Firstly, the vast majority of hospitalized patients have historically been involuntary up through the 50s and 60s, in the United States and similar countries. This makes it unfeasible to have totally separate facilities and programs for voluntary patients, especially since the regimens will not necessarily be any different at all. Additionally, in the modern era it is often the case that you are not allowed to voluntarily leave a psychiatric hospital after becoming an inpatient — even if you commit yourself, you have no power to choose your own release in many regions, making 100% of patients stuck there. The norm today is for everyone to be bunched together, though sometimes there are Psychiatric ERs or special areas for certain kinds of concerns or confinement. Secondly, the staff, procedures, and policies are shown to be the most dangerous and also insidious forces of harm in Cuckoo’s Nest. Can some patients be dangerous? Sure, particularly when in a counterproductive environment as psychiatric institutions tend to be. However, the psychiatric methodologies are still, even today, more dangerous than the average inpatient. Psychiatric drugs actually increase the rates of violence and death, not to mention disability and acute psychological crises such as what gets diagnosed as mania/hypomania or psychosis. Preventable abuses in psychiatric facilities are par for the course, as well, and anyone locked in a ward needs to be more wary of the staff than their fellow inpatients. In some places, there can be special wards for just voluntary patients, but the proverbial softer touch is often more the trademark of independent businesses or organizations which do not strictly adhere to the standard institutional model — things like recovery houses, retreats, or resorts. Psychiatric wards are generally the lowest common denominator of quality and policies, meaning a very generalized focus and lots of compromising the services for the sake of cost, convenience, and systemic dogma. There are many measures in place to ensure the psychiatric staff are the main ones controlling violence, even if it means being the perpetrators, so danger from inpatients (whatever it may truly be) is taken into account.
