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Grading the States: An Analysis of Involuntary Psychiatric Treatment Laws

Grading the States: An Analysis of U.S. Psychiatric Treatment Lawsexamines the laws that provide for involuntary treatment for psychiatric illness in each state. To do so, we asked a crucial question: Does the state law allow an individual in need of involuntary evaluation or treatment to receive timely care, for sufficient duration, in a manner that enables and promotes long-term stabilization?




The United States is effectively running 50 different experiments, with no two states taking the same approach. As a result, whether or not an individual receives timely, appropriate treatment for an acute psychiatric crisis or chronic psychiatric disease is almost entirely dependent on what state he or she is in when the crisis arises.

In addition to providing a detailed assessment of each state’s treatment laws in comparison with those of the rest of the country, the report also identifies specific statutory changes states can make to greatly improve access to care for this population.

Key Findings

  • Twenty-two states scored at or above a B-, while 10 jurisdictions received failing grades.
  • Wisconsin achieved the highest combined score, with 96 out of 100 points. Maryland received the lowest combined score, with 18 out of 100.
  • Only seven states (Alabama, Delaware, Georgia, Hawaii, Oklahoma, Pennsylvania and Tennessee) retain an outdated standard requiring that harm to self or others be imminent for a person to qualify for inpatient commitment.
  • Five jurisdictions still fail to incorporate grave disability criteria for treatment (Alabama, Delaware, District of Columbia, Maryland and New York).
  • Twenty states have incorporated a more modern psychiatric deterioration (need for treatment) standard.
  • All but three states (Connecticut, Maryland and Massachusetts) have statutory authority for some type of assisted outpatient treatment (AOT).
  • Only two states (California and New Mexico) require local adoption or legislation to implement an AOT program. Tennessee is the only one of the other 48 states and the District of Columbia whose statute directly forecloses the use of AOT from the community.
  • Length of order is vitally important for AOT’s effectiveness. However, two states (Arkansas and West Virginia) fail to allow for an initial outpatient order of at least 90 days. Seven states (Alabama, Delaware, Florida, Indiana, Kansas, Minnesota and Mississippi) fail to allow for a renewal order of at least 180 days.




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