MENTAL HEALTH COMMITMENT LAWS: A SURVEY OF THE STATES
The tragic consequences of ignoring the needs of individuals with the most severe mental illness who are unable or unwilling to seek treatment are on vivid display nationwide: on our city streets, where an estimated quarter million people with untreated psychiatric illness roam homeless; in our jails and prisons, which now house 10 times as many people with severe mental illness than do our psychiatric hospitals; in our suicide and victimization statistics, where individuals with psychotic disorders are grossly overrepresented; and in our local news, which reports daily on violent acts committed by individuals whose families struggled vainly to get them into treatment.
In the U.S., primary responsibility for treatment of this vulnerable and at-risk population falls to state and local governments. The performance of this vital public health function is guided by an array of laws, regulations, policies and budgeting choices, all of which vary markedly from one jurisdiction to the next. As a result, any individual’s likelihood of receiving timely and effective treatment for an acute psychiatric crisis or chronic psychiatric disease depends largely on the state and county where he or she happens to be located when such need arises.
For “Mental Health Commitment Laws: A Survey of the States,” the Treatment Advocacy Center comprehensively examined the laws each state uses to determine who within its population might qualify to receive involuntary treatment and for what duration and graded each state on two measures of their response to the treatment needs of this small but high-impact population:
- Quality of involuntary treatment (civil commitment) laws: the adequacy of its statutory provisions to facilitate emergency hospitalization for evaluation in a psychiatric emergency; commitment to a psychiatric facility for treatment; and/or – in the 45 states where applicable – commitment to the less-restrictive option of a court order to remain in treatment as a condition of living in the community.
- Use of involuntary treatment laws: the extent to which the state applies its laws to intervene and provide treatment for psychiatric crisis and/or chronic severe mental illness in the population that meets its civil commitment standard, according to mental health officials within the state.
The analysis found the following:
- No state earned a grade of “A” on the use of its civil commitment laws.
- Only 14 states earned a cumulative grade of “B” or better for the quality of their civil commitment laws.
- 17 states earned a cumulative grade of “D” or “F” for the quality of their laws.
- Only 18 states were found to recognize the need for treatment as a basis for civil commitment to a hospital, and several of those were found to have less than ideal standards.
- While 45 states have laws authorizing the use of court-ordered treatment in the community, only 20 of those were found to have optimal eligibility criteria.
- 27 states provide court-ordered hospital treatment only to people at risk of violence or suicide even though most of these states have laws allowing treatment under additional circumstances.
- 12 states rarely or never make use of court-ordered outpatient treatment (often called “assisted outpatient treatment” or “AOT”), including eight states with laws on their books authorizing such treatment.
- 20 states received penalty points for the prevalence of bed waits. In two of the most populous states – Florida and Texas – bed waits were reported to typically exceed two weeks.
- Significant delays in delivering medication over objection were found in only five states, four of them in New England. In Vermont and New Hampshire, the typical delay in providing medication over objection to individuals in psychiatric crisis who were unable to recognize their need for treatment was found to be more than two months.
The deplorable conditions under which more than one million men and women with the most severe mental illness live in America will not end until states universally recognize and implement involuntary commitment as an indispensable tool in promoting recovery among individuals too ill to seek treatment. To that end, the Treatment Advocacy Center recommends:
- Universal adoption of need-for-treatment standards to provide a legally viable means of intervening in psychiatric deterioration prior to the onset of dangerousness or grave disability.
- Enactment of AOT laws by the five states that have not yet passed them – Connecticut, Maryland, Massachusetts, New Mexico and Tennessee
- Universal adoption of emergency hospitalization standards that create no additional barriers to treatment.
- Provision of sufficient inpatient psychiatric treatment beds for individuals in need of treatment to meet the standard of 50 beds per 100,000 in population.