Involuntary Commitment (Assisted Treatment) Standards (50 states) - Treatment Advocacy Center Report - Mental Illness Policy Org
Involuntary Commitment (Assisted Treatment) Standards (50 states) – Treatment Advocacy Center Report 2017-02-20T13:54:12+00:00

Standards for Involuntary Commitment (Assisted Treatment) State-by-State (Source Treatment Advocacy Center)

Important note about involuntary commitment:

  1. Having a law, does not mean a state makes use of it. Very few states make use of involuntary outpatient commitment (Asssited Outpatient Treatment, AOT) laws.
  2. When inpatient commitment is used, most states still rely on the “dangerousness” standard, and rarely use the other standards they have available to them. Further “dangerous” is often interpreted very narrowly to mean “imminently” dangerous.
  3. No state law includes all the provisions in the model law on this site, and therefore all states can improve their law.
  4. All states could improve care and save money wby making greater use of the options they already have available to them.
  5. Do not rely on the following before checking to see if the law has changed and how courts have interpreted it.

Alabama

Involuntary commitment for inpatient care: 

ALA. CODE § 22-52-10.4

(a). A respondent may be committed to inpatient treatment if the probate court finds, based upon clear and convincing evidence that:

(i) the respondent is mentallyill;

(ii) as a result of the mental illnessthe respondent poses a real and present threat of substantial harm to self and/orothers;

(iii) the respondent will, if nottreated, continue to suffer mental distress and will continue to experience deteriorationof the ability to function independently; and

(iv) the respondent is unable to makea rational and informed decision as to whether or not treatment for mental illness wouldbe desirable.

(b) If the probate judge finds that notreatment is presently available for the respondent’s mental illness, but that confinementis necessary to prevent the respondent from causing substantial harm to himself or toothers, the order committing the respondent shall provide that, should treatment for therespondent’s mental illness become available at any time during the period of therespondent’s confinement, such treatment shall be made available to him immediately.

Involuntary commitment for outpatient care: 

ALA. CODE § 22-52-10.2. A respondentmay be committed to outpatient treatment if the probate court finds, based upon clear andconvincing evidence that:

(i) the respondent is mentallyill;

(ii) as a result of the mental illnessthe respondent will, if not treated, continue to suffer mental distress and will continueto experience deterioration of the ability to function independently; and

(iii) the respondent is unable to makea rational and informed decision as to whether or not treatment for mental illness wouldbe desirable.

Alaska

Involuntary commitment for inpatient care: 

ALASKA STAT. § 47.30.755(a).”[M]entally ill and as a result is likely to cause harm to self or others, or isgravely disabled.”

Involuntary commitment for outpatient care: 

ALASKA STAT. § 47.30.795. Involuntary outpatient care for committed persons.

(a) A respondent who was originallycommitted to involuntary inpatient care under AS 47.30.700 – 47.30.915 may be releasedbefore the expiration of the commitment period if a provider of outpatient care acceptsthe respondent for specified outpatient treatment for a period of time not to exceed theduration of the commitment, and if the professional person in charge, or that person’sprofessional designee, finds that:

(1) it is not necessary to treat the respondent as an inpatient to prevent the respondent from harming self or others;and

(2) there is reason to believe thatthe respondent’s mental condition would improve as a result of the outpatient treatment.

ALASKA STAT. § 47.30.915(10).”likely to cause serious harm” means a person who

(A) poses a substantial risk of bodily harm to that person’s self, as manifested by recent behavior causing, attempting, orthreatening that harm;

(B) poses a substantial risk of harmto others as manifested by recent behavior causing, attempting, or threatening harm, andis likely in the near future to cause physical injury, physical abuse, or substantialproperty damage to another person; or

(C) manifests a current intent to carry out plans of serious harm to that person’s self or another

ALASKA STAT. § 47.30.915(7).”gravely disabled” means a condition in which a person as a result of mentalillness

(A) is in danger of physical harmarising from such complete neglect of basic needs for food, clothing, shelter, or personalsafety as to render serious accident, illness, or death highly probable if care by anotheris not taken; or

(B) will, if not treated, suffer orcontinue to suffer severe and abnormal mental, emotional, or physical distress, and thisdistress is associated with significant impairment of judgment, reason, or behaviorcausing a substantial deterioration of the person’s previous ability to functionindependently.

