In Reply: Dr. Geller does not deny that an expanded array of well-provided intensive community services might divert individuals in crisis from involuntary hospital admissions to voluntary community services. At the same time, we do not deny that effective use of involuntary interventions is an essential component of a well-designed services system. Indeed, liberalized commitment criteria and expanded authority to use mandatory outpatient treatment were included in the comprehensive reform package adopted in Virginia in the wake of the Virginia Tech tragedy.

However, Virginia’s Commission on Mental Health Law Reform—the architect of these reforms and of our study of emergency evaluations to which Dr. Geller refers—was convinced that enhancing access to voluntary alternatives to hospitalization (as well as to the full continuum of preventive services) can reduce unnecessary involuntary interventions (1). Our research team also thinks that a declining rate of temporary detention orders in specific service regions can serve as one useful indicator, among others, of progress in mental health system transformation.