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[PERCUSSIVE DRUMS] SPEAKER 1: As far as I'm concerned, it started January 5, 1978. And my mind sort of went numb with shock.

SPEAKER 2: So I got to the hospital. And they put me in a locked ward.

SPEAKER 3: For about three hours, I just couldn't believe it was happening. And I just couldn't believe that I'd be picked up when I hadn't done a darn thing wrong. I was just astounded.

[PERCUSSIVE DRUMS]

[CHATTER]

NARRATOR 1: Hennepin County Medical Center, main lobby, street level. As the largest medical facility in the County, it's a small city for the ill. And for each illness, there is a treatment. For most patients, their time here will be short, dictated only by the skill of their doctors, and the strength of their bodies. For others, it's not so simple. Their lives are not their own. And while they're here, they'll live under close observation.

NARRATOR 2: The patients call it 8A. It's the psychiatric ward, 8th floor, A building. Tucked away in remote hospital corridors, there are no signs leading the way. Visitors are brought here under escort, patients, against their will. And the only entrance is through a bolted steel door.

[CHATTER]

SPEAKER 2: For a couple of years or so, we had been having family problems. And it involved my husband, and my older daughter, who was then about 19, and myself. And I felt that she should see a psychiatrist. So my husband and I went to a psychiatrist about this problem, I thought. And when we walked into the office, the psychiatrist said, we're putting you in the hospital for a while. I think you should have a rest. I think you're depressed. And I looked at her. I just couldn't believe this. It just really shocked the daylights out of me. And here I was being committed. Either I go walk on my own two feet, they said, or they call the police and carry me.

SPEAKER 1: I couldn't believe that my brothers would subject me to the horror of commitment.

SPEAKER 3: I was sleeping 7:00 o'clock in the morning. And my landlady brought two well-dressed men up to my room, thinking they might be business associates of mine. And when she realized I was being taken away, I thought she was going to faint. She really got excited.

NARRATOR 1: The mental commitment process in Hennepin County is under attack. Critics, including mental health professionals, attorneys, and former mental patients say the state law governing the mental commitment process is inadequate. And in Hennepin County, the law is said to be so poorly administered that persons are sometimes picked up, confined against their will, and even committed for treatment with little or no justification. Attorney Bill Messinger is among those working for change.

BILL MESSINGER: One of the worst kinds of situations is where there's simply no doctor's statement supporting the petition. While doctors or physicians don't have the last word or say in a commitment process, at least if their statement is present, you have something to corroborate the fact that the person may be mentally ill. But in substantial percentage of cases, there is not a doctor's recommendation. And so somebody can be picked up from their own home virtually on the word of a relative or somebody else who might have some personal feelings against that individual, and has basically concocted a case.

[PERCUSSIVE DRUMS]

NARRATOR 2: They say it almost always starts early in the morning. The idea is to catch the proposed patient at home, to catch the proposed patient by surprise, avoiding difficulties. Two men come, Sheriff's deputies wearing plain clothes, driving an unmarked car.

SPEAKER 1: I think I was just getting out of bed. Or I was in bed, but awake. I can't remember exactly. But I looked up. And my door was being opened. And two rather burly men came into my room. And they said I was going to be taken to the hospital. And I think I knew then that this was a commitment procedure, that I was-- that they were picking me up under the law to be confined.

SPEAKER 3: I really was in a state of shock, because I'd only went to bed at 4 AM. And this was 7 AM. And I asked him, what's going on? And he said, well, we have a paper for you. And he showed me the paper. And I said, I can't believe it. This has got to be a bad dream.

[PERCUSSIVE DRUMS]

SPEAKER 2: I just couldn't believe this. I felt that I was being betrayed by my husband, the person that I felt I should have the most trust in. And I had threatened him with divorce. But I thought we had worked this out. And I just could not believe this. It just-- because when I got there, they told me that he would sign a petition to keep me there until they'd have a hearing.

NARRATOR 1: Under the law, any interested person may petition the County probate court for the commitment of another. The petition must be accompanied by two written statements, one from the petitioner, another by a physician, a physician who's examined the proposed patient and agrees that commitment is necessary. But in Hennepin County, a physician statement is not always necessary. Pete Fransway, Assistant Hennepin County Attorney.

PETE FRANSWAY: By statute, the doctor's statement is required, if it can be obtained. If it cannot be obtained, and sometimes that is the case, a person refuses to leave their home or apartment, won't go anywhere on advice of friends, counsel, whatever, in that event, a social worker trained in the field of social psychology is sent out to interview the patient, proposed patient at that time. And if the person refuses to go to see a physician, and it's thought by the social worker that there is imminent danger of this person harming him, or herself, or others, then they can supply the letter, which would be substituted for the physician's statement, which is required for the petition.