Arizona

For both inpatient and outpatient: 

ARIZ. REV. STAT. § 36-540 (A).”If the court finds by clear and convincing evidence that the proposed patient, as aresult of mental disorder, is a danger to self, is a danger to others, is persistently oracutely disabled or is gravely disabled and in need of treatment, and is either unwillingor unable to accept voluntary treatment . . . .”

ARIZ. REV. STAT. § 36-501(5).”Danger to others” means that the judgment of a person who has a mental disorderis so impaired that he is unable to understand his need for treatment and as a result ofhis mental disorder his continued behavior can reasonably be expected, on the basis ofcompetent medical opinion, to result in serious physical harm.

ARIZ. REV. STAT. § 36-501(6).”Danger to self” means:

(a) Behavior which, as a result of amental disorder, constitutes a danger of inflicting serious physical harm upon oneself,including attempted suicide or the serious threat thereof, if the threat is such that,when considered in the light of its context and in light of the individual’s previousacts, it is substantially supportive of an expectation that the threat will be carriedout.

(b) Behavior which, as a result of amental disorder, will, without hospitalization, result in serious physical harm or seriousillness to the person, except that this definition shall not include behavior whichestablishes only the condition of gravely disabled.

ARIZ. REV. STAT. § 36-501(16).”Gravely disabled” means a condition evidenced by behavior in which a person, asa result of a mental disorder, is likely to come to serious physical harm or seriousillness because he is unable to provide for his basic physical needs.

ARIZ. REV. STAT. § 36-501(33).”Persistently or acutely disabled” means a severe mental disorder that meets allthe following criteria:

(a) If not treated has a substantialprobability of causing the person to suffer or continue to suffer severe and abnormalmental, emotional or physical harm that significantly impairs judgment, reason, behavioror capacity to recognize reality.

(b) Substantially impairs the person’scapacity to make an informed decision regarding treatment and this impairment causes theperson to be incapable of understanding and expressing an understanding of the advantagesand disadvantages of accepting treatment and understanding and expressing an understandingof the alternatives to the particular treatment offered after the advantages,disadvantages and alternatives are explained to that person.

(c) Has a reasonable prospect of beingtreatable by outpatient, inpatient or combined inpatient and outpatient treatment.

Arkansas

For both inpatient and outpatient: 

ARK. CODE ANN. § 20-47-207(c). Aperson shall be eligible for involuntary admission if he or she is in such mentalcondition as a result of mental illness, disease, or disorder that he or she poses a clearand present danger to himself or herself or others;

(1) As used in this subsection,”a clear and present danger to himself or herself” is established bydemonstrating that:

(A) The person has inflicted seriousbodily injury on himself or herself or has attempted suicide or serious self-injury, andthere is a reasonable probability that such conduct will be repeated if admission is notordered; or

(B) The person has threatened toinflict serious bodily injury on himself or herself and there is a reasonable probabilitythat such conduct will occur if admission is not ordered; or

(C) The person’s recent behavior orbehavior history demonstrates that he or she so lacks the capacity to care for his or herown welfare that there is a reasonable probability of death, serious bodily injury, orserious physical or mental debilitation if admission is not ordered; and

(2) As used in this subsection,”a clear and present danger to others” is established by demonstrating that theperson has inflicted, attempted to inflict, or threatened to inflict serious bodily harmon another, and there is a reasonable probability that such conduct will occur ifadmission is not ordered.

California

For both inpatient and outpatient: 

CALIF. WELF. & INST. CODE § 5250.If a person is detained for 72 hours under the provisions of Article 1 (commencing withSection 5150), or under court order for evaluation pursuant to Article 2 (commencing withSection 5200) or Article 3 (commencing with Section 5225) and has received an evaluation,he or she may be certified for not more than 14 days of intensive treatment related to themental disorder or impairment by chronic alcoholism, under the following conditions:

(a) The professional staff of theagency or facility providing evaluation services has analyzed the person’s condition andhas found the person is, as a result of mental disorder or impairment by chronicalcoholism, a danger to others, or to himself or herself, or gravely disabled.

(b) The facility providing intensivetreatment is designated by the county to provide intensive treatment, and agrees to admitthe person. No facility shall be designated to provide intensive treatment unless itcomplies with the certification review hearing required by this article. The proceduresshall be described in the county Short-Doyle plan as required by Section 5651.3.

(c) The person has been advised of theneed for, but has not been willing or able to accept, treatment on a voluntary basis.

