The argument about creating a more therapeutic environment by making the hospital bigger is a joke. You cannot create a therapeutic environment with the kind of authoritarian coercive treatment that was practiced at VSH. Nearly all ‘patients’ at VSH were involuntary. The existence of places like VSH with its involuntary treatment procedures actually keep people from seeking help because they are afraid of being locked up against their will.

A Scandinavian study showed the unfavorable psychological treatment outcomes of involuntary treatment (Kaltiala-Reino, Laippala, & Salokangas, 1997). The authors conclude that “coercive treatment arouses negative feelings in the patient, creates negative expectations about the outcome of treatment, and fails to result in a trusting relationship between the patient and the professionals.”

Studies have repeatedly shown that when persons with even the most serious mental illnesses are provided with appropriate and comprehensive community mental health services, they succeed (White House Conference on Mental Health Fact Sheet, 1999). Most often, the crisis that results in commitment does not arise instantaneously. Before the crisis, the individual had mounting problems, for which the mental health system offered little or no help, and the involuntary admission could have been avoided by early and effective interventions. Involuntary and acute care admissions should be viewed as failures of community services. Building a responsive mental health system with services like mobile crisis teams, assertive community treatment teams (ACT), and supported housing is the best strategy for ensuring that people receive needed treated.