SPEAKER: We don't-- you know our judgments are based on pretty hard data. You can usually see if a person is not feeding themselves, if they're not providing themselves with shelter, if they are hallucinating or speaking in such a way that you can't carry on a minimal rational conversation with them. Their behavior has to be the indicator that tells us that there is a problem.

NARRATOR 1: When does one's behavior require commitment? And who should make the judgment? Ultimately, a hearing will be held. And a court will decide. In the meantime, the process will begin. Each year, more than 1,000 people find themselves subjected to involuntary commitment proceedings, 1,000 in Hennepin County alone. The probate court and County attorneys say each petition is carefully screened. Mistakes are seldom made. But what if a mistake is made?

SPEAKER 3: When a petition is filed alleging that somebody is mentally ill, when that petition is filed, the probate court also issues a hold order, which allows the Sheriff to pick somebody up and confine them in the hospital. And virtually in every case in Hennepin County in which a petitioner has filed a hold order is also issued. And that results in the individual being locked up until that individual's commitment hearing.

NARRATOR 2: Once they arrive, there's no escape. If there's been a mistake, it's too late. You're on the way to 8A.

SPEAKER 1: They identify themselves as Sheriff's deputies. And my mind sort of went numb with shock and horror. And well, I think I had the kind of sensation that people have when their heart seems to fall to the bottom of their shoes. And one of the Sheriff's deputies noted that I was being very cooperative. I don't know how. I don't know if I made response to that statement. But I think I remembered that if I wasn't cooperative, they could use force. They could forcibly restrain me. So I went without-- I went without any resistance.

SPEAKER 3: It was unreal. It was-- I think the French call it deja vu. It can't be happening to me. I've done nothing. But yet it was. And there was nothing I could do about it. I'm not saying that no one needs to be committed. Under our current system, no, this is impossible, at least from my vantage point, to say that we're not committing or bringing the commitment process a vast number of people who do not deserve to be committed at all.

SPEAKER 1: In the car, I just-- there was a sense of unreality. This simply couldn't be happening to me. And also a real terror as to what was going to happen to me. I was aware that there was such a thing as commitment. But I never, never saw it as applying to myself. Never thought that I myself would be in any danger of being committed. I suppose that I feared that I would never be free again, that there would be permanent confinement.

SPEAKER 2: Well, I was overcome. I mean, I just couldn't really-- you just can't really think. I cried. I can-- like I say I could cry about it right now when I think about it. And it's a feeling of devastation, of loneliness, disbelief, hurt, anger, more hurt than anger. The anger was there. But it was such hurt. I hurt now. I'm sorry.

SPEAKER (ON RADIO): Dr. Biswas, 3500. Dr. Biswas, 3500.

SPEAKER 1: When we got off the elevator, one of the upper floors, the lock unit was just a short distance away. And before I knew it, I was sitting at one of the tables in the lounge talking to the head nurse.

[CHATTER]

NARRATOR 2: 8A has 38 beds. And it's nearly always filled to capacity. The sleeping rooms surround a large combination lounge and recreation area. At one end, a small nursing station guards the only entrance to a smaller ward, also locked. There, they keep the patients considered particularly dangerous. Attendants at the station talk quietly into phones, prepare medication, review patient records. They have a clear view of both open areas. And while they work, they watch.

[CHATTER]

Most of the patients are spending their time in the lounge area. Some are reading. Some just sit. A small group sits at a table playing cards. Others fill a small television room bathed in blue light. A few are shuffling aimlessly about, some silently, others anxious to talk to anyone who'll listen.

SPEAKER: Hello. I've seen you quite often. But I know you work somewhere.

SPEAKER: Yes.

SPEAKER: Often elective, and I-- but I don't know what-- I don't see you. I see your pass by quite often.

SPEAKER: Which knock are you working on?

SPEAKER: Well, I really don't know. I had three of them that examined me so through, honestly. You know all those little rubber things?

SPEAKER: Yes.

SPEAKER: And--

NARRATOR 2: A striking feature of 8A is the quiet. Everything seems subdued. The doctors say there are occasional outbursts, violent scuffles, small explosions. When that happens, the attendants move quickly, restraining the offender and isolating the problem. But now, it's quiet. Some of the patients have been given antipsychotic drugs, others, tranquilizers, and some, nothing at all. 8A is occupied with people who are waiting, marking time.