(d)

(1) Notwithstanding paragraph (1) ofsubdivision (h) of Section 5008, a person is not “gravely disabled” if thatperson can survive safely without involuntary detention with the help of responsiblefamily, friends, or others who are both willing and able to help provide for the person’sbasic personal needs for food, clothing, or shelter.

(2) However, unless they specificallyindicate in writing their willingness and ability to help, family, friends, or othersshall not be considered willing or able to provide this help.

(3) The purpose of this subdivision isto avoid the necessity for, and the harmful effects of, requiring family, friends, andothers to publicly state, and requiring the certification review officer to publicly find,that no one is willing or able to assist the mentally disordered person in providing forthe person’s basic needs for food, clothing, or shelter.”

CALIF. WELF. & INST. CODE §5008(h)(1) “gravely disabled” means either of the following:

(A) A condition in which a person, asa result of a mental disorder, is unable to provide for his or her basic personal needsfor food, clothing, or shelter.

(B) A condition in which a person, hasbeen found mentally incompetent under Section 1370 of the Penal Code and all of thefollowing facts exist:

(i) The indictment or informationpending against the defendant at the time of commitment charges a felony involving death,great bodily harm, or a serious threat to the physical well-being of another person.

(ii) The indictment or information hasnot been dismissed.

(iii) As a result of mental disorder,the person is unable to understand the nature and purpose of the proceedings taken againsthim or her and to assist counsel in the conduct of his or her defense in a rationalmanner.

For outpatient via assisted outpatienttreatment*

5346.  (a) In any county in which services are available as provided in Section 5348, a court may order a person who is the subjectof a petition filed pursuant to this section to obtain assisted outpatient treatment if the court finds, by clear and convincing evidence,that the facts stated in the verified petition filed in accordance with this section are true and establish that all of the requisite criteriaset forth in this section are met, including, but not limited to, each of the following:    (1) The person is 18 years of age or older.    (2) The person is suffering from a mental illness as defined in paragraphs (2) and (3) of subdivision (b) of Section 5600.3.    (3) There has been a clinical determination that the person is unlikely to survive safely in the community without supervision.    (4) The person has a history of lack of compliance with treatment for his or her mental illness, in that at least one of the followingis true:   (A) The person’s mental illness has, at least twice within the last 36 months, been a substantial factor in necessitatinghospitalization, or receipt of services in a forensic or other mental health unit of a state correctional facility or local correctionalfacility, not including any period during which the person was hospitalized or incarcerated immediately preceding the filing ofthe petition.    (B) The person’s mental illness has resulted in one or more acts of serious and violent behavior toward himself or herself or another,or threats, or attempts to cause serious physical harm to himself or herself or another within the last 48 months, not includingany period in which the person was hospitalized or incarcerated immediately preceding the filing of the petition.    (5) The person has been offered an opportunity to participate in a treatment plan by the director of the local mental healthdepartment, or his or her designee, provided the treatment plan includes all of the services described in Section 5348, and theperson continues to fail to engage in treatment.    (6) The person’s condition is substantially deteriorating.    (7) Participation in the assisted outpatient treatment program would be the least restrictive placement necessary to ensure theperson’s recovery and stability.    (8) In view of the person’s treatment history and current behavior, the person is in need of assisted outpatient treatment in order toprevent a relapse or deterioration that would be likely to result in grave disability or serious harm to himself or herself, or toothers, as defined in Section 5150.    (9) It is likely that the person will benefit from assisted outpatient treatment.

* Standardonly applies in counties that have adopted provisions established by Assembly Bill 1421(2002) (a.k.a. Laura’s Law); otherwise mandated outpatient treatment only permittedvia conservatorship process.]

Colorado

For both inpatient and outpatient: 

COLO. REV. STAT. § 27-10-111(1).”The court or jury shall determine that the respondent is in need of care andtreatment only if the court or jury finds such person mentally ill and, as a result ofsuch mental illness, a danger to others or to himself or gravely disabled . . . .”

COLO. REV. STAT. § 27-10-102(5)

(a) “Gravely disabled” meansa condition in which a person, as a result of mental illness:

(I) Is in danger of serious physicalharm due to his inability or failure to provide himself the essential human needs of food,clothing, shelter, and medical care; or

(II) Lacks judgment in the managementof his resources and in the conduct of his social relations to the extent that his healthor safety is significantly endangered and lacks the capacity to understand that this isso.

