Parham v. J. R.

OF DEPARTMENT COMMISSIONER, PARHAM, GEORGIA, et OF RESOURCES HUMAN al. R.

J. et al. 10, 1978— Reargued October Argued December No. 75-1690. 1977— June Decided White, Court, in which J., opinion the delivered the C. Burger, J., joined. Stewart, filed an JJ., and BlackmuN, RehNQUist, Powell, post, BreNNAN, J., filed an p. 621. opinion concurring judgment, in part, dissenting in Marshall part and in which opinion concurring in post, p. JJ., joined, 625. Stevens, Georgia, Douglas Attorney General Lackey, Assistant

R. on briefs him appellants. for With reargued the cause Bolton, Attorney Arthur were K. original argument on the Attorney II, Robert Stubbs Executive Assistant 8. General, Attorney General, Langham, Don First Assistant A. General, Bowers, Attorney General, Assistant Michael J. Senior Attorney General. Cosgrove, Atha Assistant Carol Cromartie, Jr., appellees. for the cause reargued John L. him on original With the brief on Gerald R. argument was Tarutis* Burger

Mr. Chief opinion delivered the Justice Court. question presented is appeal process this is what

constitutionally guardian due a minor child or whose seek state administered institutional mental health care for the child and specifically adversary whether an proceeding required prior to or after the commitment.

I (a) Appellee being Georgia a child in a state R., J. treated was hospital, plaintiff action2 based class on 42 U. § S. C. for Middle District Court District of Georgia. Appellants Commissioner State’s by

*Briefs of amici curiae urging filed William B. affirmance were Spann, Jr., Lashly, John H. and Daniel L. Skoler Bar for the American Association; by Stephen Berzon, Wright Edelman, P. Marian B. and Paul Friedman for Orthopsychiatric al.; by the American Association et Joel I. Psychiatric Klein for the American al.; by Association Robert L. Walker et League by Stanley for the Child America; C. Welfare Van Ness for the Department Advocacy Advocate, Public Division of Health Mental Jersey; of New Robert S. Catz for the Urban Law Institute. McCree, Attorney Days, Solicitor General Assistant General Brian K. Landsberg, and Mark L. Gross filed a brief the United States as amicus curiae. 1Pending review, plaintiffs our one of the named the before District Court, L., Although moot, J. died. the individual claim of L. J. is we because, they part, discuss the facts of claim in this form the basis for the holding. District Court’s 2 by by Court, objection appel The class certified the District without lants, years persons younger age consisted “of all than 18 of now or by any diagnosis hereafter received defendant for observation and and/or any 'facility’ for care and treatment at the detained within State Georgia pursuant (1975). Although to” Ga. Code one witness §88-503.1 may any given day class, testified that on there be 200 children in the in only December 1975 there 140. were

588 of the Director Resources, the of Human Department

of the Re- Human Department of the Division Health Mental where hospital at the Medical Officer and the Chief sources, declaratory- sought Appellee treated. being was appellee for procedures voluntary commitment Georgia’s judgment 88-503.2 88-503.1, §§ Code age 18, the Ga. children under Fourteenth of the Clause Due Process violated the (1975),3 future their against injunction an requested and Amendment enforcement. to 28 pursuant convened was three-judge

A District Court ex considering After ed.) 2284. (1970 §§ U. S. C. after visit exhibits and lay testimony and pert and extensive hospitals, health regional mental State’s ing two un statutory was scheme Georgia’s held that District Court adequately protect because it failed constitutional Supp. Parham, F. rights. L. v. process due J. appellees’ commit- future enjoined the court remedy violation, To It also Georgia statute. procedures in based on the ments expend whatever appropriate Georgia commanded nonhospital necessary” provide “reasonably was amount to be the state officials by appellant deemed facilities provides: Section 88-503.1 facility any may for observation receive superintendent of “The appli- years age for such any whom under 18 diagnosis . . . individual evidence parent guardian If found to show by or .... is made his cation may treatment, person such to be suitable of mental illness and may person be de- facility and at such such given care and treatment may as conditions facility period and under such for such tained such by law.” be authorized provides: 88-503.2 Section voluntary patient facility discharge any shall superintendent “The improved sufficiently or who has from his mental illness

who has recovered patient hospitalization determines that superintendent longer no desirable.” some, respects but references was amended Section 88-503 question. provisions in at the time effect herein are to appropriate most for the treatment of those plain- members of n. 2, supra, class, tiffs’ drastic, who could in be treated less nonhospital Supp., environment. F. at 139.

Appellants challenged aspects all of the District Court’s judgment. probable jurisdiction, We noted 936, 431 U. and S. heard argument during 1977 Term. The case was then Secretary Public v. Institution- consolidated with Welfare Juveniles, alized post, p. reargued this Term.

(b) a plaintiff J. before the is now L., District Court who deceased, was admitted 1970 at age years of 6 to Central Regional Hospital State Prior Milledgeville, Ga. to his outpatient J. L. had received at admission, treatment hospital for over two months. L.’s re- J. mother then quested hospital to admit him indefinitely.

The admitting physician interviewed L. his parents. J. He learned parents that J. L.’s natural his had divorced and mother had remarried. He also learned had been that J. L. expelled from school because he was uncontrollable. ac- He cepted parents’ representation boy had been extremely aggressive diagnosed having the child as “hyperkinetic reaction of childhood.” stepfather

J. L.’s mother and agreed participate to family therapy during hospitalized. the time their son was this program, permitted Under L. was go J. home for short stays. Apparently his behavior during these visits was erratic. parents After several months, requested discontinuance program. In stepfather the child was returned to his mother and e., i. on a furlough basis, go he would live home but hospital. parents school at the they found were unable L. satisfaction, family to control J. to their created and this they stress. Within two mоnths, requested his readmission L.’s relinquished parental Central State. J. their rights county to the in 1974.

Although hospital employees several recommended that J. L. placed should be special foster home warm, sup- with “a ported, truly involved couple,” Department the of Family and Children Services was unable place him in such a setting. On October 24, 1975, L. (with R.) J. filed J. suit requesting an order of the court him in placing a less drastic environment suitable his needs.

(c) Appellee J. was R. a neglected by declared child the county and removed from his natural parents when he was 3 months old. He placed was in seven different foster homes prior succession to his admission to Central Hospital State age at of 7.

Immediately preceding his J. R. hospitalization, received outpatient treatment at a county mental health center for several months. He then began attending school where he was so disruptive and incorrigible that he could not conform to normal patterns. behavior Because of his abnormal be- havior, J. R/s seventh set of foster requested his removal from their home. The Department Family Children sought Services then his admission Central State. The agency provided hospital with complete socio- history medical at the time of his admission. In addition, separate three interviews were conducted by with J. R. admission team of hospital.

It was determined that he was borderline retarded, and suffered an “unsocialized, aggressive reaction of childhood.” It was recommended unanimously that he would “benefit from the structured environment” of hospital and would “enjoy living and playing with boys of the age.” same

J. R/s progress was In periodically. re-examined addition, unsuccessful efforts were made Department of Family and Children Services during stay his at the hospital to place J. R. various foster On homes. October 24, J. 1975, R. (with L.) J. filed this suit an requesting order the court placing him in a less drastic environment suitable to his needs.

(d) Georgia § Code 88-503.1 (1975) provides for the volun- tary admission to a regional state hospital children such as J. L. and R. Under J. that provision, begins admission an application for hospitalization signed by “parent or guard- ian.” Upon application, superintendent of each hospital given the power to temporarily any admit for “obser- vation and diagnosis.” If, after observation, superin- tendent finds “evidence mental illness” and that the child is “suitable for treatment” in the hospital, then may the child be admitted “for such period and under such as conditions may be by authorized law.”

Georgia’s mental health statute provides also for the dis- charge of voluntary patients. Any child who has been hospitalized for more than days may five the discharged at request parent guardian. of or 88-503.3 § (1975). Even (a) request without a for discharge, however, superintendent the each regional hospital has an duty any affirmative to release child “who has from recovered his mental illness or who has sufficiently improved the superintendent determines that hospitalization of patient the no longer is desirable.” §88-503.2 (1975).

Georgia’s Mental Health Director has published not any statewide regulations defining specific what procedures each superintendent must employ when child admitting under 18. Instead, regional each hospital’s superintendent responsible is procedures for the in his or her facility. There is substantial among variation the regard institutions with to their admission procedures and procedures their for patients review of after they have been admitted. A brief description of differ- the ent hospitals’ procedures4 will variety the demonstrate 4 Although the State eight regional has hospitals, superintendents from only seven deposed. of them were addition, In the District Court referred only hospitals seven in its plaintiff list of members the Appar class. ently, eighth hospital, the Regional Northwest Ga., in Rome, had no chil being dren treated there. The against District Court’s order was issued the Department State Commissioner of the of Human Resources, who is throughout hospitals regional by the taken approaches State. in built was Ga., Thomasville, Hospital Southwestern instituted, was program adolescent and Its children

1966. has hospital unit adolescent The children 1974. only of suit time at the beds, but capacity of a maximum there. treated being were 10 children hospital testified superintendent

The Southwestern not was who patient voluntary child never admitted a has If clinic. health community mental by a previously treated clinic deter- community at professional health a mental child, then for a helpful may be treatment hospital mines that need evaluate jointly staff hospital staff clinic during hospitalization, proper treatment hospitalization, thus decision initial admission likely release date. and a hospital. made is not reviews weekly hospital has admitted, a child

After profes- medical internal by its performed his condition each monthly reviews There also staff. sional weekly in the involved hospital staff composed group average The people. staff community clinic and reviews in at Southwestern being treated was child who stay for each days. 100 1975 was in 1968. At opened was Hospital Regional

Atlanta children 17 Court, District before hearing time of the children hospital’s in the treated being were 21 adolescents unit. and adolescent mental health community nine with hospital is affiliated

The be “persons will them agreement an and has centers health centers mental community comprehensive in the treated hospitalized.” being than instance, rather every possible voluntary for Regional Atlanta at The admission criteria policy a formal It has the same. involuntary patients are Northwest including eight hospitals, all for the activities responsible Regional.

to admit voluntary patient patient unless the is found to be a threat or himself others. The record discloses that approximately of all referrals from the community cen- 25% rejected ters are by the hospital admissions staff.

After admission, the staff reviews the condition of each child every week. In addition, there monthly utilization reviews by nonstaff mental health professionals; this review considers a random sample of children's average cases. The length each stay child’s in 1975 was 161 days.

