One-third of states received a grade of B or better, with only seven states receiving an A grade. One out of every five states received a failing grade. Of note, it was beyond the scope of the report to analyze how the states utilize the laws, therefore a passing grade does not necessarily mean that the state provides adequate treatment services for individuals with severe mental illness.
Perhaps more important than the evaluation and grade themselves, this report is the first-of-its-kind in laying out the Treatment Advocacy Center’s evidence-based policy recommendations. In Section Two of the report, we highlight state laws that allow timely and effective treatment as well as those that impose artificial treatment barriers. Each policy recommendation is bolstered with peer-reviewed research or evidence to support the claim.
Requiring imminent dangerousness
For example, the fifth policy recommendation in the report states the following:
Statutory language defining the “danger to self or others” standard should not require imminence of harm.
Seven states require that harm to self or others must be imminent for qualifying for inpatient commitment, despite the bountiful evidence showing that this severely limits one’s ability to receive timely treatment and has long-term consequences on an individual’s disease progression. Research shows that statutes that require the individual present an imminent danger to self or others before any intervention leads to criminalization. In a 2008 Journal of Medical Ethics article Dr. Large and colleagues from St. Vincent’s hospital in Australia write, “dangerousness criteria unfairly discriminate against the mentally ill, as they represent an unreasonable barrier to treatment without consent, and they spread the burden of risk that any mentally ill person might become violent across large numbers of mentally ill people who will never become violent.”
By requiring an individual to decompensate to the point of current dangerousness, the situation is almost guaranteed to become a public safety risk. Law enforcement is trained to handle threats to public safety within the confines of the criminal justice system, leading to the horrible outcomes we have reported on previously, such as having a 16 times higher risk of becoming a fatal police encounter or the overrepresentation of serious mental illness in jails and prisons.
Laws that include only an immediate dangerousness criterion have been shown to lead to longer duration of untreated psychosis, which in turn leads to worsening permanent brain damage. One study reports that individuals who live in countries that utilize a dangerousness criterion for commitment have an average of five months longer duration of untreated psychosis than those who live in countries without a dangerousness criterion. And research shows that the longer an individual has untreated psychosis, the longer it will take to emerge from it, and the less likely the person is to make a full recovery. Timely treatment, before significant decompensation occurs, has been proven to improve an individual’s prognosis for the illness course.
For the full list of evidence-based policy recommendations about state involuntary treatment standards, please refer to the full report.
