Treatment Advocacy Center: Involuntary treatment laws fall short in one-third of states

The Treatment Advocacy Center (TAC), a national not-for-profit that advocates for removing barriers to timely and effective treatment of severe mental illness, says Involuntary treatment laws in a third of states in the U.S. fall short in protecting and providing care for individuals with severe mental illness, based on findings in a study it released this week.

The report analyzes laws in all 50 states and Washington, D.C., to determine if they allow for individuals to receive involuntary evaluation or treatment “in a timely fashion, for sufficient duration, and in a manner that enables and promotes long-term stabilization.”

Among TAC’s findings:

• Michigan and Wisconsin were the only two states to receive an A grade, with Wisconsin registering the highest overall score, 96 out of 100. Laws in Arkansas, Louisiana, North Dakota, Vermont and Wyoming each graded out at an A-.
• Nine states (Alabama, Connecticut, Delaware, Maryland, Massachusetts, Montana, Pennsylvania, Rhode Island and Tennessee) and Washington, D.C., received failing grades, while seven rated in the D-grade range.
• Seven states retain a standard requiring harm to self or others be imminent for a person to qualify for inpatient commitment.
• Four states and Washington, D.C., do not incorporate grave disability criteria for treatment.
• Twenty states have incorporated a psychiatric deterioration (need for treatment) standard that TAC considers “more modern.”

The TAC report also includes 12 policy recommendations related to emergency psychiatric evaluation, inpatient commitment to a hospital facility, and outpatient commitment to care in the community. Among the recommendations:

• The duration of initial emergency custody should be at least 48 hours, with a strong preference of at least 72 hours.
• Statutory language defining “danger to self or others” and “grave disability” should not require imminence of harm, or for grave disability, an unreasonably high risk of harm.
• Any responsible adult, or at a minimum, guardians and family members, should be able to petition courts to seek a court order for evaluative custody, inpatient civil commitment or assisted outpatient treatment.

Of note: The Treatment Advocacy Center’s positions on involuntary commitment diverge from other industry groups that do not support a lower threshold for initiating involuntary commitment. For example, the Bazelon Center for Mental Health Law, which advocates for civil rights, full inclusion and equality of adults and children with mental disabilities, states on its website, “People with mental illnesses have the right to choose the care they receive. Forced treatment…is only appropriate in the rare circumstance when there is a serious and immediate safety threat. In general, circumstances that give rise to the use of force are not spontaneous and do not occur in isolation.”