One Year After Sandy Hook: Progress in More Than 1 in 5 States

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Legal reforms are a step in the right direction, but the system for providing timely and effective treatment to individuals with severe mental illness is still in tatters, says the Treatment Advocacy Center

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Unfortunately, it often takes a tragedy to tip the balance toward making court-ordered treatment more widely available.

In the year following the Dec. 14 mass killings at Sandy Hook Elementary School, legislatures in nearly a dozen states showed newfound resolve to reform the public policies that leave their most severely ill residents without the care they need to begin recovering.

Nearly a dozen state legislatures passed or improved their laws that determine who receives court-ordered treatment for symptoms of severe mental illness in a hospital and/or the community. The Treatment Advocacy Center said states making civil commitment reforms in 2013 included:

  •     Nevada – which became the 45th state to allow court-ordered “assisted outpatient treatment” (AOT) for individuals with severe mental illness who qualify under strict state criteria.
  •     New York – which strengthened Kendra’s Law, already the nation’s most widely used AOT law authorizing mandatory treatment in the community.
  •     California – which incentivized counties to use its AOT law – known as Laura’s Law – by clarifying that state mental health funds could be used to pay for it.
  •     Montana – which broadened its standard for emergency hospitalization for psychiatric crisis.
  •     Colorado, Hawaii, Indiana, North Dakota, Oregon, Missouri and Texas which enacted other reforms to make treatment possible for more individuals in the population most at risk for consequences of non-treatment, including violence.

“Unfortunately, it often takes a tragedy to tip the balance toward making court-ordered treatment more widely available,” said Doris A. Fuller, executive director of the Treatment Advocacy Center. “Some of the bills that passed in 2013 have been under consideration in one form or another for years. What changed with Sandy Hook was that the public demand and official will for them to pass grew.”

Despite the progress in 2013, the Treatment Advocacy Center said the system for providing timely and effective treatment to individuals too ill to seek help remains in tatters.

  •     Connecticut itself failed to pass a bill to improve its mental illness treatment laws. It remains one of only five states with no provision for court-ordered treatment in the community.
  •     Half of U.S. states continue to withhold court-ordered outpatient treatment from people with severe untreated mental illness until they have deteriorated to a state of danger or grave disability.
  •     Public psychiatric beds have been reduced more than 90% while the U.S. population nearly doubled since the 1950s, according to “No Room at the Inn,” the organization’s 2012 study of state hospital bed populations.
  •     Less than half the U.S. population lives where the most basic methods of diverting people with severe mental illness from the criminal justice system are in use, according to “Prevalence of Mental Health Diversion Practices: A Survey of the States,” the organization’s 2013 report on the use of mental health courts and crisis intervention team policing.
  •     Law enforcement is under stress from the demand for peace officers to be mental health first-responders, as evidenced by the increasing role of untreated mental illness in officer-involved homicides, according to “Justifiable Homicides: What is the Role of Mental Illness?
  •     Individuals with untreated mental illness remain more likely to be jailed than hospitalized in every state, according to “More Mentally Ill Persons in Jails and Prisons,” a state survey co-authored with the National Sheriffs’ Association in 2010.

“Mass killings are merely the most newsworthy of a long list of terrible consequences that befall critically ill individuals and their families when we pursue policies that neglect those who need help the most,” Fuller said. “Removing legal and other barriers to treatment will pay dividends for people living with untreated severe mental illness and their communities. As long as these barriers remain, tragedies in all their many forms and magnitudes will continue to occur daily.”

ADVISORY: Rep. Tim Murphy (R-PA) will hold a press briefing on proposed new federal legislation to improve mental illness treatment Thursday, 9:45 am, in the TV/Radio correspondents gallery - studio A, in the Capitol Visitors Center (HVC 117).


The Treatment Advocacy Center is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness. The nonprofit promotes laws, policies and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

The organization does not accept funding from the pharmaceutical industry. The American Psychiatric Association awarded the Treatment Advocacy Center its 2006 presidential commendation for "sustained extraordinary advocacy on behalf of the most vulnerable mentally ill patients who lack the insight to seek and continue effective care and benefit from assisted outpatient treatment.”

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Jamie Mondics
Treatment Advocacy Center
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