Beyond ‘Grading the States’ and Progressing Toward Decriminalizing Severe Mental Illness

By Elizabeth Hancq -- Yesterday, the Treatment Advocacy Center released a 2020 update to its landmark report, Grading the states: An analysis of involuntary psychiatric treatment laws. The report represents the results of Treatment Advocacy Center staff’s evaluation and grading of the involuntary treatment laws in all 50 states and the District of Columbia, updating state report cards with any changes to the state laws since the report’s original release in September 2018.  

Each state has been graded based on a variety of different factors regarding its law and whether it permits someone who may need involuntary evaluation or treatment to receive it in a timely and effective manner. This analysis is purely based on the laws themselves, not how they are implemented in practice. However, the Treatment Advocacy Center believes that state commitment laws form the foundation for how the mental health system is built and is an important starting point for reform.  

The analysis found that six states (Alabama, Delaware, Georgia, Oklahoma, Pennsylvania and Tennessee) have an outdated requirement that harm to self or others be imminent for a person to qualify for inpatient commitment. The Treatment Advocacy Center recommends that inpatient criteria should not require that danger or harm be imminent for eligibility because this inevitably leads to criminalization of the illness.  

In fact, previous research has indicated that laws that require an individual to present an imminent danger to self or others before they can meet criteria leads to the criminalization of mental illness, resulting in the vast overrepresentation of people with mental illness in every stage of the criminal justice system.  

An article published earlier this year in CNS Spectrums by late Treatment Advocacy Center board member Dr. H. Richard Lamb details the factors that have led to the criminalization of individuals with serious mental illness and strategies for how it is being addressed.  

“The failure of the mental health system to provide a sufficient range of timely interventions, including an adequate number of psychiatric inpatient beds, has contributed greatly to persons with serious mental illness entering the criminal justice system,” Dr. Lamb and his coauthor, Linda Weinberger, write.  

In addition to the deinstitutionalization movement and resulting shortage of inpatient psychiatric beds we have today, contributing to the criminalization of serious mental illness is the restrictive and outdated state civil commitment laws, they argue. Restrictive civil commitment laws result in fewer and shorter commitments, resulting in patients being discharged from psychiatric hospitals because they no longer meet the criteria. Too often, these patients are released into the community without the resources to help them adjust.  

“They may have had difficulties maintaining psychiatric stability, controlling their impulses, living in unstructured community settings, and adopting to the demands of community living,” the authors write. “Thus, some of these individuals might have decompensated to the point where they committed criminal acts and entered the criminal justice system.” 

Lamb and Weinberger suggest that decriminalizing persons with serious mental illness requires providing treatment and support services to individuals in the community to prevent their entering into the criminal justice system at all, a core tenant to the Treatment Advocacy Center’s work.  

To see your state’s grade and how to improve access to treatment for people with serious mental illness, read the full Grading the States report here.  

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Elizabeth Hancq is the director of research at the Treatment Advocacy Center