Most severely mentally ill persons who refuse treatment, especially medications, are known to us. Why do we not act to place them in some form of mandatory outpatient treatment, such as outpatient commitment? Many of them have also demonstrated what any good clinician recognizes as a need for 24-hour, highly structured inpatient care, perhaps for a brief period of stabilization, perhaps for an intermediate or long-term period. Increasingly, mentally ill persons are receiving mandatory outpatient treatment and 24-hour structured care through the criminal justice system. But they should not have to commit a crime to receive the care they need. To be labeled both mentally ill and criminal is to be doubly stigmatized.