Rouse v. Cameron (No. 1)

In 1962, Appellant Rouse was involuntarily committed to a mental hospital pursuant to D.C. Code § 24-301 after being found not guilty by reason of insanity of carrying a dangerous weapon, a misdemeanor for which the maximum imprisonment was one year. Rouse challenged his commitment on grounds of habeas corpus; he had been confined for four years at the time of the litigation.

The District Court denied relief in habeas corpus and refused to consider Appellant’s contention that he had received no psychiatric treatment.

The court first examined whether an individual involuntarily committed to a mental hospital on being acquitted of an offence by reason of insanity has the right to treatment cognizable in habeas corpus. The court held that:

The purpose of involuntary hospitalization [was] treatment, not punishment. The provision for commitment rest[ed] upon the supposed necessity for treatment of the mental condition which led to the acquittal by reason of insanity. Absent treatment, the hospital [was] transform[ed] [] into a penitentiary where one could be held indefinitely for no convicted offense, and this even though the offense of which he was previously acquitted because of doubt as to his sanity might not have been one of the more serious felonies or might have been, as it was here, a misdemeanor.

The court held that Congress established a statutory “right to treatment” for institutionalized patients under the Hospitalization of the Mentally Ill Act, 1964 (the Act),[1] which was intended to cover persons institutionalized under D.C. Code § 24-301. The Court explained that while other sections of the Act applied only to persons “hospitalized pursuant to the 1964 Act or to mentally ill persons . . . defined by the Act to exclude persons committed by court order in a criminal proceeding,” there were no such limitations in the “right to treatment” provision. The Court added that “the considerations underlying the right to treatment provision in the [] Act appl[ied] with equal force to commitment under D.C. Code § 24-301.”

The court noted that the right to treatment was recognized in many states. This, combined with the existence of a judicial remedy available for violation of the Act’s requirement that hospitals keep publicly available records of the psychiatric care and treatment provided, supported the court’s view that Congress intended to implement the right to treatment.

The court further stated that involuntary confinement without treatment was “shocking.” It suggested that there may even be “greater need for the protection of the right to treatment for persons committed without the safeguards of civil commitment procedures.”

The court then examined whether a violation of the right to treatment was established.

The court held that, according to leading experts, psychiatric care and treatment included “not only the contacts with psychiatrists but also activities and contacts with the hospital staff designed to cure or improve the patient.” Therefore, the court held that hospitals were not obligated to show that treatment would cure or even improve the patient, “but only that there [was] a bona fide effort to do so.” The court held that such effort required hospitals to show that:

1. initial and periodic inquiries were made into the needs and conditions of the patient with a view toward providing suitable treatment for him; and
2. the program provided was suited to the particular needs of the patient.

The court further held that a hospital must attempt to provide treatment “in light of present knowledge,” and that lack of staff or facilities could not justify a “continuing failure to provide suitable and adequate treatment.”

The court held that where a mandatorily committed patient was being held in violation of the Constitution and laws, a court could allow the hospital “a reasonable opportunity to initiate treatment.” In determining what constituted a “reasonable opportunity,” the court held that a court must consider “the length of time the patient [had] lacked adequate treatment, the length of time he [had] been in custody, the nature of the mental condition that [had] caused his acquittal, and the degree of danger, resulting from the condition, that the patient would present if released.”

“The purpose of involuntary hospitalization is treatment, not punishment. The provision for commitment rests upon the supposed ‘necessity for treatment of the mental condition which led to the acquittal by reason of insanity.’ Absent treatment, the hospital is ‘transform[ed] * * * into a penitentiary where one could be held indefinitely for no convicted offense, and this even though the offense of which he was previously acquitted because of doubt as to his sanity might not have been one of the more serious felonies" or might have been, as it was here, a misdemeanor.’” 373 F.2d, pp. 452 – 453.

“According to leading experts ‘psychiatric care and treatment’ includes not only the contacts with psychiatrists but also activities and contacts with the hospital staff designed to cure or improve the patient. The hospital need not show that the treatment will cure or improve him but only that there is a bona fide effort to do so. This requires the hospital to show that initial and periodic inquiries are made into the needs and conditions of the patient with a view to providing suitable treatment for him, and that the program provided is suited to his particular needs. Treatment that has therapeutic value for some may not have such value for others. For example, it may not be assumed that confinement in a hospital is beneficial ‘environmental therapy’ for all.” 373 F.2d, p. 456.

“It has been said that ‘the only certain thing that can be said about the present state of knowledge and therapy regarding mental disease is that science has not reached finality of judgment.’ But lack of finality cannot relieve the court of its duty to render an informed decision. Counsel for the patient and the government can be helpful in presenting pertinent data concerning standards for mental care, and, particularly when the patient is indigent and cannot present experts of his own, the court may appoint independent experts. Assistance might be obtained from such sources as the American Psychiatric Association, which has published standards and is continually engaged in studying the problems of mental care. The court could also consider inviting the psychiatric and legal communities to establish procedures by which expert assistance can be best provided.” 373 F.2d, p. 457.

“One who is ‘in custody in violation of the Constitution and laws’ of the United States is entitled to relief in habeas corpus, and the court is required to ‘dispose of the matter as law and justice require.’ If the court finds that a mandatorily committed patient, such as appellant, is in custody in violation of the Constitution and laws, it may allow the hospital a reasonable opportunity to initiate treatment. In determining the extent to which the hospital will be given an opportunity to develop an adequate program, important considerations may be the length of time the patient has lacked adequate treatment, the length of time he has been in custody, the nature of the mental condition that caused his acquittal, and the degree of danger, resulting from the condition, that the patient would present if released. Unconditional or conditional release may be in order if it appears that the opportunity for treatment has been exhausted or treatment is otherwise inappropriate. It is unnecessary to detail the possible range of circumstances in which release would be the appropriate remedy.” 373 F.2d, pp. 458 – 459.