The Georgia Mental Health Decatur, Institute (GMHI) Ga., was built in 1965. Its children and unit adolescent housed children time this suit was brought. hospital

The has a formal community affiliation with four mental health centers. Those may centers refer patients hospital only if they certify appropriate that “no alterna- tive resources are available within the geographic client’s For year area.” prior to the trial in case, no child was admitted except through a referral from clinic. Although the hospital policy has a of generally for 24 hours accepting all referrals from a community it clinic, has team of staff members who review each admission. If “no the team finds reason not to treat community” deputy and the superintendent of the hospital will agrees, then it release applicant to his home.

After a child is there admitted, a review must admission decision within days. is also unspec- There an periodic ified hospitalization by review each child’s need a team of staff average stay for the children members. who were at GMHI days. in 1975 was

Augusta Regional Hospital opened was in 1969 affiliated community with 10 clinics. Its chil- health dren and adolescent housed 14 in ‍​​​‌​​​​‌​‌​‌​​‌​‌​​​​​​‌​‌‌​‌‌​​‌​​‌​​‌‌‌‌​​​​‌‍unit children December 1975.

Approximately of the children admitted to the hospital 90% first have received in community, treatment but not all them were specific admitted on a from based referral a clinic. 594 hospitaliza- needs “the child is whether criterion admission

The psychiatrists. by two approved be must decision and that tion,” if child admitting practice informal an is also There program. therapy family in a participate refuse his by a days 10 within reviewed is decision admission The professionals; health mental physicians of staff team addition, In every week. is reviewed child each thereafter, staff clinic team by a is reviewed condition child’s every children stay for average days. The every 100 members days. was 92 in December Augusta at housed and it in built was Hospital Regional Savannah mem- staff hospital The suit. the time 16 children clinics. health community mental also directors bers are admis- seeking child any hospital that of the is the policy It community by a referred be must basis nonemergency on sion a staff by made be must decision admission The clinic. by the provided materials on the based it is psychiatrist, an applicant, with interview an community clinic, child. any, if parents, interview with child, is there of a admission after weeks Within three mem- staff clinic hospital and composed by group review court juvenile as such community, from the people bers and each reviews staff hospital Thereafter, judges. be ready to child is that a concludes If the staff weekly. the child’s reviews committee community then the released, children stay of the average The in placement. assist case to days. was December in at Savannah being treated opened was Ga., Columbus, Hospital Central West purposes budgetary organized was and it December hospital The clinics. community health several 16 of adolescents, for children and only beds has itself was filed. the time this suit occupied at were which admission seeking children all policy that a formal There community clinic. by a referred must hospital treating resort last as “the staff regarded hospital is a child”; of the children referred are turned away by 50% admissions team at the hospital.

After admission, there are staff meetings daily to discuss problem cases. The hospital has a practicing psychia- trist who reviews cases once a week. Depending on the nature of the problems, the consultant reviews between and 20 cases. The average stay of the children who were at West Central in December 1975 was 71 days.

The children’s unit at Central State Regional Hospital Milledgeville, Ga., was added to the existing structure during the 1970’s. It can accommodate 40 children. hospital The also can house 40 adolescents. At the time of suit, hospital housed 37 children under 18, including both named plaintiffs.

Although Central State is affiliated with community clinics, it seems tо have a higher percentage of nonreferral admissions than any of the other hospitals. The admission decision is made an “admissions evaluator” and the “admitting physi- cian.” The evaluator is a D. Ph. psychology, social worker, or a mental-health-trained nurse. The admitting physician is a psychiatrist. The standard for admission is “whether or not hospitalization is the more appropriate treatment” for the child. Prom April 1974 to November 9 of 29 children applicants screened for admission were referred to noninstitu- tional settings.

All children who are temporarily admitted are sent to the children and adolescent unit testing and development of plan. treatment Generally, days seven after the admission, members of the hospital staff review all of the information compiled patient about a “to determine the need for continued hospitalization.” Thereafter, there is an informal review of the patient approximately every days. patients who were at Central State in December 1975 had been there, on the average, 456 days. There is no explanation in the record for this large variation from the average length of hospitaliza- tion at the other institutions. on the was District Court focus of

Although most Georgia to note that it is relevant hospitals, State’s and clinics community health mental funds over 50 presently seven has built The homes. State foster care specialized 13 has and it years, 15 past within the regional hospitals new The state hospital. to its oldest unit new children’s added mental million for $150 year 1976 was fiscal almost budget in per in states among the 22d ranks Georgia care. health total 15th health and for mental expenditures capita expenditures.5 entire the State’s rejected District Court nonetheless

The procedural both care on mental health providing system 46 found that Court District grounds. The and substantive less restric- another, for cared “optimally children could Supp., F. if were available.” setting it non-hospital tive, group homes, included settings “optimal” 124-125. These at Governor home-care services. therapeutic camps, Com- Appropriations two chairmen Georgia and Court, in the District testifying legislature, of its mittees informed the program Georgia in the confidence expressed budget its justify enlarging could court State treatment specialized provide year during fiscal then available. to those by appellees addition settings urged Georgia’s background the factual described Having plain- of the named its program and treatment health for the District legal bases examine the turn now to tiffs, we judgment. Court’s

II statutory procedure Georgia’s In unconstitutional holding first District Court juveniles, voluntary commitment for any eight regional that commitment determined Mental Association of State data is these National The source Agency Health Directors, State Mental Program Report: State Health 1, 1978). (Aug. Expenditures

hospitals6 constitutes severe deprivation of a child's liberty. The court defined this liberty interest in terms of both freedom from bodily restraint and freedom from the “emo tional and psychic harm” caused by the institutionalization.7 Having determined that liberty interest is implicated by a child's admission to a mental hospital, the court considered process what is required protect interest. It held process that the due “includes at least the right after notice to be heard before an impartial tribunal.” 412 F. Supp., 137.

In requiring prescribed hearing, rejected court Georgia's argument that no adversary-type hearing was re- quired since the State was merely assisting parents who could not afford private by care making available treatment similar

to that offered in private hospitals private physicians. The court acknowledged that parents most who seek to have their children admitted to a state hospital mental do so in good faith. It, however, relied on one of appellees’ witnesses who expressed an opinion that “some still look upon mental ” hospitals as a ‘dumping ground.' Id., at 138.8 No specific 6The very record is sparse with regard to physical the facilities and daily routines at the regional various hоspitals. only hospital The dis by appellees’ cussed expert witness was Central State. The District Court visited Central State and one other hospital, but did not discuss the visits in opinion. its 7In respects, both the District Court strong found support for its holding in this Court’s decision In Gault, re 387 U. S. 1 In that decision, we held that a state cannot juvenile institutionalize a delinquent without first providing certain process due protections. light In of the District holding Court’s judicial that a quasi-judicial or body should review voluntary commitment decisions, it is at least interest ing to note that the witness who made the quoted statement in the text was not referring to people as the who “dump” children into hos pitals. opined This witness juvenile that some judges court and child wel agencies fare misused hospitals. the App. 768. See also Rolfe Mac- & Clintoek, The Due Process Rights of “Voluntarily Minors Admitted” to Institutions, Mental Psychiatry J.4 & L. (1976) (hereinafter Rolfe & MaeClintoek). the found be can however, “dumping,” such evidence record. review that the argument rejected also Court District

The was staffs their hospitals the superintendents the court The liberty interest. child’s protect to sufficient with coupled psychiatry, inexactness held make to used information the sources possibility made reliable, always be may not decision commitment due satisfy arbitrary to too decision superintendent’s from drastically focus its then shifted The court process. what analysis to process due procedural clearly a was what con analysis and process due abe substantive to appears face failure, in its for “officialdom” Georgia’s demned for addi “need” outlining report9 a state-funded pro treatment, nonhospital spent on to be resources tional care. health noninstitutional resources more vide relationship a causal was there court concluded The ability provide the State’s intransigence between District appellees. to the process” any “flexible due expend appropriate the State ordered Court therefore nonhospital provide necessary to would resources as such would who class appellees’ members to those treatment from it. benefit

Ill coping inherent problems day, an earlier In were abnormalities emotional or mental with afflicted children & R. Brakel family. S. See the within largely dealt (1971). Some- 4 Law the and Mentally Disabled The Rock, While doctor. family aor by teachers aided parents were times disturbed their deal with able to were doubt parents no some 9 Health on Mental Study by Commission the study conducted was This by the State and financed Youth was Children Services distinguished scholars eight up of was made Commission Georgia. The studying the five They spent six months health. of mental in the field time. that in existence that were hospitals regional

children specialized without assistance, others, especially those of limited means and education, they were not. Increasingly, turned for assistance public local, sources or chari- private ties. Until recently, most did states little more than provide custodial institutions for the of persons confinement who were considered dangerous. Id., at 5-6; Crim- Slovenko, inal Justice Procedures Civil Wayne L. Commitment, Rev. (1977) (hereinafter Slovenko).

As medical knowledge about ill mentally public concern for their condition expanded, states, aided sub- stantially by federal grants,10 sought have to ameliorate the human tragedies of seriously disturbed children. Ironically, as most states have expanded their efforts to assist the men- tally ill, their actions been have subjected increasing litiga- tion and heightened scrutiny. constitutional Courts have been required to resolve thorny constitutional attacks on state programs and procedures precedential with limited guidance. In this case, appellees have Georgia’s challenged procedural and substantive balance of the individual, family, and social interests at stake in the voluntary commitment a child to one of regional its hospitals. parties agree our prior holdings have set out a

general approach for testing challenged state procedures under process a due claim. Assuming thе existence of protectible property liberty or interest, Court has required a balancing of a number factors: private

“First, interest will be affected official action; second, the risk of an depriva- erroneous tion of such through interest procedures used, probable if value, any, of additional or proce- substitute dural safeguards; and finally, the Government’s inter- est, including the function involved and the fiscal and administrative burdens the additional or substitute g., See, Community e. Health Centers Act, 77 amended, Stat. as seq. U. S. C. 2689 et § 600 Mathews v. would entail.” requirement

procedural v. Smith quoted 335 319, (1976), 424 S. Eldridge, U. 848-849 Families, 816, S. Foster 431 U. Organization (1977). the child’s first consider we must criteria,

In these applying since however, Normally, committed. being interest in not interest parents’ inextricably linked with the this interest pri- child, health of and for the welfare obligation child’s of the combination a interest at stake is vate interest the State’s examine we must parents’ Next, concerns.11 and treat- adopted for commitment has procedures in the it well how consider we Finally, must ment of children. deci- in the arbitrariness Georgia’s protect against procedures hospital. child a state to commit a sion adults, common with child, disputed It is not (a) unnec confined being in not liberty has a substantial interest involve the state’s essarily for medical treatment action state decision constitutes ment in the commitment Texas, Addington v. See the Fourteenth Amendment. under ; 27 Gault, (1967) In re 387 U. S. (1979); 418, 441 U. S. recognize also Patterson, We (1967). S. Specht v. U. conse social produces adverse sometimes that commitment to the of some reaction quences because Cf. care. psychiatric received discovery that the child has Texas, supra, at 425-426. Addington v. the com- equated need

