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Many of the issues of mothers with mental illness are generic to all parents; others are specific to the situation of living with mental illness. Mothers with mental illness must play a role in developing standards for clinical care and the research agenda in this area.

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Although family members may seem to be natural supports for mothers with mental illness, their involvement in the context of parenting may not be entirely positive. The contributions of family members to the context of parenting for mothers with mental illness must be considered by treatment providers if unintentional negative outcomes are to be avoided.

The last half-century of psychiatric services in the United States is examined through developments and trends reported in the 50 years of publication of Psychiatric Services. The journal, earlier named Mental Hospitals and then Hospital and Community Psychiatry, was launched by the American Psychiatric Association in January 1950 and marks its 50th anniversary this year. The author organizes his review of psychiatric services largely around the locus of care and treatment because the location of treatment--institution versus community--has been the battleground for the ideology of care and for the crystallization of policy and legal reform. He uses "dehospitalization" to describe the movement of patients out of state hospitals, rejecting the widely used term "deinstitutionalization" as inappropriate; one reason is that the term wrongly implies that many settings where patients ended up were not institutional. Also covered in detail, as reflected in the journal, are community care and treatment, economics, patient empowerment, and the interface issues of general hospitals, outpatient commitment, and psychosocial rehabilitation. The author notes that some concepts, such as outpatient commitment and patient empowerment, emerged earlier than now assumed, and that others, like psychosocial rehabilitation, recurred in slightly different forms over time. He concludes that even after 50 years of moving patients out of state hospitals and putting them somewhere else, mental health policymakers and practitioners remain too myopically focused on the locus of care and treatment instead of on the humaneness, effectiveness, and quality of care.

Over the last 20 years, involuntary outpatient commitment has periodically been proposed as a possible strategy for providing mental health services to chronic mental patients. Under this approach, patients meeting certain criteria of dangerousness or need for treatment could be compelled by the courts to take part in treatment programs in the community. This article examines the available literature regarding this policy and the arguments for and against it. The final section outlines implementation issues that should be considered in designing any such policy so that it could be both legally acceptable and clinically sound.

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