O'Connor v. Donaldson

That mentally ill persons have constitutional rights.

During the turbulent decades of the 1960s and 1970s many minority groups began to fight for their rights. African Americans worked to gain basic civil rights, including the right to vote, order a hamburger at a segregated lunch counter, and sit in the front of a crowded bus. Women tried to achieve equal pay for equal work, universal day care, and have men take responsibility for the home and child care. Gays and lesbians worked to halt the discrimination they faced every day.

Within this context of social activism, mentally ill persons also began to challenge the health system that often warehoused them in mental institutions for years at a time, sometimes without receiving any treatment to help cure their disorder. Nondangerous patients were housed with dangerous patients, and severe overcrowding in many institutions assured that many patients went for years without meeting with a licensed psychiatrist. In addition, many patients were denied their basic civil rights, including the right to a trial by jury. Others were committed to institutions against their will for an indefinite period of time.

Mental health advocates chose to use the court system to try to rectify the abuses found within the mental health system across the nation. In choosing to appeal to the court system to protect the civil rights of persons with a mental illness, mental health advocates followed the lead of other minority groups who had successfully won their own civil rights by appealing to the courts. For example, African Americans won the right to attend formerly segregated schools by court order, while women received the right to abortion in the controversial case of Roe v. Wade. Judging from the success of these past cases, lawyers, usually under the aegis of the American Civil Liberties Union (ACLU), sent test cases to court to fight against the involuntary commitment of patients, the warehousing of nondangerous patients for years without cause, and the right to treatment if patients were forced to remain within a hospital. As Bruce Ennis, an early advocate for the rights of the mentally ill commented in The Legal Rights of the Mentally Handicapped, mentally ill persons were "our country's most profoundly victimized minorities."

The strategy of appealing to the courts to achieve the rights for the mentally ill led to a flurry of lawsuits instituted on behalf of mental patients. One of the first of these lawsuits to reach the Supreme Court was the case of O'Connor v. Donaldson. In a unanimous decision, the Supreme Court ruled that Donaldson possessed certain rights and that he could be awarded damages from individuals who had taken away his rights. O'Connor v. Donaldson was one of the first cases to attempt to define the rights of mentally ill individuals.

In 1956, Kenneth Donaldson, a 48-year-old man from Philadelphia, traveled to Florida to visit his elderly parents. While there, Donaldson reported that he believed one of his neighbors in Philadelphia might be poisoning his food. His father, worried that his son suffered from paranoid delusions, petitioned the court for a sanity hearing. Donaldson was evaluated, diagnosed with "paranoid schizophrenia," and civilly committed to the Florida State mental health system. At his commitment trial, Donaldson did not have legal counsel present to represent his case.

Once he entered the Florida hospital, Donaldson was placed with dangerous criminals, even though he had never been proved to be dangerous to himself or others. His ward was also dangerously understaffed, with only one doctor--who happened to be an obstetrician--for over 1,000 male patients. There were no psychiatrists or counselors, and the only nurse on site worked in the infirmary. Because of the severe overcrowding and lack of doctors, Donaldson claimed that he did not receive any treatment during his 14 and a half year stay at the Florida State hospital. During the trial, the hospital administration admitted that the only treatment Donaldson received was "milieu therapy"--which was really a euphemism for confinement in the hospital itself. For most of his years in the hospital, Donaldson was simply kept in a room with 60 other patients, most of whom were criminally committed.

Beginning immediately upon arrival in the hospital, and for the next 14 and a half years, Donaldson fought to speak to a lawyer and have his case heard before a court. Donaldson argued that he should be freed because he was not provided with counsel at his commitment hearing; he was not mentally ill or dangerous to himself or others; and if he was mentally ill, the state had not offered any treatment for his affliction. Later, Donaldson also complained that he had not been released, despite the promise by two different sources to take responsibility for his care. In 1963, for example, a reputable half- way home for mentally ill persons in Minnesota had offered to assume responsibility for Donaldson. In addition, a college friend had sought to have the state release Donaldson to his care. Seemingly with no cause, both of these offers were rejected.

Finally, Donaldson received a hearing for his case and was released from the hospital. He immediately found a job as a hotel clerk and had no difficulty holding his job or living on his own. Despite his release from the hospital, his case eventually worked its way up to the Supreme Court where it was heard in October of 1975.

The Supreme Court ruled unanimously in favor of Donaldson, although its decision was a narrow interpretation of the case. First, the Court ruled on the ability of the state to hospitalize mentally ill persons. The Court ruled that the diagnosis of mental illness does not alone justify confining persons against their will and for an indefinite time. As Justice Stewart wrote in the Supreme Court opinion, "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 ruling, however, only applied to involuntarily civilly committed patients who were not dangerous to themselves or others.

Second, O'Connor v Donaldson held that state hospital officials were liable to pay damages if their actions violated the constitutional rights of the patient. In the case of Donaldson, Dr. J. B. O'Connor, the director of the Florida State Hospital where Donaldson resided, could be held liable for his refusal to release Donaldson, provide him with legal counsel, and offer him any viable treatment.

Third, and most important, the Supreme Court decision recognized the necessity of court cases protecting the rights of mentally ill persons, and encouraged other cases of the same nature. Finally, although many have interpreted theDonaldson case as supporting a right to treatment, the Court did not go that far in their ruling. Justice Stewart, writing for the majority, explained that "there is no reason now to decide whether mentally ill persons dangerous to themselves or to others have a right to treatment upon compulsory confinement by the state." The way was open, however, for other cases to address the right of patients to receive treatment if they are hospitalized for mental illness.

The case of O'Connor v. Donaldson recognized that civilly committed mental patients have constitutional rights. If these rights were violated, the patient could sue the health care officials for taking away their rights. Although narrowly construed, perhaps the most important legacy of O'Connor v. Donaldson was that it encouraged others to challenge the system and protect the rights of America's "most profoundly victimized minorities." Although many of the rights of mental patients were challenged in the 1980s and 1990s, Donaldson's case helped pave the way for the deinistutionalization of thousands of patients in the 1960s and 1970s.