In October 15, 1998, a federal court of appeals issued an important decision favoring needs-based treatment for those suffering from severe mental illness in Jurasek v. Utah State Hospital (10^th Cir. 1998). The federal court of appeals is the second highest court in the country, just one step below the U.S. Supreme Court. As such, the decision sets a precedent that will be followed by other courts.

The court ruled that a state psychiatric hospital could involuntarily medicate a mentally ill patient who was "gravely disabled" and determined to be incompetent to make medical decisions. "Gravely disabled" as defined in the Utah statute includes a person who suffers from a mental disorder who "manifests, or will manifest, severe deterioration in routine function evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety." The court found that this definition incorporates the concept of "danger to self" and therefore is consistent with prior Supreme Court decisions authorizing administration of medication over objection for individuals who "pose a likelihood of serious harm" to themselves or others.

The implications of this case go beyond the issue of treatment decisions. In finding that Utah’s definition of "gravely disabled" satisfies the concept of "danger to self," the court opens the doors to incorporating "gravely disabled" as a standard for commitment decisions. This would allow for more timely assisted treatment of those suffering from the severe and debilitating symptoms of severe mental illness.

This obviates the need for a separate hearing to determine medication de-cisions, thereby preventing patients being hospitalized without the ability to administer needed treatment. The court also approved of Utah’s administrative proceeding when a treatment decision is reviewed at a time subsequent to the commitment hearing, thereby preventing the need for another full court hearing.

Perhaps one of the most signi-ficant and encouraging aspects of the decision is that the court recognized that "treatment with psychotropic drugs is not punishment." The court appears to recognize that it is more humane to administer medication which can alleviate the devastating symptoms of these illnesses rather than withhold it from persons who lack the capacity to make an informed decision about treatment.

This is a positive decision, one that allows for more patients to receive the treatment they need.