Since the late 1960s mental health advocates have filed numerous lawsuits against mental health institutions in an effort to narrow the standards for civil commitment, improve the care of patients, and define patients' rights. While many of the lawsuits were successful in attaining these goals at the district and appellate court levels, review by the Supreme Court generally has resulted in decisions blunting the lower court rulings. The high court has rejected broadly worded lower court decisions on commitment laws, standards of proof in commitment hearings, and patients' rights. The court also has upheld the traditional reliance on decision-making by medical professionals. The author describes a number of these cases and their decisions and concludes that cases now before the Supreme Court very likely will result in decisions that strike a balance between the needs of the patients and those of treatment staff.