New Report Card of State Psychiatric Treatment Laws Finds Many States Have Outdated or Vague Rules
Outdated laws increase interactions between people with severe mental illness and police, delay treatment, frustrate families
September 22, 2020
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Arlington, Va. - A new report card of state psychiatric treatment laws from the Treatment Advocacy Center, a national nonprofit that advocates for elimination of barriers to effective treatment for individuals with severe mental illness, 
finds that despite bright spots, many state laws do not allow for timely, appropriate treatment during a psychiatric crisis and beyond. The report gives each state a letter grade -- A+ through F -- and recommends specific statutory changes to improve each state’s criteria.
In many states, vague or outdated laws for emergency evaluation and civil commitment increase the likelihood that someone in a severe mental health crisis will interact with police and the criminal justice system, and can delay treatment and increase the severity of illness.
“The U.S. strategy for severe psychiatric illness is effectively 50 different experiments, with no two states taking the same approach,” Lisa Dailey, director of advocacy at the Treatment Advocacy Center and co-author of the report. “Our patchwork system means many states create needless barriers to treatment with confusing, vague, or outdated laws that ultimately hurt Americans with severe mental illness and frustrate families and loved ones who just want appropriate, evidence-based care for psychiatric illness just as we expect for any other condition.”
The report, “Grading the States: An Analysis of U.S. Psychiatric Treatment Laws,” examines the state laws that provide for involuntary treatment for psychiatric illness including whether an individual who needs involuntary evaluation or treatment can receive it in a timely fashion, for sufficient duration and in a manner that enables and promotes long-term wellbeing. Whether a person receives timely, appropriate treatment for an acute psychiatric crisis or chronic psychiatric disease is almost entirely dependent on what state that person is in when the crisis arises.
The report specifically focuses on laws rather than implementation. Some states have notable gaps between strong laws on the books and poor implementation and access. Still, the right laws provide a necessary foundation that states can use to build systems that promote a successful continuum of care and better outcomes.
The Treatment Advocacy Center developed a 100-point grading scale for each state report card that evaluates the involuntary treatment laws of each state and compares the laws with policy recommendations. The report card provides specific scores for state policies as well as guidance on which aspects of a statute must change in order to eliminate barriers to treatment.
“Americans living with untreated mental illness are 16 times more likely to be killed by police and part of the reason is state laws that require police interaction before someone can get the treatment they need,” said John Snook, executive director of the Treatment Advocacy Center. “These deaths are preventable tragedies. We want this report to provide a roadmap for legislators, advocates and health care professionals to enact state laws that support consistent, easily accessible care.”
Overall, the report finds states are close to universal use of certain recommended best practices on several issues identified in the report’s policy recommendations, including:
- A majority of states authorize an emergency psychiatric hold of at least 72 hours for evaluation and crisis care.
- Only a small number of states require that danger to self or danger to others be imminent to qualify for hospitalization. This “imminent threat” standard is the same standard used by many police agencies to justify use of force.
- Nearly all states recognize a person’s failure to meet basic needs (such as food, clothing and shelter) due to mental illness as a basis for intervention.
- All but three states have laws that authorize civil commitment on an outpatient basis.
However, the report also identifies many states whose criteria have not been updated for many years, resulting in laws that create needless barriers to treatment for people with severe mental illness. Additionally, the report highlights states whose procedures are confusing or vague, making them even more difficult to navigate for families and practitioners alike.
The report’s policy section serves as an educational tool to help mental health advocates better understand the foundation of their state’s laws and what they should be advocating for, as well as a blueprint for lawmakers to guide legislative reform.
To see how a state’s laws compare with the rest of the country, view the report and each state’s grade sheet on the Treatment Advocacy Center website.
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The Treatment Advocacy Center is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness by promoting laws, policies and practices for the delivery of psychiatric care and supporting the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.
