When we quit locking everyone up in the State Hospital who was 'different' in any way and went to the "danger to self or others" standard as the only test for mandatory hospitalization and treatment, we invented these results.   The appellate courts routinely overturn local judges who are concerned about mentally ill people unless that standard is met.  Until they actually harm someone or themselves, if they aren't willing to participate in treatment, nothing can be forced upon them.    I don't see a solution.  Hand wringing just doesn't do it.