Since the 1960s in the United States, hundreds of thousands of patients with severe psychiatric disorders were discharged from public mental hospitals. At the same time, activists forced changes in commitment laws that made it impossible to treat many of those patients, relegating them to a precarious existence on the margins of society. Over forty years later, the problem persists. One of its most dramatic manifestations is violence: untreated individuals commit crimes, including murder and assault, and many are themselves victims of violent crime.

Determining the proper scope of involuntary care of the severely mentally ill is not exclusively a state matter. The federal government plays a surprisingly influential role in shaping treatment laws—and in undermining their reform. In his book The Insanity Offense (W. W. Norton, 2008), psychiatrist E. Fuller Torrey outlines what needs to be done to reverse this troubling state of affairs. A panel of specialists in community psychiatry and politics will comment.