[CHATTER]

SPEAKER 2: Well, it wasn't really uncomfortable. But I mean, feeling that you don't belong there, that you're being put there and locked up in a place. It's just-- it's a-- I find it hard to find words to describe it, because the feeling is something that you just cannot hardly describe.

SPEAKER 1: There were a few other patients. I remember one patient who was shuffling around. He wasn't walking. He was shuffling. He shuffled two or three steps. And then he would-- in one direction, then two or three steps in another direction. He seemed to be very, very uncomfortable and unable to even sit down. And I sensed that he was on one of the drugs that caused that kind of restlessness.

SPEAKER 2: I felt like it was the Gestapo. I mean there was no recourse that I could feel that I had. I was just locked up. And I just didn't know which way to turn, or what to do, or anything.

SPEAKER 1: I was in a state of shock. I was dumbfounded. I was terrified. I was not to-- I was grasping for ways to remove myself from the situation like a drowning man. I felt very helpless, very desperate, at the mercy of people whom I did not know, who could have done anything they wished in regard to me. Or at least I felt they could do anything they wanted to. And there would be nothing that I could do about it.

SPEAKER 2: A psychiatrist came to talk to me. And a doctor, a male. And he talked to me for about two or three minutes. So what can you do about that? They just took some of my physical history is all. And then a woman psychiatrist talked to me. And I'm trying to think at that time what they did. But no one wanted to hear any of my story. They took my husband's and daughter's word for it. Nothing I said had any bearing at all. It's just nobody asked my opinion. Nobody asked me if this were true, what they were saying. I was just a nothing.

NARRATOR 1: The patients in 8A are waiting for one of two things. Patients undergoing treatment are waiting for release. The others are waiting for a hearing. For those patients, the question of whether they need to be confined is still to be settled. The law allows up to 14 days confinement before a hearing must be scheduled. Probate court officials claim most patients receive a hearing within 5 to 7 days. But former patients, and the attorneys challenging the system, say confinement before the hearing is usually longer, in some cases, more than two weeks. During this wait, these patients have little more than hope, sometimes, not even that.

SPEAKER 3: One of the serious defects is that the person is not allowed to contest whether or not he or she is dangerous prior to the full commitment hearing. And I think if the analogy is to criminal law, in criminal law, one is at least entitled to a bail hearing, I think, within 36 hours of being accused of a crime. And that's, I guess, one of the real reasons that we think a probable cause hearing or some kind of initial hearing is necessary, that the individual should have a right to confront the evidence that's being used to hold them, him or her, in the locked ward prior to the commitment hearing.

SPEAKER: I'm going to scratch on these now. I'm not going in your skin on these scratches. There you go.

NARRATOR 2: Sometimes, patients are probed by the electroencephalograph, the EEG. Twenty-two electrodes are attached to the scalp. They measure 16 areas of brain activity. Sixteen markers record the brainwaves on a moving graph. The chart can reveal organic dysfunction, a tumor or a blood clot. But it can't tell the doctors if a patient is mentally ill. Diagnosis of mental illness is much more subjective.

[MACHINE WHIRRING]

SPEAKER: Psychiatry Service. I'm sorry. He's busy right now. Can I take a message for him? All right. Mm-hmm. Bye, bye.

NARRATOR 1: The staff members in charge of 8A have a formidable job. They are responsible for assessing the behavior of the proposed patients in custody. Under the law, persons can be involuntarily committed only if they are both mentally ill and dangerous, dangerous either to themselves or to others. Mental illness alone is insufficient.

Throughout the commitment process, the court relies heavily on professional psychiatric judgment. Critics say psychiatry is an unreliable science. And psychiatrists have a vested interest in pursuing treatment. The staff at Hennepin Medical Center disagrees. And Dr. Charles Dean is in charge.

CHARLES DEAN: Conceivably, I think it would be possible for someone with bad intentions to go to the probate court to sign a petition, and to even have his or her spouse picked up and brought to the hospital. There, however, is where we hope that things would change. Because even if someone like that were to be admitted, then that person immediately begins to be examined, to be interviewed by a number of people, and not just one or two.

SPEAKER 1: The hospital could have concluded that I was-- that I should be hospitalized, because I was so obviously, not feeling very well. And they were ignoring the effects that the hospitalization itself were having on me.

SPEAKER 2: This is what they diagnosed me as paranoid. Well, I'll tell you. When anyone finds their husband turns on them, the person they've trusted all the years, and all of a sudden, they find that they turn on them, this is such an experience that who wouldn't become paranoid, just even temporarily? I think this is going to shake the most well-adjusted person.