This reaction, however, state labeled resulting being from munity response dangerous. mentally possibly ill and delinquent, criminal, as or Davis, Gault, 424 U. S. ibid.; supra, 23; In re Paul See voluntary com- its through 711-712 The state provides it child; does not “label” the procedures mitment arising when opinion, the issues part of the we will deal with In hospital. In to a state the child seek commitment natural IV, presented when the child is deal with the situation Part we will of the state. ward

601 diagnosis and treatment that medical specialists conclude the In requires. child terms public of reaction, the child who exhibits may abnormal behavior seriously injured by an erroneous decision not to commit. Appellees overlook sig- a nificant public source of the reaction mentally for ill, truly what is “stigmatizing” is symptomatology a mental of or emotional Addington Texas, illness. supra, at 429. See also Psychiatric & Schwartz, Astrachan, Myers, Labeling the Rehabilitation of the Mental 31 Archives of Gen- Patient, eral Psychiatry (1974).12 329 pattern The of ab- untreated, normal behavior —even if nondangerous at as least —arouses much negative reaction as treatment that public becomes knowledge. A person but not needing, receiving, appropriate may medical care well greater face even social ostracism resulting from the observable symptoms an of untreated disorder.13

However, we need not decide what effect these factors might have in a different purposes case. For of decision, we assume that child protectible has a only interest not in being free of unnecessary bodily restraints but also not being labeled erroneously by persons some an im- because of proper by decision the state hospital superintendent.

(b) We next deal with the interests of who have on decided, the basis of their observations and independent professional recommendations, that their child needs institu-

12 Fain, See also Gove & Stigma of Mental Hospitalization, 28 Psychiatry 494, General (1973); Archives 500 Phillips, Rejection of the Mentally Ill: The Sex, Influence of Behavior and Sociological 29 Am. Rev. (1964). 686-687 Schwartz, Research Myers, and Astrachan and Gove and stigma Fain found “that the hospitalization of mental major problem ex-patient.” for the Schwartz, Myers, Astrachan, & Psychiatric Labeling and the Rehabilitation of the Patient, Mental Psychiatry Archives of General Myers, As Schwartz, and Astrachan concluded: “Discharge hospital] a mental before [from disturbed behavior is well con- may trolled patient advance the an inhospitable into world that can incu- bate chronicity that was to be place.” Id., avoided the first at 334. rights constitutional argue Appellees tional care. likelihood magnitude such child inter- traditional parents’ great so abuse is parental their upbringing responsibility in and the. ests providing extent least to the be subordinated must voluntary commitment. to a prior adversary hearing formal civili Western reflected historically has jurisprudence Our parental broad unit family as a concepts of zation consistently have Our cases children. minor authority over re ago long system course; our constitutional followed that of the creature mere is “the a any notion that child jected generally parents that asserted contrary, on the and, State” and recognize high duty, coupled with right, “have the Pierce obligations.” for additional prepare children] [their Wis also See Sisters, 535 510, 268 U. Society v. S. Massa Prince v. (1972); 213 Yoder, 205, 406 consin v. U. S. Nebraska, 262 Meyer v. (1944); 166 chusetts, U. S. 321 duty” to “high a includes (1923). Surely, 400 U. S. medical follow and to seek and illness recognize symptoms of presump on family a of the rests concept law’s advice. The ex in maturity, child lacks what a possess parents tion that making life’s for required judgment capacity perience, and recog historically has it important, More difficult decisions. in to act parents lead bonds that natural affection nized Blackstone, 1 Commen children. W. of their best interests *190. American Law on 2 Commentaries ; Kent, J. taries *447 experience legal presumptions, many As with so other point; a accepts starting what the as reality may rebut law this. attests abuse cases neglect of child the incidence against “may acting times parents That some Kremens, Bartley v. in as stated of their children” was interests remanded, (ED Pa. vacated 1975), 1039, 1047-1048 Supp. F. 402 but for caution, a (1977), creates basis U. S. 43 pages of human wholesale to discard those reason hardly is in the generally do parents that act teach еxperience child’s best interests. See Rolfe & MacClintock 348-349. The statist notion governmental power should supersede parental authority all cases because some abuse and neglect children repugnant to American tradition. we have

Nonetheless, recognized state is not without constitutional control over parental discretion dealing with- children when their physical or mental health is jeopardized. See Wisconsin v. Yoder, supra, at 230; Prince Massachusetts, v.

supra, at 166. Moreover, Court recently declared uncon- stitutional state statute that granted parents an absolute veto over a minor child’s decision to have an abortion. Planned Parenthood Central Missouri Danforth, U. S. 52 (1976). Appellees urge precedents that these limit- ing the traditional rights of if parents, viewed the context liberty interest of and the of paren- likelihood tal abuse, require us to hold parents’ that the decision to have a child admitted to a mental hospital subjected must be an exacting constitutional scrutiny, including a formal, adversary, pre-admission hearing.

Appellees’ argument, however, sweeps broadly. too Simply because the decision of a parent is not agreeable a child to or because it involves risks does not automatically transfer the power to make that decision from the parents to agency some or officer of the state. The same characterizations can be made for a tonsillectomy, or appendectomy, other procedure. medical Most children, even in adolescence, simply are not to able make judgments sound concerning many decisions, including their need for medical or care treatment. Parents can and must make those judgments. Here, there is no finding by the District Court even a single instance of bad faith any parent of any member of 'appellees’ class. We cannot assume that the result in Meyer v. Nebraska, supra, and Pierce v. Society Sisters, supra, would have been different if the children there had a preference announced to learn only Eng- lish or a preference go to ato public, rather than a church, or hospitalization at balk may a child that The fact school. surgery cosmetic provide to refusal parental about complain best is what authority to decide parents’ the diminish does the for Care Medical Goldstein, generally See the child. Autonomy, Parental Supervention On State at Risk: Child Allocation Bennett, (1977); 664-668 J. Yale L. Suggested Authority: A Decisionmaking Care Medical Child Neither Rev. L. 62 Ya. Analysis, Interest such review to equipped are courts nor federal officials state decisions. parental Parenthood, Planned on reliance particular place

Appellees par- deference little how holding indicates its that arguing a constitu- exercising is the child when appropriate ents was however, case, in that situation basic right. tional pa- absolute an involved Parenthood Planned different; very abortion. obtain an ability to the child’s over rental veto com- right to an absolute have in no sense Georgia Parents re- statute the hospitals; state mental children their mit to exercise hospital regional of each superintendent quires for confinement. need child’s as to judgment independent supra, 591. See of the and prerogatives rights respective defining

In we setting, voluntary commitment in the parent child and retain parents permit precedents our that conclude absent decision, in the role dominant, if not the substantial, pre- traditional abuse, neglect or finding their interests best act sumption conclude, however, alsoWe apply. should decision commitment nature and the rights child’s unreview- always have absolute parents cannot such that a child institution- have whether to to decide discretion able such authority to seek plenary retain course, They, alized. independent subject physician’s to a children, for their care judgment. and medical examination con- significant interest obviously has

(c) The Statе fining the use of its costly mental health facilities to cases of genuine need. The Georgia program seeks first to determine whether patient seeking admission has an illness that calls for inpatient treatment. To accomplish purpose, has State charged the superintendents of each regional hospi- tal with the responsibility ‍​​​‌​​​​‌​‌​‌​​‌​‌​​​​​​‌​‌‌​‌‌​​‌​​‌​​‌‌‌‌​​​​‌‍for determining, before authorizing an admission, whether a prospective patient is mentally ill and whether the patient will likely benefit from hospital care. In addition, the State has imposed a continuing duty on hospital superintendents to release any patient who has recovered to point where hospitalization is no longer needed.

The State in performing its voluntarily assumed mission also has a significant interest in not imposing unnecessary pro- cedural obstacles that may discourage mentally ill or their families from seeking needed psychiatric assistance. The parens patriae interest in helping parents care for the mental health their children cannot be fulfilled if are unwilling to take advantage of the opportunities because the admission process is too too onerous, or too con- embarrassing, tentious. is It surely not idle to speculate as many to how parents who believe they acting good faith would forgo state-provided hospital care if such care contingent is on participation in an adversary proceeding designed to probe their motives and other private family matters in seeking the voluntary admission.

The State also has genuine interest in allocating priority to the diagnosis and of patients treatment as soon as they are admitted ato hospital rather than to time-consuming proce- dural minuets before the admission.14 One factor that must

14Judge Friendly cogently has pointed out: “It should be procedural realized requirements entail expendi- ture of limited resources, point that at some the benefit to individuals from an safeguard additional substantially outweighed by the pro- cost of viding such protection, and that the expense of protecting likely those to be found undeserving probably will come out of pockets 606 psychiatrists, of time of the utilization is the

be considered for preparing specialists behavioral and other psychologists, the performing than hearings rather' participating Be- them. has fitted training special which their for task little are of hearings courtrooms experts in havioral help patients. to al. et Association Psychiatric American brief amici ain psychiatrist staff average page 20 out at

points to time his only devote able to presently is hospital 47% pro- increasing the consequence One care. patient direct voluntary child’s prior provide must state cedures be will professionals health mental be that admission will in order patients treatment from more even diverted be could for—what wait in—and participate to and travel year. Obvi- each hearings thousands —of even hundreds —or public from the would come procedures of these ously the cost See care. health for intended moneys legislature 34-35. Slovenko protects process what consideration turn to We now

(d) reducing risks rights constitutional the child’s adequately parental on trenching traditional unduly without of error “efforts, to further undercutting authority without patient and the state both the interests legitimate Texas, 441 Addington v. voluntary commitments. by” served at 335. Eldridge, 424 S.,U. v. Mathews also 430. See S.,U. parental inherent risk of error conclude We health for mental child institutionalized have a decision to inquiry should kind sufficiently that some great care whether determine “neutral factfinder” by a made See are satisfied. admission statutory requirements Morrissey v. (1970); 271 254, S. Kelly, 397 U. Goldberg v. care- must inquiry That (1972). 489 Brewer, U. S. Hearing,” 123 Pa. L. U. Rev. Friendly, Kind of deserving.” “Some Montgomery, 280, 282 S.U. Wheeler also See opinion). (1970) (dissenting

fully probe the background child’s using all available sources, including, but not limited to, parents, schools, other social agencies. Of course, the review must also include an interview with the child. It is necessary that the decisionmaker have the authority to refuse to any admit child who does not satisfy the medical standards for admission. it is Finally, necessary that the child’s continuing need for commitment be reviewed periodically by a similarly independent procedure.15

areWe satisfied procedures that such protect will the child from an erroneous admission decision in a way that neither unduly burdens the states nor parental inhibits decisions to seek state help. process

Due has never been thought to require that neutral and detached trier of fact be law or judicial trained or administrative officer. See Goldberg v. Kelly, supra, at 271; Morrissey Brewer, supra, at 489. this is the Surely, case as to medical decisions, for “neither judges nor administra- tive hearing officers are qualified better than psychiatrists to render psychiatric judgments.” re In Roger S., 19 3d Cal. 921, 942, 569 P. 2d 1286, 1299 (1977) (Clark, J., dissenting). Thus, staff physician will suffice, so as long he or she is free to evaluate independently the child’s mental and emotional condition and need for treatment.

