Securing patients' rights--responsibly.

The patients' rights activist has power without clinical responsibility. Major problems can result when power is wielded by people who lack an appreciation of the clinical complexities of work with the severely mentally ill. The patients' rights movement has been an extremely constructive force, but every movement, no matter how well intended, must be monitored so that more good than harm is done. Two advocacy cases in which the struggle itself seemed to be more important to the advocates than the rights or welfare of the patients are described. Mental health professionals should not treat patients' rights as if they were a sacred cow, but should distinguish responsible advocacy from irresponsible advocacy. Long-term, severely ill patients, in particular, need to be protected from irresponsible "benefactors." The author's suggestions include that advocates be required to have experience providing direct service to severely disturbed patients for six months to a year and that advocates be rigorously screened within bureaucracies.