SPEAKER 3: It seems to me that in this area of making decisions on whether or not people need to be committed or locked up prior to a hearing, the focus should be on the actions of the individual. In other words, a psychiatrist could make a prediction. But it's very, very difficult for a psychiatrist to make reliable predictions about human behavior. It's one of the most difficult sciences at all. And I don't think there's been any studies that show that those kinds of predictions are very reliable. Rather than relying on opinion, I think we should look at acts. Has someone done something which leads a court or County attorney's office to believe that person is eminently dangerous?

SPEAKER: We do not-- at least we should not take one piece of behavior and say that this is indicative of a mental illness or a psychiatric problem of some kind. Because, as you say, there's almost an endless variation of normal human behavior.

[PERCUSSIVE DRUMS]

NARRATOR 2: After days or even weeks, the day of your hearing finally draws near. A day or two before the hearing, your attorney pays you a visit. For the first time, you're told of the allegations against you. You're preparing your defense. And now you can respond.

SPEAKER: Your brother says that you're a danger to yourself because you don't have the ability to care for yourself. You're jobless and homeless, without funds. You're unable to provide yourself with food, clothing, or shelter.

SPEAKER: No, he's wrong.

SPEAKER: OK. And he says that you're under the care of Dr. Kim, who says you have a paranoid thought disorder, and that you came to the attention of the police, because you put your head in the female toilet at a bar.

SPEAKER: [LAUGHS] Yeah, I did.

SPEAKER: OK. What was that all about?

SPEAKER: I was just messing around. I was over by Mortimer's Bar on Franklin--

SPEAKER 1: One thing that happened that stands out is the visit by my court-appointed attorney. And I remember sitting at the table in the lounge area of the locked unit while he read the petition in a very fast staccato voice. And I was very angered by some of the allegations that had been made in the petition, which I felt were untrue. But he read the petition so fast. And then I think he told me that there would be a hearing after, in a short while, that I would-- then before the hearing, there would be a pre-hearing examination by two doctors.

SPEAKER 2: Then they appointed an attorney. I kept calling him after they appointed him. And I never could get through to him. And he finally called me. And he came over and talked for just a very short time, you know 20 minutes, maybe 10, 20 minutes. I don't know, not very long.

SPEAKER 3: At best, you're given a half hour to an hour the night before the hearing. And that really isn't adequate time to prepare anything, because it's the night before the hearing. You don't have time to contact people to come as character witnesses or anything like that, while the other side has had the full 10 days to build up their case.

SPEAKER: Are you on any drugs or medicine right now?

SPEAKER: Yes.

SPEAKER: What kind?

SPEAKER: There's Thorazine, Haldols. I can't remember them all.

NARRATOR 1: Most proposed mental patients rely on a court-appointed attorney. In Hennepin County, the records show that over a recent two-year period, the same five attorneys represented 94% of all the proposed patients. They are paid a flat fee of $40 per client. They receive the same fee regardless of how much time they spend preparing a defense. $40 for 15 hours, or 15 minutes.

SPEAKER 2: I felt that he was not going to do anything for me either, that they just pay very little attention to you. Like nobody believes you. I mean, they appointed an attorney. But at the same time, I suppose he feels if you're supposed to be mental, that you don't know what you're talking about either.

[PERCUSSIVE BELLS]

NARRATOR 2: I met the court-appointed attorney outside 8A. It was a Sunday about 1:00 o'clock. He was coming from another hospital where he had already seen five clients. He said he wanted to get home as early as possible. But there were four more clients to see. They received about 20 minutes each. The attorney was on his way home by 3:00. 8:30 Tuesday morning, the hearing would begin.

[CHATTER]

SPEAKER: But you submit your witnesses. And that's it. You don't have any other witnesses to call. You rested your case. If it's not good enough, fine. You lose.

NARRATOR 2: Before the hearing begins, the referee, attorneys, and physicians wait for late arrivals. No cameras or recorders will be allowed during the hearing itself. The sessions are informal and held at the hospital in a hearing room near the psychiatric ward.

When the hearing begins, the proposed patient will be brought in and seated at the end of a long rectangular conference table. Two court-appointed psychiatrists will sit to his or her right. To the left, the court-appointed defense attorney. At the other end of the table, the referee presides. And near him, the County attorney representing the petitioner.