It is not necessary that the deciding physician conduct a quasi-formal formal or hearing. A state is free to require such a hearing, but process due is not violated by use of informal, traditional medical investigative techniques. Since well-established procedures medical already exist, we do not undertake to outline with specificity precisely what this inves- tigation must involve. The mode and procedure of medical 15As we discuss fully more later, infra, the District Court did not decide and we therefore have no reason to consider at this time what procedures for review are independently necessary justify continuing a child’s merely confinement. We hold that a subsequent, independent of patient’s review provides condition a necessary check against pos sible arbitrariness in the initial admission decision. isWhat judges. of business not the is procedures diagnostic be must that decision medical an individual is for a child best no doWe case. in each physicians of judgment left to the an represent should decision that emphasize than more all requires the child what of judgment independent by phy- on traditionally relied information sources be consulted. should specialists and behavioral sicians divorced cannot constitutionally due is process What made. being decision ultimate nature from the most made can be officers state determination every Not or admin judicial tools procedural “the effectively by use Univ. Curators Board decisionmaking.” istrative also See Horowitz, 435 U. S. Missouri v. ante, 13-14; Inmates, at Penal Nebraska Cafe v. Greenholtz 895 367 U. S. McElroy, v. Workers & teria Restaurant (1961).16 gov 16 dealing with past decisions from statements general Relying on here, the involved remotely to those similar even actions ernmental must there involved then interest is protectible if a that concludes dissent hearing or administrative adversary, judicial, traditional, form

be some mandated, in their is result That deprivation. its or after before either protect designed to has the state process what view, regardless of the fair as to record demonstrates regardless what the individual approach. ness state’s that assertion repeated our inconsistent with is dissenting approach as the protections procedural for calls such process is “due flexible 471, 481 Morrissey Brewer, 408 U. S. v. demands.” particular situation exactly as to requirement there no added). is Just as (emphasis (1972) hearing is judicial-type a traditional employ whenever procedures to what v. McDon (1975); 565 Lopez, 419 U. v. S. mandated, compare Goss Wolff Goldberg v. supra, Brewer, with Morrissey v. (1974); nell, 418 U. S. judicial-type require a is no reason (1970), there S. Kelly, 397 U. expands governmental action scope As the circumstances. hearing in all review, incum it is judicial for controversies creating new areas new into individual protect rights that design procedures on courts bent the states deal legitimate burdening efforts unduly without con factfinding for all judicial model for problems. The social difficult nature, ra can turn regardless of their interests, stitutionally protected enterprise. unmanageable decisionmaking into an tional Here, the questions are essentially medical in character: whether the child mentally is or emotionally ill and whether he can benefit from the treatment provided is the state. While facts are plainly necessary for a proper resolution of those they questions, only a first step in the process. In an opinion for a unanimous Court, we recently stated in Addington Texas, S.,U. de- termination a person whether mentally ill “turns on the meaning of the facts which must interpreted by expert psychiatrists and psychologists.”

Although we acknowledge the fallibility of medical psychiatric diagnosis, see O’Connor v. Donaldson, 422 U. S. 563, 584 (1975) (concurring opinion), we do not accept notion that the shortcomings of specialists can always be avoided by shifting the decision from a trained specialist using the traditional tools of medical science to an untrained judge or administrative hearing officer after a judicial-type hearing. Even after a hearing, the nonspecialist decisionmaker must make a medical-psychiatric decision. Common human ex- perience and scholarly opinions suggest the supposed protections of an adversary proceeding to determine appropriateness of medical decisions the commitment and treatment of mental and emotional illness may well be illusory more than real. See Albers, Pasewark, & Meyer, Involuntary Hospitalization and Psychiatric Testimony: The Fallibility of the Doctrine of Immaculate Perception, Cap. IT. L. Rev. 11, 15 (1976).17

17See Albers & Pasewark, Involuntary Hospitalization: Surrender at the Courthouse, 2 Am. Community J. Psychology 287, 288 (1974) (mean hearing time for 21 of 300 consecutive commitment cases was 9.2 minutes); Miller & Schwartz, County Lunacy Commission Hearings: Some Observa tions of Commitments to a State Mental Hospital, 14 Social Prob. 26 (1966) (mean time for hearings minutes); was 3.8 Scheff, The Societal Reaction to Deviance: Ascriptive Psychiatric Elements the Screening of Mental factfinding formalized, a requiring with problem Another into intrusion significant poses it danger the lies in hearing child and parents Pitting the relationship. parent-child the presumption the with odds be at will often adversaries as one is It child. of their interests in the best act parents review careful a make to physician a neutral require thing to from proper is sure it make to in order decision parents’ the employ matter to wholly different is a it standpoint; medical moti- parents’ the whether ascertain contest adversary an interests. child’s the with consistent is vation such into how inquire appropriate is it Moreover, treat- long-range successful to the contribute would hearing it would a risk is there Surely, patient. the ment of the between already exist tensions whatever exacerbate do usually and can parents the Since parents. and the child child the while treatment in the role signifícánt play ais serious there release, after more so even and hospitalized the adversely affect will adversary confrontation an risk hospital. in the while child the to assist parents the ability of more diffi- home return subsequent his make it will Moreover, critical especially results unfortunate These cult. occur likely to they seem child; emotionally disturbed

an parents the in which hearing adversary an context the family relation- intimate such over A confrontation testify. impact adult normal distress ships would significantly be would certainly almost child on a disturbed greater.18 (average (1964) hear- Prob. 401 State, 11 Social in a Midwestern Patients Attorney and Cohen, Function minutes). See also 9.2 ing lasted L. Ill, 44 Texas Rev. Mentally of the Commitment apparently opinion Court District clear, altogether While proposed notice by a written preceded hearing contemplated a given an presumably would hearing the At commitment. right to cross- evidence, present be heard opportunity also The court course, parents. witnesses, including, examine by suggested hearing

It has been that a conducted someone in order to admitting physician necessary than the is other their parents “guilty railroading instances where detect asylums” using “voluntary into or are commitment children they disap- in procedures order to sanction behavior which Commit- prove].” Ellis, Volunteering Children: Parental of Minors to Mental L. Rev. Institutions, ment Calif. Parham, 412 F. 850-851 also See J. L. v. seems 133; Appellees Curiously, Brief for 38. it Supp., at “dump” their granted parents to be who to taken seek their inevitably will be able conceal children on the state to admitting psychiatrists motives and thus deceive the review the professionals other mental health who make and elementary early diagnostic is admission It that one decision. of a child into of an emotional disturbance inquiry the cause is into of the child. is an examination the environment It an abandon if not that a decision to unlikely, inconceivable, into in- him an emotionally healthy child and thrust normal, circumstances. leaving discrete no stitution will be a act trail interviews emerge conflicts will either Evidence such believe secondary unrealistic to from sources. It or sorting eliciting responses, skilled in psychiatrists, trained nuances sensing motivational medically facts, relevant surrounding family often situation will be deceived about required render a written decision impartial an trier of fact who would accepting rejecting parental application. reciting or the reasons for seeking the admission to parents in this situation are child’s Since the procedure contemplated the District Court institution, the state guard- person designated be as a call for other to presumably would some lawyer, guardian, turn, if not a ad litem to act for the child. The ian the child’s an advocate of empowered retain counsel act as would interest. adversary may hearings course, provide elect such

Of state may odds, and a child be at perceives it situations where compels procedures. nothing but in the Constitution such 612 law- or even Surely lay, a disturbance.19 emotional child's process in this skilled more no would

trained, factfinder professional. than decision- medical in confidence some expressing

By free. is error it suggesting means by no arewe process, making admitting phy- an mislead initially may oсcasion, On as child diagnose erroneously may a physician or sician or an negligence because either care institutional needing error be risks may That there of caution. overabundance holding uncon- for predicate no rational affords process in scheme administrative statutory and entire an stitutional “[P]ro- 30 states.20 more than followed generally is it is by parents, 19 “dumping” detecting problem evaluating the In con hospitals has regional each of keep mind important Serv Family Children Department relationship with the tinuing when Department to the cases hospitals refer those staffs ices. sensitive and thus being mistreated a child they suspect family conflicts point. The is in situation fact, L.’s J. In problem. Equally well records. hospital in the documented well were problems disturbances emotional however, the child’s severe were documented, treatment. need his 36-518, 20 Ann. (1975); Stat. §§ Ariz. Rev. 47.30.020 Ann. Stat. § Alaska Inst.& (B) (1971); Cal. Welf. 59-405 Ann. Stat. (1974); Ark. § 36-519 21-512 §§21-511, 1979); D. Code C. (West Supp. Code Ann. §6000 88-503.1, 1979); Code (a) (Supp. (1) §§ Ga. 394.465 (1973); Fla. Stat. § child (1976) (only for (a) (2) 334-60 Stat. Rev. (1978); Haw. § 88-503.2 1978) may (parent (Supp. 66-318, 66-320 15); Idaho Code §§ than less Stat., release); Rev. may 16 Ill. obtain over but child under admit ; (1976) 16-14-9.1-2 1978); Ind. Code (Supp. § 3-502, 9iy2, 3-503 ch. §§ Ky. 1978); Stat. Rev. (Supp. 59-2905, 59-2907 Ann. Kan. Stat. §§ 1979); Supp. (C) (West Ann. (1977); Stat. §28:57 La. Rev. 202A.020 § permis 1978) (parental consent (Supp. (g) Code, Art. § Md. Ann. (a) 123, 10 Ann., ch. § facilities); Laws Mass. Gen. only to some sible may (child (1976) Comp. Laws 1979); Mich. §330.1415 (West Supp. 41—21— Ann. Code hearing); Miss. § receive days and object within physicians from two for treatment (certificate need 1978) (1) (Supp. (2) (1978); Nev. (2) (1)(2), 202.115 Stat. required); Mo. Rev. §§202.115 Hyg. 9.13 Law § Mental (1975); N. Y. 422A.560, 433A.540 Stat. §§ Rev. process shaped by cedural due rules are the risk of error process applied gen inherent as to the truthfinding erality Eld exceptions.” not the rare Mathews v. cases, ridge, 424 at 344. In we are satisfied S., general, U. an in independent decisionmaking medical which process, thorough psychiatric investigation earlier, cludes the described followed additional periodic condition, review of a child’s protect will admitted; children who should not we do be significantly believe the risks of be process error would by reduced a issue judicial-type hearing. more The formal, whether in the Georgia remains as described practices, comport process record before with minimum due us, these requirements. a medical

