HOW DOES YOUR STATE RANK?
(9-21-20) A report released today by the Treatment Advocacy Center entitled Grading the States: An Analysis of U.S. Psychiatric Treatment Laws has reached the same conclusion that most of us have experienced in person.
There is no national, standardized mental health care system.
Involuntary commitment laws differ wildly, as does available treatment. From the report:
“The U.S. mental health system is not one single broken system, but many…We are effectively running 50 different experiments, with no two states taking the same approach. As a result, 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.”
I would take this a step further. Not only do different states use different commitment standards, different counties and cities do too.
Fairfax County, Va. where I live, historically has been much more reluctant to involuntarily commit an individual who is in crisis than its adjacent counties. The state law is the same but the administrative law judges in charge in Fairfax are more hesitant.
The 160 page report lists each state’s criteria for involuntary commitment and describes how that state accesses dangerous. It contains useful information about inpatient commitment, who can petition for emergency evaluations, and outpatient commitment along with how long a state can “hold” someone.
TAC used a 100 point grading scale, according to Lisa Dailey, the report’s primary author. TAC was initially founded to push for adoption of Assisted Outpatient Treatment laws but has expanded its mission to “eliminate barriers” to all treatment. Recently, it has been lobbying for more crisis care beds.
“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,” according to the TAC press release issued with its report.
Overall, the report finds..
● 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.
You can check your state’s grade and read why Dailey and her colleagues reached that state’s score here.
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A |
A+ |
Minnesota (97) |
|
A |
Wisconsin (96), Michigan (95), West Virginia (94) |
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A- |
North Dakota (92), Vermont (92), Arkansas (91), Hawaii (91), Louisiana (90), Wyoming (90) |
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|
B |
B+ |
Indiana (89), South Carolina (88), Mississippi (87), Washington (87) |
|
B |
Missouri (86), Ohio (86), Idaho (85), Nevada (84), Oregon (84), Arizona (83) |
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|
B- |
Georgia (82), Illinois (82), Virginia (82), Iowa (80), North Carolina (80) |
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|
C |
C+ |
Kentucky (79), Oklahoma (79), Pennsylvania (79), Maine (77), Texas (77) |
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C |
New York (76), New Mexico (75), Kansas (73), Utah (73) |
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C- |
South Dakota (72), Colorado (71), New Hampshire (71) |
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|
D |
D+ |
New Jersey (67) |
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D |
Florida (66), Alaska (65), Nebraska (63) |
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D- |
Alabama (60), California (60) |
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F |
F |
Montana (59), Tennessee (57), Rhode Island (57), District of Columbia (56), Connecticut (41), Massachusetts |
The report concludes with these recommendations:
The time limit for an emergency hold should not be less than 72 hours with 48 hours as an absolute minimum.
Emergency evaluation laws should provide clear guidance for practitioners, law enforcement and families.
Any responsible adult or, at a minimum, a guardian or family member, should be authorized to petition the court for both emergency evaluation and inpatient civil commitment.
Criteria for danger to self should expressly include grave disability and psychiatric deterioration.
Criteria for grave disability should not require either unreasonably severe harm or for families to be required to deny assistance.
Criteria for psychiatric deterioration should allow consideration of treatment history and the likelihood of future psychiatric deterioration without treatment.
Criteria for danger to self or danger to others should not require imminent harm.
AOT criteria should allow consideration of at least three years of treatment history and must be suitable for outpatient use.
AOT criteria should not place unreasonable limitations on eligibility.
Any responsible adult or, at a minimum, guardians and family members should be authorized to petition the court for AOT.
AOT procedures should be described in sufficient detail to provide guidance to practitioners and to make maximum use of the “black robe effect.”
The duration for an initial AOT order should be a minimum of 90 days, and renewed orders should be for a minimum of 180 days.
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