Twenty-four years ago a class action lawsuit was filed in a United States District Court in Texas aimed at improving the living conditions in the state's eight psychiatric hospitals. The suit maintained that the constitutional rights of patients were being violated: patients were being subjected to bad or inadequate treatment and put at risk of physical harm. The suit aimed to reform the hospitals in such a way that patients would be protected, would receive adequate psychiatric treatment, and upon discharge would be cared for adequately in the community.

In this, Pharis explores the reasons why the lawsuit took so many years to be resolved successfully. The suit was strongly resented by some agency administrators and legislators who believed it represented federal intervention in state business. Yet mental health advocates believed the suit had the potential for providing major necessary reform. The first ten years of the lawsuit were very acrimonious with Plaintiffs and Defendants always in contentious disagreement over the findings of a Court-appointed case monitor.