(e) Georgia’s diagnostic statute careful envisions by at each inquiry admitting physician be conducted regional brief for United hospital. The amicus States explains, pages at 7-8: every or not instance the decision whether

“[I]n accept by physician the child treatment is made employed by the .... State decision is based on interviews and recommenda-

“That by hospital community or health center staff. tions parent guardian interviews the child and the or who staff facility attempts are brings the child to the . . . [and] (McKinney 1978) may admit, may release); (parent child obtain own but 1977); (Supp. D. Code Ann. N. Cent. Code 25-03.1-04 Ohio Rev. § (B) 1978); (Supp. Stat., 43A, (1971); Okla. Tit. Ore. Rev. 5122.02 § § (1977); Ann., (Purdon (1) Supp. Stat. Pa. Stat. Tit. §426.220 §7201 1978-1979) (only 14); (Supp. for child less than I. Laws 26-2-8 R. Gen. § (requires insane); 1978) physicians certificate of two that child is C. S. (2) (Supp. 1978); Comp. Code 44^17-310 S. D. Ann. 27A-8-2 Laws § § (a) (1976); (1) (1977); Tenn. Code Ann. 33-601 Utah Code Ann 64r- §§ § 7-29, (2) (1953); (2) (1978) (child 64-7-31 Wash. Code 72.23.070 Rev. § consent); (b) (1976) (consent over 13 also must W. Ya. Code §27-4^1 required); Wyo. (a) (i) (1977). of child over 12 Stat. §25-3-106 possible sources with other to communicate made the child . about information . . any absence of as the on it saw what

Focusing primarily deci- initial physician’s review of the mechanism for formal de- the medical unaccountably saw the District Court sion, Supp., discretion.” F. of “unbridled cision as exercise an no substitute extravagant characterizations at 136. But Georgia process we must examine for careful analysis, person one exercises any setting if, to determine indeed, its such discretion. initially conclude

In of a typical case, prob- there is some emotional from child’s behavior that They may respond wrong.” “something short, lem—in con- generally the first problem ways, various but to the bring child to they occurs when tact the State community psychologist psychiatrist or examined clinic. mental health outpatient by examination is followed

Most often, child’s In community addition, clinic. treatment at participate required, sometimes encouraged, insight a bettеr family therapy in a obtain program to a all the care In problem. into this is instances, most outpatient care, period of requires. if, However, after may be he persists, condition the child’s abnormal emotional regional by clinic staff to an affiliated referred the local hospital. composed of regional hospital an admissions team

At professional one other mental health psychiatrist and at least in- privately interviews the examines and most child — pro- records then examines the medical This team stances. parents. clinic Based on vided staff and interviews the any background that can information, additional diagnosis and deter- obtained, the admissions team makes a likely will from institution- mines whether the child benefit alized If care. the team finds either condition not met, admission is refused.

If the team admits a child as suited for hospitalization, child’s condition and continuing need for hospital care are reviewed periodically by at- least one medical independent, review group. For the most part, the reviews are as frequent as weekly, but none are less often than every once two months. Moreover, as we noted earlier, the superintendent of each hospital charged with an affirmative statutory duty to dis- charge any child who is no longer mentally ill or in need of therapy

As with most medical procedures, Georgia’s are totally free from risk of error in the sense they give total or absolute assurance that every child admitted a hospital has a mental illness optimally suitable for institutionalized treat- ment. it But bears repeating that “procedural due process rules are shaped by the risk of error inherent in the truth- finding process applied as to the generality of cases, not the rare exceptions.” Mathews v. Eldridge, supra, at 344.

Georgia’s procedures are not “arbitrary” in the sense that a single physician or professional other has the “unbridled dis- cretion” the District Court saw to commit a child to regional hospital. To so find on this rеcord would require us to as- sume that the physicians, psychologists, and mental health professionals who participate in the admission decision and who review each other’s conclusions as to the continuing validity of the initial decision are either oblivious or indif- ferent to the child’s welfare —or that they are incompetent. We note, however, District Court found to the contrary; it was “impressed by the conscientious, dedicated state em- 21While the record does demonstrate that procedures may vary from case case, it also reflects that no child Georgia in was admitted for indefinite hospitalization being without interviewed personally and without the admitting physician’s checking with secondary sources, such as school or work records. conscien- equally help with the who, psychiatrists

ployed and social psychologists employed state dedicated tious, .” children . . . plaintiff for faithfully care workers, Supp., F. at 138. effectively rebuts also Court District finding

This hospital that amici of the briefs made in some the suggestion detached” “neutral and actually be may not administrators no child who has to admit pressure because institutional may place take a practice such care. That hospital need for for a find- affords no basis places in in some some institutions pro- in the record the evidence Georgia’s program; as to ing the staffs charge against for support no whatever vides if cases, hospitals. Such eight regional any of the State’s they do not individually;22 they can be dealt found, to class-action remedies. lend themselves a whole record as the voluminous We are satisfied that staffs of the hos- conclusion the admissions supports the in mak- fashion acted in a neutral and detached pitals have children. in the best interests judgments medical ing programs, provides mental health State, through its to assist exam- authority professionals for trained emotionally children. treating disturbed ining, diagnosing, provides well-staffed and Through hiring practices, its it found— hospitals and —as the District Court well-equipped benefi- public employees implement State’s conscientious purposes. cent case satisfies our of the record us

Although review statutory administrative and scheme Georgia’s general voluntary per commitment of children is not se for the obtaining important means of individual relief for these children One availability corpus. appellants’ explains, As the brief of habeas any ‍​​​‌​​​​‌​‌​‌​​‌​‌​​​​​​‌​‌‌​‌‌​​‌​​‌​​‌‌‌‌​​​​‌‍provides that at and without 88-502.11 . . . time notice “Ga. Code § may facility, person, or a relative or friend of such person detained question corpus legality petition a writ of habeas the cause and person.” Appellants Brief for the detention of the 36-37. unconstitutional, we cannot on decide this record whether every in appellees’ class received an inde- adequate, pendent diagnosis of his emotional condition and need for confinement under the standards announced earlier this opinion. On remand, the District is free Court and should any consider individual claims that initial did admissions not meet the standards we have described in opinion.

In addition, we note appellees’ original complaint alleged that the had State failed provide adequate periodic review their need for institutional care and claimed that this was an process additional due violation. Since the District Court held that appellees’ original confinement was unconstitutional, it had no reason to separate consider this claim. Similarly, we have no for basis whether determining procedures review hospitals various are adequate to provide process called for or process what might if required a child contests his by requesting. confinement a release. These require matters factual findings present not in the District opinion. Court’s peri- We have held that the odic reviews described in the record reduce the risk error the initial admission they and thus are Whether necessary. they sufficient to justify continuing voluntary commit- ment is an issue for the District Court on The Dis- remаnd. trict Court is free require additional evidence on this issue.

IV (a) Our discussion in III Part was directed at situation where a child’s natural request his admission to a state mental hospital. appellees’ Some members of class, including J. R., were Georgia wards of the State of at the time of their Obviously admission. their situation differs from those members of the parents. class who have natural While process determination what is due varies some- what when the rather than a state, natural parent, makes request we conclude commitment, that the differences proce- different requiring justify do the two situations to the admission initial the child’s of the time dures hospital. no adult may well be there state, a ward of the

For deeply. him for who cares thoroughly him knows who natural a presumed there is where natural with Unlike Commentaries Blackstone, action, W. their to guide affection *190, Law American on Commentaries Kent, *447; J. general child’s a protect state the will that presumption the 24A- § Code Ga. statute. state specific a from stems welfare how- dissent, the of suggestion Contrary the to has Georgia the when State that assume cannot ever, we parent natural differently from a so it acts of a child custody has one No child. for the assistance seeking in medical that statutory presumption validity the questioned such Nor could interest. child’s best acts in the State no is us. There before on the record be mounted challenge admit to attempted as State, acting guardian, that the evidence treat- for child’s need unrelated to any child reasons appellees nor the District Court neither the Indeed, ment. any receive should of the State that wards suggested have with natural from children different treatment constitutional parents. child’s for a application State’s accept we

Once ques- then good faith, in hospital is made to a admission decisionmaking approach the medical is whether tion process. We satisfy to due adequate is physician admitting judg- independent medical that an recognized alrеady have of the interests of the best perspective from the made ment means acceptable an investigation a careful child after We do not believe voluntary commitment. justifying less any the decisionmaking is of this the soundness in setting. reasonable regard to wards with the decision anything, if

Indeed, light in of the reasonable more may well be even the State extensive written records compiled that are about each child while the State’s In custody. case, admitting R.’s J. physician a complete had social history and medical child before even diagnosis. carefully After beginning him interviewing reviewing phy- his three files, extensive sicians independently concluded that institutional care was his best interests. supra, See at 590.

Since the agency having state custody and control of the loco parentis duty has a to consider the best interests of the child respect to a decision on commitment mental hospital, may the State constitutionally allow custodial agency speak for the child, subject, course, the restrictions governing natural parents. On this we record, cannot declare Georgia’s unconstitutional proce- admission dures for wards the State.

(b) It is possible that the procedures required in reviewing a ward’s need for continuing care should be different from those used to review the need a child with natural parents. As we have suggested the issue of earlier, process what is due justify to continuing voluntary commitment be must con- sidered by the District Court on remand. In making that in- quiry, the District might Court well consider whether wards of the State should be with respect treated continuing ther- apy differently from children with natural parents.

The absence of an adult who deeply cares for a child has little effect on the reliability of the initial admission de- cision, but it may have some effect on how long will remain in hospital. We noted in Addington Texas, 441 U. atS., that 428-429, “the concern family and friends generally provide will opportunities continuous for an errone- ous to be commitment corrected.” aFor child without natural parents, we must acknowledge the risk of being “lost shuffle.” Moreover, there at is least some indication that J. R.’s commitment was prolonged because the Department of Family and Children Services difficulty had finding a foster have generally of the State wards him. Whether home for parents, natural children with than protection less received matters are however, it, done about what should be if and, so, District by the instance first in the decided must that is still issue court concludes if the remand,23 Court on alive.

