Mental Health Commitment Laws

Mental Health Commitment Laws

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Mental Health Commitment Laws:

A Survey of the States

February 2014

 

Every Western nation, and every US state, has established civil commitment laws and criteria that govern when the condition of an individual with acute or chronic psychiatric symptoms warrants a court order to mandate mental health treatment in a hospital or, where enabling statutes exist, as a condition of living in the community. Among other provisions, these laws address how long and under what criteria patients can remain hospitalized for psychiatric treatment against their wishes; whether the state can require patients to adhere to court-ordered treatment after hospital discharge; and how much deterioration must occur before a patient can be re-hospitalized involuntarily.

Mental Health Commitment Laws: A Survey of the States comprehensively examined the laws each state was using in 2014 to determine who within the state’s population might qualify for court-ordered treatment and for what duration. Each state was graded on the adequacy of its statutes to facilitate short-term emergency hospitalization; longer-term commitment to a psychiatric hospital; and, where applicable, provisions for the less-restrictive option of court-ordered treatment (often called “assisted outpatient treatment” or “AOT”) in the community.

Top Takeaway

Civil commitment laws may be universal, but the quality of the laws that govern them and their implantation are not. The quality of the civil commitment laws in the vast majority of states remains far below what is necessary to provide a readily accessible path to treatment and recovery for individuals with the most severe mental illness who are unable to seek care for themselves.

Fast Facts

  • 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.
  • No state earned a grade of “A” on the use of its civil commitment laws.

Recommendations

  • 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 states that have not yet passed them
  • 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

Since the Study

  • New Mexico in 2016 enacted legislation authorizing AOT in the state, leaving only four states without outpatient commitment laws (Connecticut, Maryland, Massachusetts, Tennessee).
  • Congress in 2016 appropriated $15 million to fund new AOT programs, increasing interest and use of the program.
  • States continued to review and reform provisions of their civil commitment laws, generally moving to increase access to treatment for individuals with acute or chronic serious mental illness.