NARRATOR 1: Hearings are scheduled four days a week. The cases are heard by a court-appointed referee acting on behalf of a probate court judge. Until recently, a single referee heard up to a dozen or more cases each day. Apparently threatened by growing criticism and pending lawsuits, the probate court in May of 1979 appointed more referees and limited each to six cases per day.

The caseload reduction has made little difference, though, as most cases are still heard within a 30-minute period. More importantly, the fundamental process has remained unchanged. Critics say the fundamental weaknesses remain unchanged.

[CHATTER]

NARRATOR 2: These people, the psychiatric experts and officers of the court, are appointed from a small pool of regulars. And they know each other well. While they represent different interests, the state, the petitioner, and the alleged mental patient, their familiarity creates a club-like atmosphere. Everyone knows what to expect. It's a matter of routine. So the hearings will go smoothly, efficiently.

[CHATTER]

SPEAKER 3: You give your defense at the opening. Then your testimony is taken from the people that are against you. Then they're asked, have you reached a decision? And you're guilty. You don't even know what's going on. I call my attorney out into the hall. And I asked him, are you being my advocate or a stooge? I said, I could do a better job. I pointed out to you a half a dozen times where these people are either telling half truths or outright lying. And you haven't objected a bit to what they're saying. Everything has gone into the record.

NARRATOR 2: It seemed as though little weight was given to the patient's testimony. The defense attorney would occasionally enter an objection. But the defense lacked any evidence of vigor. In criminal cases, you're presumed innocent. But here, it seemed there was little presumption of sanity.

SPEAKER 3: When you're the supposed nut, or whatever you want to call it, you talk first. And the referee asks you questions. And the doctors can ask you questions. And that's over in maybe five minutes. That's the last chance you get.

NARRATOR 2: Great weight was given to the evaluations of the examining psychiatrists, naturally. But the exam is brief and conducted during the hearing. The hospital staff is heard. Then each psychiatrist asks a series of questions. It's over in 10 minutes, maybe 15.

Some of the patients were under the influence of drugs. But these are experienced men, it said. And they can evaluate the patients quickly. As a matter of fact, records show one frequently appointed psychiatrist diagnosed patients at more than 1,600 hearings between 1975 and 1977.

SPEAKER 1: I was examined by two psychiatrists. I think I tried to give some description of what had happened in the months prior to the commitment. But I was too frightened to think clearly.

NARRATOR 2: Do these people need commitment? Many, perhaps most, do. But which ones? One young patient said he had psychic powers. He said he had worked for the CIA. And he had a vision of life in the 31st century. A repeat offender, he'd been picked up for annoying people at the airport. The psychiatrist said he was deluded and needed commitment. Maybe he was mentally ill. He was certainly odd. But was he dangerous to himself and to others?

SPEAKER 3: And right then, they asked the doctors, have you reached a decision? And they say, yes. You're guilty. The referee sentences you. And it's over with. And you don't even realize it's happened. You think your turn is still coming.

SPEAKER 1: It was my understanding that I would be called back to make a statement of my own. And I wasn't. So I was-- after the pre-- after this conversation with the court, I went back to the locked unit. And the next thing I knew, my court-appointed attorney was in the locked unit telling me that I had been committed.

NARRATOR 2: They were all committed. Maybe it was necessary. Perhaps they all needed help. Later, the judge told me, it's a human system made by humans. So it has some problems. Nothing is foolproof, he said. And one of the defense attorneys said something similar. He said, on the whole it works, but it's not flawless. He agreed that the court's decisions are often judgment calls. But then he added, that's life.

[PERCUSSIVE DRUMS]

SPEAKER 2: That's the word for it. It was a nightmare. I just couldn't believe that it was happening, that it was true.

SPEAKER 3: The probate court system in Hennepin County anyway is arranged so that cases can be processed quickly and speedily. And therefore, there's not enough individual attention given to each case.

SPEAKER 1: I couldn't believe this was happening. There was an air of unreality about the whole thing.

SPEAKER: In order to be committed, you have to be, one, mentally ill, and two, danger to yourself. If you don't have both of those, you're not committable. The first time you get into the system, you believe that there is equal justice for all, and good will prevail, and the flag, and Ma, and Apple pie, and the whole thing. But after you're convicted, you become very, very cynical about any kind of lawyers, especially a public defender.

[PERCUSSIVE DRUMS]

NARRATOR 1: "The Way to 8A" was written and produced by Greg Barron, associate producer and audio mixing, David Carlton Phelan, reporters Claudia Hampton and Bob Potter.

[PERCUSSIVE DRUMS]

This has been a Public Affairs presentation of Minnesota Public Radio.