V Georgia’s purpose remember the we that important is It substan- seeks It program. health comprehensive cannot who for those care provide great cost tively and to screen procedurally treatment private to obtain afford care institutional to assure applicants carefully all com- resists The State patient. particular suited to because District Court by the ordered procedures plex rights, child’s unnecessary protect they are its view objective central from resources public they divert tensions risk care, they aggravating health administering barriers they erect family situation, in the inherent dis- aid medical seeking from discourage parents may child. turbed medical Georgia’s satisfied we are record,

On this with con- consistent reasonable processes factfinding to hold it error Accordingly, was guarantees. stitutional a child admitting for procedures State’s the unconstitutional is judgment The hospital. to a state for treatment 23 violation, Court ordered the District remedy constitutional the To 2, supra. class, see n. plaintiff of for each member hearings be held to “less drastic” to treatable in of the class found members For 46 moneys expend such to also State District Court ordered settings, the programs. facilities and treatment necessary provide alternative to as were remedy due for substantive as a a appropriate more the order is While The on that order findings made no issue. violation, court process remedy process violation procedural due to was intended apparently no for to reversed, basis us judgment is there Since that it found. remedy. the correctness consider

621 therefore reversed, the case is remanded the District Court for further proceedings consistent with this opinion.

Reversed and remanded. Justice Stewart, in concurring the judgment. Mr. For centuries it has been canon of common law parents speak for their minor deeply children.1 So imbedded in our traditions is this principle of law that the Constitution may compel itself respect it. Meyer Nebraska, State v.

262 U. S. 390; Society Sisters, Pierce v. 268 U. In S. 510.2 of ironic contrast, the District Court in this has said that case requires the Constitution the State of Georgia disregard principle. I established agree. cannot 1 Blackstone, 1 See *452-453; Kent, W. Commentaries J. Commen taries on *203-206; Schouler, American Law J. A on the Treatise Law (3d Domestic 1882); Field, Legal Relations 335-353 ed. G. Relations Infants 63-80 “It is cardinal us custody, that the care and nurture of reside first parents, in the primary whose function and freedom include preparation obligations supply state can neither nor hinder.” Prince Massachusetts, v. 158, U. S. 166. history “The and culture of Western strong civilization reflect tradition parental concern for the upbringing nurture and of their children. This primary role of the upbringing of their children is now beyond established enduring debate as an American tradition.” Wisconsin Yoder, 205, S.U. 232. may “Because he not foresee the consequences decision, of his a. minor may not make an bargain. may enforceable He lawfully not work or travel where pleases, he or even attend constitutionally exhibitions of protected pictures. adult motion Persons age below a may certain marry parental without consent.” Planned Parenthood Central Mis- Damforth, souri v. 428 U. S. 102 (SteveNs, J., concurring part dissenting part). Stump Cf. v. Sparkman, 435 U. S. (dissenting opinion). 2“The child is not the mere creature the State; those who nurture destiny him and direct his right, have the coupled high with the duty, to recognize prepare him obligations.” for additional Society Pierce v. Sisters, S., 268 U. at 535. mental to а commitment no doubt There can be liberty,” of curtailment “massive results institution In addition to 504, 509. Cady, U. S. Humphrey v. Donaldson, 422 O’Connor involved, confinement physical by affected substantially liberty is also person’s U. S. But hospital.3 in a mental to treatment stigma attached liberty, of deprivation liberty is every governmental loss of not Process Clause Due invokes the only is the latter and it Amendment. Fourteenth of the section following under the committed appellees

The were Code: of the Georgia voluntary patients— to

“Authority receive for may facility receive any “(a) superintendent years age, any diagnosis individual and observation individual any making therefor, application or older, made application for whom such years age under 18 adjudged legally any person by guardian his or parent is made application whom such incompetent for to be mental illness evidence If found to show his guardian. may be person such treatment, be suitable person facility and such at such care and treatment given period facility for such by such may detained be by law.” may authorized as be under conditions such 88-503.1 § Ga. Code had were adults who in this case appellees if the

Clearly, themselves a state voluntarily chosen to commit thereby had not claim State they could hospital, Fourteenth liberty in violation deprived them whose I children on clearly, think, Just as Amendment. may mean it does stigma unjustified be The fact that such past public reaction commit the fact that does not exist. Nor does detract from may to aberrant behavior ment than the reaction less past may disappear, while fact assessment. The aberrant behavior lasts forever. institutionalization

behalf parents their have invoked these voluntary procedures can make no such claim.

The Georgia statute recognizes the power party to act on behalf of another person under the voluntary commitment procedures in two situations: when the other person is a minor not over 17 years of age and the party is that person’s parent or guardian, and when the other person been has “legally adjudged incompetent” and party the person’s that guardian. In both instances two conditions are present. the First, person being committed is presumptively incapable making voluntary commitment decision for himself. And second, parent or guardian is presumed to be acting person’s best interests.4 In the case of guardians, these presumptions grounded are in statutes whose validity nobody questioned has in this case. Ga. Code § 49-201 (1978).5 In the case of the presumptions parents, grounded in a statutory embodiment of long-established principles of the common law.

Thus, the basic question in this case is whether Consti- tution requires Georgia ignore basic principles so long accepted by our society. For only if the State this setting is constitutionally compelled always to intervene between parent and child can there any question as to the constitu- tionally required extent of that intervention. I believe question basic must be answered in the negative.6 4 This is also true of a child removed from'the control of his parents. For juvenile court then duty has a to “secure for nearly him care as possible equivalent as to that which parents] [his should given have him.” Ga. Code §24A-101 power “The guardian of the over the person of his or her ward shall be the same as that parent of the over child, his or her guardian stand ing in his or her place; and in like manner it shall duty be the guardian protect and maintain, and, according to the circumstances of ward, to educate him or her.” 6 Planned Parenthood Central Danforth, Missouri U. S. was entirely an different ease. The Court’s opinion today discusses some for their decisions make constantly law, our Under some- liberty, children deprive children minor Amend- Fourteenth surely Yet itself. life even times upon decides parent informed an when invoked ment is I can hospital. a state child, even his surgery major commit- between differences constitutional basic no perceive decisions parental and other hospital to a ment liberty. of loss a child’s in result his commit to decision a parent’s that course, realize, I loss greater ain far results institution mental ato state child appendectomy an have to his decision does liberty than contrary if, But hospital. in a state the upon performed aof level difference, to the rises this factual my belief, objective I that believe difference, then constitutional in embodied decision, commitment parents’ upon the checks are 613-617, ante, at discussed, thoroughly and law Georgia constitutionally sufficient. more than acting in the is parent presumption sure,

beTo since one, rebuttable be a must his child interests best motive unselfish by the actuated are parents all certainly parents. unfit simply are Some presumes. law can parent unfit that an clearly provides Georgia But with dealing laws authority under parental his stripped of children.7 abuse and neglect family and involving the Issues easy case. an is not

This difficult most among illness mental concerning issues serious do they often involving as face, have that courts constitutional questions disguised as policy problems one. a more fundamental is there I think ante, differences, at but these an upon decide right to expectant mother’s an case involved The Danforth Wade, 410 v. right. Roe constitutional substantive personal abortion —a in contrast, appellees By 179. Bolton, 410 U. S. 113; Doe U. S. hospitalized to be right not constitutional no substantive had this case psychiatric treatment. 630-631, n. 16. post, opinion, BreNNAN’s See Mr. Justice

law. But when a state legislature makes a reasonable defini- tion of age of minority, creates rebuttable presump- tion in invoking the statutory procedures for voluntary parent commitment a is in acting the best interests of his I minor child, cannot believe that the Fourteenth Amendment is violated. This is not to say that in this area the Constitu- tion compels a respect State to authority traditional aof parent, as the Meyer and Pierce I cases. believe, as Prince v. Massachusetts, 321 U. S. that the Constitution would tolerate intervention by the State.8 But that far cry frоm holding such intervention is constitutionally compelled.

For these reasons I concur in the judgment. with whom Mr. Justice Marshall

Mr. Justice Brennan, join, concurring Justice part and dis- Stevens Mr. senting in part.

I agree Court that the juveniles commitment of state hospitals by their parents or by state officials acting in parentis loco involves action impacts state upon constitutionally protected interests and therefore must be accomplished through procedures consistent with the constitu- tional mandate of process due of I law. agree also District Court erred in interpreting the Due Process Clause to require preconfinement commitment hearings in all cases which wish hospitalize to their I children. disagree, however, with the Court’s pretermit decision to questions con- cerning postadmission procedures due Georgia’s institu- tionalized juveniles. question While the of frequency postadmission hearings may review properly be deferred, 8The Prince case may held the State constitutionally intervene parent-child in the relationship purpose for the enforcing its child- labor law. If the intervened, procedures State its would, course, subject be to imposed by limitations the Fourteenth Amendment. 626 can should hearing and postadmission at least one

right to conclusion Court’s disagree I with the affirmed now. also of the State wards procedures juvenile due concerning unconstitu- Georgia I statute Georgia. believe that hearings to preconfinement tional in that it fails to accord acting by the State committed of the State juvenile wards -parentis. loco

I Rights Mental Institutions Committed Children necessarily entails a mental institution

Commitment Cady, 405 Humphrey v. liberty,” curtailment of “massive “fundamental inevitably affects (1972), and 504, U. 509 S. 113 Herald, Baxstrom 383 U. S. rights.” v. only deprived hospitals are incarcerated mental

Persons friends, deprived of they also physical are liberty, their patients mental community. Institutionalized family, continuous surroundings under the must live in unnatural to intrusive They subject strangers. control of are detailed may unwarranted, if violate their especially which, treatment in- may bodily modalities right integrity. Such treatment aver- psychotropic medication,1 clude forced administration psycho- therapy,3 even conditioning,2 sive convulsive ante, at as the surgery.4 recognizes, Court see Furthermore, as stigmatized confined in institutions persons denied, Miller, (CA2), 404 985 v. 446 F. 2d 65 cert. U. S. 1 See Winters (CA3 McGuire, (1971); Plante, 1976); Scott v. 532 F. 2d 939 Souder 1976). (MD Supp. 830 Pa. F. Mackey (CA8 Gillman, 1973); 2d v. Pro Knecht v. 488 F. See 1973). curer, (CA9 477 F. 2d 877 28, Wyatt (MD 26, Hardin, Ala., v. 3195-N Feb. June See No. Sheppard, July 1, 1975); 250, Price v. 239 N. 2d 905 307 Minn. W. May 16, (R) (SD Miss., (1976); Hudspeth, A. Nelson v. C. No. J75-40' 1977). 4 Michigan Dept. Health, v. 42 L. See Kaimowitz Mental U. S. W. (Cir. Wayne Cty., Mich., 1973). 2063 Ct.

