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Treating people with a mental disorder without their consent always has been the defining human rights issue in mental health law. For centuries, unwanted treatment took place in a closed institution—a mental hospital. What has changed is that in recent years the locus of involuntary treatment has shifted from the closed institution to the open community. Much of the strident policy debate on outpatient commitment—a civil court order requiring a person to adhere to mental health treatment in the community—treats it as if it were simply an extension of inpatient commitment, viewing it within the same conceptual and legal framework historically used to analyze commitment to a mental hospital. Increasingly, however, it is becoming apparent that concepts developed within a closed institutional context do not ...

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