Earlier this month, I posted a blog titled, Understanding Lack of Access to Mental Healthcare in the US: 3 Lessons from the Gus Deeds Story. In that post, I highlighted how current mental health commitment laws were one of the barriers to accessing mental health care:
“….federal and state laws, surrounding the involuntary hospitalization of individuals with mental illness, whilst designed to protect patient’s rights, often leave loved ones and mental health professionals who understand the patient and their illness with no voice, and minimal sway and influence over decisions that get made in courts.”
In follow up to this point, I am blogging today on a recent report published by the Treatment Advocacy Center (a national nonprofit organization) titled Mental Health Commitment Laws: A Survey of the States.
The results of this report validate the experience of those of us who work in the mental health field. For many of us, it often seems like an uphill battle to get much needed mental health services for patients living with serious mental illness, because our hands are tied by restrictive laws (or restrictive interpretations of such laws).
The deinstitutionalization movement of the 1960’s brought a national trend to reform civil commitment laws and a shifting of focus to the person’s “dangerousness to self or others” as the sole basis for civil commitment (i.e. involuntary treatment or hospitalization).
By the late 1970’s, the results of deinstitutionalization were becoming more apparent, and many had started to wonder if perhaps the pendulum had swung too far. Though community integration had improved the lives of some, a large number of desperately ill people had been abandoned to the streets or to the prison system.
This is why it is so important to re-evaluate the laws surrounding civil commitment and change the very reductionistic and rigid focus on imminent risk of violence or suicide as the only reasons that warrant hospital commitment. Another approach has been to minimize the need for involuntary hospitalizations via the use of less intrusive modalities, such as court-ordered outpatient treatment (i.e. AOT= assisted outpatient treatment).
Results of the TAC report?
The TAC report analyzed the quality and use of laws that each state had enacted to meet the needs of people with severe mental illness who cannot recognize their own need for treatment. The report graded each state on the quality of the civil commitment laws that determined who received court-ordered treatment for mental illness, under what conditions, and for how long. States also received grades on their use of treatment laws based on a survey of mental health officials.
No state earned a grade of “A” on the use of its civil commitment laws. Seventeen states earned a cumulative grade of “D” or “F” for the quality of their laws, and only 14 states earned a grade of “B” or better for the quality of their civil commitment laws. Twenty-seven states provide court-ordered hospital treatment only to people at risk of violence or suicide, even though most of these states have laws that allow treatment under additional circumstances.
The report ended with these recommendations:
“The deplorable conditions under which more than one million men and women with the most severe mental illness live in America will not end until states universally recognize and implement involuntary commitment as an indispensable tool in promoting recovery among individuals too ill to seek treatment. To that end, the Treatment Advocacy Center recommends:
· 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 five states that have not yet passed them – Connecticut, Maryland, Massachusetts, New Mexico and Tennessee
· 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”
I could not agree more.
To view this report, in its entirety, follow this link.