627 sick and abnormal during confinement and, some cases, even after release.5

Because of these our considerations, cases made have clear that commitment to mental hospital “is a deprivation liberty which the State cannot accomplish due process without of law.” O’Connor v. Donaldson, 422 S. 563, (1975) U. J.,C. (Burger, concurring). See, e. g., McNeil v. Director, Patuxent Institution, 407 U. 245 (1972) S. (defective delin- quent commitment following expiration of prison term); Specht v. Patterson, 386 S. 605 (sex U. (1967) offender com- mitment following criminal conviction); Chaloner v. Sher- man, 242 U. S. 455, (1917) (incompetence inquiry). In the absence of a voluntary, knowing, and intelligent waiver, facing adults commitment to mental institutions are entitled to full fair adversary hearings in which the necessity their commitment is established to the satisfaction of a neutral tribunal. At such hearings they must be right accorded the present to “be with counsel, have an opportunity to be heard, be confronted with against witnesses [them], have right to cross-examine, and to offer evidence of own.” [their] Specht Patterson, v. supra, at 610. principles

These also govern the commitment of children. “Constitutional rights do not mature and into come being magically only when one attains the state-defined ‍​​​‌​​​​‌​‌​‌​​‌​‌​​​​​​‌​‌‌​‌‌​​‌​​‌​​‌‌‌‌​​​​‌‍age of majority. Minors, as well as adults, protected by the Constitution possess constitutional rights. g., See, e. Breed Jones, 421 U. S. 519 (1975); Goss v. Lopez, 419 U. S. 565 (1975); Tinker v. Des School Dist., Moines 393 U. S. 503 (1969); In re Gault, 387 U. 1S. (1967).” Planned Parent hood Central Missouri v. Danforth, 428 S. U. it may

Indeed, well be argued that children are entitled to protection more than are adults. The consequences of an erroneous commitment decision are tragic more where chil generally See Note, Civil Commitment of Mentally Ill, 87 Harv. L. Rev. 1200 (1974). 628 for confined are average, the on Children, involved.

dren are ais Moreover, childhood adults.6 are than periods longer erroneously children life7 and of time vulnerable particularly the may bear years during their formative institutionalized provision the Furthermore, lives.8 of their the rest scars for gen for children care mental satisfactory institutionalized too commitment9 financial a substantial erally requires lower Decisions of forthcoming.10 been has often existing inadequacies have chronicled courts Assn. York State g., New e. See, for children. facilities health 756 752, Supp. F. 357 Rockefeller, v. Children Retarded for for School at Willowbrook (conditions 1973) (EDNY pro “failure involving “inhumane,” Mentally Retarded personnel substantial children,” safety of physical [the] tect Wyatt v. conditions); “hazardous” “poor” and shortage, sub 1972), aff’d (MD Ala. 391 Supp. 387, F. Stickney, 344 1974) (“grossly (CA5 2d 1305 Aderholt, F. 503 Wyatt nom. v. Mentally for the at Partlow School conditions substandard” inadequacies deplorable lead “hazardous Retarded operation”).11 institution’s commitment an erroneous chances addition, In 6 Biometry Health, Mental HEW, National Institute Dept. of See by Per Psychiatric Facilities 90, Utilization Branch, Note Statistical 1973). (July 14p. Age, Table Years of sons 18 7 Hor- (1953); J. 80 of Love Bowlby, Care and Growth Child See J. Agents of Elkin, (1976); F. 156 Psychology of Adolescence roeks, The 1968). ed. (R. Bergman 360 Behavior in Children’s Socialization 8 (1966); H. Leland 14-15 Flint, and the Institution The Child See B. Perspectives 86 Future Present and Smith, Retardation: & D. Mental (1975). 142-143 of Children Hobbs, The (1974); Futures N. 9 Children, Crisis Child Health Mental Commission on See Joint (1969). 1970’s, p. 271 Challenge Health: Mental 10 Changing Patterns Residential Wolfensberger, Kugel & See R. W. Mentally 22 Retarded for the Services 1973); (CA7 v. Wat Davis Glass, 473 F. 2d 983 v. also Wheeler See Supp. Likins, 373 F. 1974); (ND Welsch kins, Supp. Ohio 384 F. 1974). (Minn.

decision are particularly great where children are involved. Even under the best of psychiatric circumstances diagnosis and theraрy decisions are fraught with uncertainties. See O’Connor v. Donaldson, supra, at 584 (Burger, C. con- J., curring). These uncertainties are aggravated as when, under the Georgia the psychiatrist practice, interviews the child during period of abnormal stress in connection with the commitment, and without adequate time or opportunity to acquainted become patient.12 These uncertainties may be further aggravated when economic and social class separate doctor and child, thereby frustrating the accurate diagnosis of pathology.13

These compounded uncertainties often lead to erroneous commitments psychiatrists since tend to err on the side of medical caution and therefore hospitalize patients for whom other dispositions would be more beneficial.14 The National Institute of Mental Health recently found only 36% patients age below 20 who were confined at St. Elizabeths Hospital actually required such hospitalization.15 particu- Of lar relevance to this case, a Georgia study Commission on Mental Health Services for Children and Youth concluded that more than half of the State’s institutionalized children were need of confinement if other forms of care were made available or used. Cited J. L. v. Parham, 412 F. Supp. 112, (MD Ga. 1976). 12See J. Simmons, Psychiatric Examination of 1, (1974); Children Lourie Rieger, Psychiatric & and Psychological Children, Examination of in 2 American Handbook of Psychiatry (2d 1974). ed. 13See Joint Commission on Mental Health of supra Children, n.

at 267. 14See Seheff, T. Being Mentally Ill: Sociological A Theory (1966); Litwack, Ennis & Psychiatry and Presumption Expertise: Flipping Coins in the Courtroom, 62 Calif. L. Rev. 693 15 Dept. See of HEW, National Institute of Health, Mental Biometry Branch, Statistical Note Children and State Mental Hospitals 4 (Apr. 1975).

II by Parents Their Rights Committed of Children A juve- hearings denies Georgia this, all Notwithstanding Georgia parents. of their behest institutionalized niles act theory that on practice this rationalizes their waive may and therefore interests best children’s their because incarcerated Children rights. procеss due children’s really contends, Georgia confined, them parents wish their argument. accept I cannot voluntary patients. legiti- limited rights are parental society, our In may “Parents children. their interests of rights

mate not follow it does But martyrs themselves. to become be free martyrs make circumstances, to in identical free, they and age of full reached they have before their children them- choice make they can when discretion legal (1944). 170 158, U. S. Massachusetts, 321 v. Prince selves.” cases and variety of statutes in the is reflected principle This or neglected behalf on intervention state authorize 16 author- alia, parental curtail inter that, and children abused necessary withhold property,17 children’s their alienate ity to ideas exposure to deny children and treatment,18 medical 16 D. & (1971); Midonick M. Fail Parents Katz, When S. generally See Delinquency, Un- Juvenile Courts: Children,- and Parents Besharov, Behalf Intervention on Wald, State (1972); Neglect governability, Standards, 27 L. Stan. for Realistic A Search Children: “Neglected” (1975). 985 Rev. 17 1921). (CA1 Ochoa, 276 F. 99 g., Martorell v. See, e. 18 Supp. County Hospital, King F. 278 v. Witnesses g., Jehovah’s e. See, Sampson, 65 In re (1968); 598 1967), aff’d, U. S. 390 (WD 488 Wash. 1970), aff’d, County, (Fam. Ct. Ulster 641 658, Y. 2d 317 Misc. 2d N. S. 900, aff’d, 2d N. Y. (1971), 29 253 2d Y. 323 N. S. App. 2d 37 Div. Perricone, 2d J. 181 A. 37 N. (1972); State v. N. 2d E. involving the sterilization legal disputes Similarly, more recent permitted to au parents are to the conclusion led children have g., A. L. e. See, consequences. far-reaching operations such thorize and experiences they may later need as independent autonomous adults.19 This principle is also reflected in constitutional jurispru-

dence. Notions of parental authority and family autonomy cannot stand as absolute and invariable barriers to the asser- tion of constitutional rights by children. States, for example, may not condition a minor’s right to secure an abortion on attaining parents’ her consent since the right an abortion is an important personal right and since disputes between and children on question would fracture family autonomy. See Planned Parenthood Central Missouri v. Danforth, 428 U. S., at 75. This governed case is by the rulе of The right Danforth. to be free from wrongful incarceration, physical intrusion, stigmatization has significance for the individual surely as great as the right to an abortion. Moreover, as in Danforth, parent-child dispute at issue here cannot be characterized as involving only routine child-rearing decision made within the context of an ongoing family relationship. Indeed, involved only a potential Danforth dispute between parent and child, whereas here break in family autonomy has ac- tually resulted in parents’ decision to surrender custody of their child to a state institution. In my view, child who has been ousted from his family has even greater need for an independent advocate.

