SMI Research Digest: Understanding Involuntary Treatment Laws
SMI Digest is a monthly publication from Treatment Advocacy Center (TAC) that summarizes recently published research on topics related to serious mental illness (SMI) with psychosis. This month’s article features two 2026 papers that discuss involuntary treatment laws across the United States.
Reforms are needed to ensure access to medically necessary involuntary care and to protect the rights of people being held for evaluation and treatment. This month, TAC published a detailed review of laws that permit involuntary treatment in all 50 states and the District of Columbia. TAC assigned a grade to each state and provided recommendations to improve laws that enable emergency holds, inpatient commitment, and outpatient commitment. The report found that involuntary treatment laws and legal protections for people with SMI vary dramatically across states and that some state laws worsen circumstances for people with the most severe and disabling conditions. For example, the report found that 14 states permit the detention of people in carceral settings such as jails and prisons while they are waiting for emergency psychiatric evaluations. Several jurisdictions had vague or ambiguous standards for which behaviors meet the threshold for dangerousness under state law. Read more about recommended amendments in your state in the report.
Legislation to change involuntary treatment standards has increased over the past decade. A 2026 article published in Psychiatric Services examined involuntary treatment legislation that states considered from 2011 to 2022. Utilizing TAC’s bill tracker to confirm the comprehensiveness of their list, the study concluded that bills related to involuntary treatment nearly doubled during that span of 11 years. Two-thirds of the bills would likely have increased involuntary interventions, while 23% would have decreased involuntary interventions if passed, according to the authors.
Importantly, fewer than 10% of state bills designated funding for services needed to care for higher numbers of involuntary clients. Additionally, only 7% of bills included provisions for discharge services for those transitioning out of involuntary care. This is especially important as the suicide rate after discharge from inpatient psychiatric care is 45 times higher than the global suicide rate.
What can I do if I want to advocate for treatment law reform in my state?
- Sign up for action alerts. To receive the latest updates on legislation related to SMI in your state, please sign up for action alerts. Note: the authors of the recent article published in Psychiatric Services used TAC’s legislative tracking database to ensure their search was comprehensive.
- Learn about your state’s grade and TAC recommendations for improvements. Grading the States highlights specific changes that could improve involuntary treatment laws in each state, with detailed information on the research underlying these recommendations. Find your state’s grade sheet in Appendix A (pp. 59-175) and recommendations for amendments in Appendix B (pp. 176-196).
- Learn more about best practices for assisted outpatient treatment (AOT). High-quality treatment, including medication and psychosocial services, improves symptoms and quality of life for many people with SMI. While a law can enable access to care, implementation support and program evaluations are necessary to ensure that care is person-centered and trauma informed. To learn more about standards of care in involuntary outpatient treatment settings, please sign up to join the AOT Learning Network.
