the individual is "surviving safely" if he is not on the point of death. But mental health law expert Paul Stavis, counsel to the New York Commission on Quality of Care, argues that the ACLU interpretation of the Donaldson decision is wrong. When it ruled by "surviving safely in freedom," the Supreme Court did not have in mind rummaging in garbage cans for food or lying in the street in one's own waste. Nowhere in the Donaldson decision did it say that the individual must be permitted to deteriorate to the point he is dangerous. Stavis is convinced a well crafted "need for treatment" statute will survive Supreme Court scrutiny (and hopes a case reaches the Court which enables the justices to make that clear).
If the decision at the Supreme Court level was reasonable, the lower court decisions that led up to it were bizarre. Donaldson consistently denied he was or ever had been mentally ill, absolutely refused all treatment for his non-existent (in his own mind) mental illness, and was only kept in the hospital so long because he became involved in a tug of war with his doctors who were determined to treat him. It is the height of irony that he should have sued and won on the basis that his doctors had denied him treatment.