Additional considerations counsel against allowing parents unfettered power to institutionalize their children without H., G. R. App. 163 Ind. 636, 325 N. E. 2d 501 (1975); In R., re M. K. 515 S. (Mo. W. 2d 467 1974); Frazier v. Levi, 440 S. (Tex. W. 2d 393 App. Civ. 1969). 19See Commonwealth v. Renfrew, 332 492, Mass. 126 N. E. 2d 109 Meyerkorth (1955); v. State, 173 889, Neb. 115 N. 2dW. 585 (1962), appeal dism’d, 372 U. S. (1963); 705 In re Weberman, 198 Misc. 1055, 100 N. Y. S. 2d 60 (Sup. 1950), Ct. aff’d, App. 278 656, Div. 102 N. Y. 2d 418, S. aff’d, 302 N. Y. 100 N. E. 2d appeal dism’d, 342 (1951). U. S. The cause. that ascertain to hearing any without or cause interests, best children’s their act parents that presumption applica- is not decisions, child-rearing most to applicable while reveal studies Numerous context. in the commitment ble often children their institutionalize to decisions parental the to unrelated family in the dislocation results are well-meaning even Moreover, condition.20 children’s relative evaluate necessary to expertise lack parents to opposed as inpatient disadvantages and advantages decisions Parental treatment. psychiatric outpatient explored, be could questions such in which hearings waive or informed either conclusively deemed cannot therefore, it suggest, respectfully I circumstances, In these intelligent. in their act parents blindly to assume reality ignores decisions commitment making when interests best children’s rights. process due children’s their waiving when B who children treat obliged are mean States This does precisely parents of their the behest committed are com- involuntarily are who persоns other as manner same flexible process due demands The mitted. impli- practical it carries decision commitment parental While account. into take legitimately may that States cations hear- commitment requires process rule due general as a seek when hospitalization, involuntary precede ings militate considerations special children their hospitalize proceedings commitment formal postponement favor commitment adversary preconfinement mandatory against hearings. Critical Some Mentally Retarded: Rights of Murdock, Civil Emo Bell, Vogel & (1972); 133, 138 Law. Dame Issues, Notre Introduc in a Modem Family Scapegoat, as Child

tionally Disturbed Family 412 tion to

First, the prospect anof adversary hearing prior to admis- sion might deter parents from seeking needed medical attention for their children. Second, the hearings themselves might delay treatment of children whose home life has become impossible and who require some form of immediate state care. Furthermore, because adversary hearings junc- at this ture would necessarily involve direct challenges to parental authority, or judgment, veracity, preadmission hearings may well result pitting the child .in and his against advocate parents. This, in turn, might traumatize parent both child and make the child’s eventual return to his family more difficult. Because special these I considerations, believe States

may legitimately postpone formal commitment proceedings parents when seek inpatient psychiatric treatment for their children. Such children may be admitted, for a limited period, without prior hearing, so long as the admitting psy- chiatrist first interviews parent and child and concludes that inpatient short-term treatment would be appropriate. Georgia’s present procedures admission are reasonably con- sistent with these principles. See ante, at 613-616. To the extent the District Court invalidated this aspect of the Georgia juvenile commitment scheme and mandated pre- confinement hearings in all I agree cases, with the Court that the District Court was in error.

C I do not believe, however, present Georgia juvenile commitment scheme is constitutional in its entirety. Although Georgia may postpone formal commitment hearings, when seek to commit their children, the State cannot dispense with such hearings altogether. Our cases make clear that, when protected interests at stake, the “fundamental requirement of due process is the opportunity to be heard ‘at ” a meaningful time a meaningful manner.’ Mathews 634 from part quoting (1976), 319, 333 424 U. S. Eldridge,

v. Whenever (1965). 552 Manso, 546, U. S. 380 Armstrong v. rea provide must States impracticable, hearings are prior North Compare hearings. postdeprivation sonably prompt (1975), 601 Inc., U. S. Di-Chem, 419 v. Finishing, Inc. Georgia (1974). Co., 600 416 U. S. Grant W. T. Mitchell v. now Georgia procedures postadmission The informal hearings as qualify enough to not simply —let are follows all lack procedures The hearings. prompt reasonably alone decisions Commitment safeguards. process due traditional the are juveniles institutionalized Georgia’s parte. ex made are do commitment; nor for their reasons informed commitment at present to be right enjoy they right to representation, right to determination, witnesses, adverse confronted with to be right heard, the their evidence offer right to or the cross-examine, right procedures these process, of due any standard By own. (1974); 539 McDonnell, 418 U. S. v. See deficient. Wolff Director, v. McNeil 471 (1972); Brewer, 408 U. S. Morrissey v. Patter v. Specht (1972); Institution, S. 407 U. Patuxent S. 397 U. Goldberg Kelly, v. also See at 610. son, S.,U. why the Court understand I cannot 269-271 254, which procedures parte these ex condemnation pretermits even juveniles institutionalized deny Georgia’s operate Eldridge, supra, Mathews hearing,” form "some long-term rigors of suffer condemned they are before confinement.21 institutional preadmis- against that militate considerations special reported: has “[Thou Health Mental Institute The National wards back on the elderly patients confined now upon thousands sands thirty, children admitted as first were institutions . . state [mental] of . esti report from one state A recent fifty years ago. forty, even hospitals to its admitted every four children one in mates years of next 50 hospitalized for being permanently anticipate

'can ” supra Children, Health of on Mental Commission Joint their lives.’ n. at 5-6.

sion commitment hearings when seek to hospitalize their children do not militate against reasonably prompt postadmission commitment hearings. In the first post- place, admission hearings would not delay the commencement of needed treatment. Children could be cared the State pending the disposition decision.

Second, the interest in avoiding family discord would be less significant at this stage since the family autonomy already will have been fractured the institutionalization of the child. In any event, postadmission hearings are unlikely to disrupt family relationships. At later hearings, the case for and against commitment would be upon based the observa- tions of hospital staff and the judgments of the staff psychiatrists, rather than upon parental observations and recommendations. The doctors urging commitment, and not the parents, would stand as the child’s adversaries. As a postadmission consequence, commitment hearings are unlikely to involve direct challenges to parental authority, judgment, or veracity. To defend the child, the child’s advocate need dispute not the parents’ original decision to seek medical treatment for their child, or even, for that matter, their observations concerning the child’s behavior. The advocate need only argue, for example, the child had sufficiently improved during his hospital stay to warrant outpatient treatment or outright discharge. Conflict between doctor and advocate on this question is unlikely to lead to family discord. As a consequence, the prospect of postadmission hearing is unlikely to deter parents from seeking medical attention for their children and the hearing itself is unlikely so to trauma- tize parent and child as to make the child’s eventual return to the family impracticable.

Nor would postadmission hearings defeat primary purpose of the state juvenile mental health enterprise. Under the present juvenile commitment Georgia scheme, parents do not enjoy absolute discretion to commit their ante, 614^615. See hospitals. public children children accept may facilities of state Superintendents determine first they unless treatment long-term long-term from likely benefit will ill and mentally children determines superintendent If ibid. .See care. hospital or be released must unmet, condition either ibid. See desires. parents' regardless admission, refused superintend- if the suffer would interest state legitimate No proceedings fair through reached were determinations ent’s viewpoints opposing fairly presented consideration due parte ex secret, practice through present than rather deliberations.22 Georgia’s intentions good faith good

Nor can Court, by the adverted to workers, social psychiatrists procedures. parte ex Georgia’s 61.5-616, excuse ante, at see discipli- school like psychiatrists, admitting Georgia’s (1975), S. Lopez, U. in Goss described narians on act frequently faith, good in utmost “although proceeding facts controlling and the others; and advice reports disputed.” often challenge are under of the conduct nature Messinger. testimony of Dr. 188-190, App. Id., See at 580. and it all trivial, is not error Goss, the “risk inas Here, pro- without may be done if that against guarded be should air- ... process. ‘[F] the . .. or interference cost hibitive determination one-sided by secret, be rarely obtained can ness purposes may advance hearings well postadmission Indeed, accuracy and ensure promote hearings First, will enterprise. state hospitalization require who do children superintendent diverts may hearings themselves Second, programs. appropriate more to fair a they received have feel Children who therapeutic. prove confinement, their legitimacy of likely accept to may more hearing give attempting to those cooperate with illness, and acknowledge their significant impediment a turn, remove This, would treatment. Enchanting to Treatment —An Katz, Right therapy. See successful v. (1969); O’Connor 755, 768-769 L. Rev. U. Fiction?, 36 Chi. Legal concurring). J., (1975) (Burger, C. 563, Donaldson, 422 U. S. of facts decisive of fights. . ‘Secrecy . is not congenial truth-seeking and self-righteousness gives too an slender assur- ance of rightness. No better instrument has been devised for arriving at truth than to give person in jeopardy of serious loss notice of the case against him and opportunity to meet ” it.’ Goss v. Lopez, supra, at 580, quoting part from Joint Anti-Fascist Refugee Committee McGrath, 341 U. S. 171-172 (1951) (Frankfurter, J., concurring).

Ill Rights op Children Committed bt Their State Guardians

Georgia does not prior accord hearings to juvenile wards of the State of Georgia by committed state social workers acting parentis. loco The Court dismisses a challenge practice on the' grounds that state social workers are obliged by statute to act in the children’s best interest. ante, See at 619.

I find this reasoning particularly unpersuasive. With equal it logic, could be argued that criminal trials are unnecessary prosecutors since are not supposed to prosecute innocent persons.

To my mind, there justification is no for denying children committed their social workers the prior hearings that Constitution typically requires. In the first place, such chil- dren cannot be said to have waived their rights to prior hearing simply because their social workers wished them to be confined. The rule speak for their even children, if it were applicable in the commitment context, cannot be transmuted into rule that state social speak workers for their minor clients. The rule in favor of deference parental to authority is designed to shield parental control of child rearing from state interference. See Pierce v. Society of Sisters, 268 U. S. 535 (1925). The rule cannot be invoked in defense of unfettered state control of child rearing or to immunize from review the decisions of state social work- deserving of not relationship is worker-child soсial The ers. parent- the to accorded and deference protection special the parentis in loco acting officials and state relationship, Donaldson, v. O’Connor See parents. equated be cannot Yoder, 406 U. S. Wisconsin (1975); U. S. postponement justify considerations special the Second, to seek whenever proceedings commitment of formal are the children when absent are children their hospitalize recom- the upon committed being are of State wards pre- of prospect workers. their social mendations workers social state deter likely to not hearings admission atten- psychiatric securing and' duties their discharging from children Moreover, since the clients. disturbed for their tion custody as wards form of state in some already be will needy prevent not hearings will prehospitalization State, pendency during the care state receiving from children in which hearings Finally, proceedings. commitment state other reviewed are workers social of state decisions to hinder children or traumatize likely to not are officials recovery. eventual their exigent in the absence that, I believe reasons,

For these recommendation upon committed circumstances, juveniles commit- preadmission to are entitled workers social their Georgia’s I hold would consequence,. As a hearings. ment hearings prior juveniles these denying practice present unconstitutional.

IV con- institutions public Children incarcerated to contest opportunity a fair stitutionally entitled to some are entitled They confinement. of their legitimacy stands who behalf and their ‍​​​‌​​​​‌​‌​‌​​‌​‌​​​​​​‌​‌‌​‌‌​​‌​​‌​​‌‌‌‌​​​​‌‍on speak can who champion should Georgia wrongful commitment. oppose ready champion and that opportunity deny that permitted wish guardians them parents or children’s simply because to be confined without a hearing. The risk of erroneous commitment is simply great too unless there is some form of adversary review. And fairness demands that children aban- doned by their supposed protectors to the rigors of insti- tutional confinement given help separate some voice.

Case Details

Case Name: Parham v. J. R.

Court Name: Supreme Court of the United States

Date Published: Jun 20, 1979

Citation: 442 U.S. 584

Docket Number: 75-1690

Court Abbreviation: SCOTUS