(b) A person who, because of careprovided by a family member or by an individual with a similar relationship to the person,is not in danger of serious physical harm or is not significantly endangered in accordancewith paragraph (a) of this subsection (5) may be deemed “gravely disabled” ifthere is notice given that the support given by the family member or other individual whohas a similar relationship to the person is to be terminated and the individual with mental illness:

(I) Is diagnosed by a professional person as suffering from: Schizophrenia; a major affective disorder; a delusional disorder; or another mental disorder with psychotic features; and

(II) Has been certified, pursuant tothis article, for treatment of such disorder or has been admitted as an inpatient to atreatment facility for treatment of such disorder at least twice during the lastthirty-six months with a period of at least thirty days between certifications oradmissions; and

(III) Is exhibiting a deterioratingcourse leading toward danger to self or others or toward the conditions described inparagraph (a) of this subsection (5) with symptoms and behavior which are substantiallysimilar to those which preceded and were associated with his hospital admissions orcertifications for treatment; and

(IV) Is not receiving treatment whichis essential for his health or safety.

Connecticut*

For inpatient*: 

CONN. GEN. STAT. ANN. § 17a-498(c).If, on such hearing, the court finds by clear and convincing evidence that the personcomplained of has psychiatric disabilities and is dangerous to himself or herself orothers or gravely disabled, it shall make an order for his or her commitment, consideringwhether or not a less restrictive placement is available, to a hospital for psychiatricdisabilities to be named in such order, there to be confined for the period of theduration of such psychiatric disabilities or until he or she is discharged or converted tovoluntary status pursuant to section 17a-506 in due course of law.

CONN. GEN. STAT. ANN. § Sec.17a-495(a). “dangerous to himself or herself or others” means there is asubstantial risk that physical harm will be inflicted by an individual upon his or her ownperson or upon another person, and “gravely disabled” means that a person, as aresult of mental or emotional impairment, is in danger of serious harm as a result of aninability or failure to provide for his or her own basic human needs such as essentialfood, clothing, shelter or safety and that hospital treatment is necessary and availableand that such person is mentally incapable of determining whether or not to accept suchtreatment because his judgment is impaired by his psychiatric disabilities.

* Connecticut does not have anassisted outpatient treatment law.

Delaware

For both inpatient and outpatient: 

DEL. CODE ANN. tit. 16, § 5010. As aresult of the hearing to determine mental illness, the court shall make specific findings:. . . (2) That based upon clear and convincing evidence, the involuntary patient is amentally ill person in which case the court shall enter an order of disposition, whichdisposition shall be effective for a period not to exceed 3 months. In determining thedisposition of the involuntary patient the court shall consider all availablealternatives, including inpatient confinement at the hospital, and shall order suchdisposition as imposes the least restraint upon the involuntary patient’s liberty anddignity consistent both with affording mental health treatment and care with protectingthe safety of the involuntary patient and the public.

DEL. CODE ANN. tit. 16, § 5001(6).”Mentally ill person” means a person suffering from a mental disease orcondition which requires such person to be observed and treated at a mental hospital forthe person’s own welfare and which both

(i) renders such person unable to makeresponsible decisions with respect to the person’s hospitalization, and

(ii) poses a real and present threat,based upon manifest indications, that such person is likely to commit or suffer seriousharm to that person’s own self or others or to property if not given immediate hospitalcare and treatment.

District of Columbia

For both inpatient and outpatient: 

D.C. CODE ANN. § 21-545(b). If thecourt or jury finds that the person is mentally ill and, because of that illness, islikely to injure himself or other persons if allowed to remain at liberty, the court mayorder his hospitalization for an indeterminate period, or order any other alternativecourse of treatment which the court believes will be in the best interests of the personor of the public.

Florida*

For inpatient*:

FLA. STAT. ANN. § 394.467(1). Criteria – A person may be placed in involuntarily inpatient placement for treatment upon a finding of the court by clear and convincing evidence that:

(a) He or she is mentally ill andbecause of his or her mental illness:

1.

a. He or she has refused voluntaryplacement for treatment after sufficient and conscientious explanation and disclosure ofthe purpose of placement for treatment; or

b. He or she is unable to determinefor himself or herself whether placement is necessary; AND

2.

a. He or she is manifestly incapableof surviving alone or with the help of willing and responsible family or friends,including available alternative services, and, without treatment, is likely to suffer fromneglect of refuse to care for himself or herself, and such neglect or refusal poses a realand present threat of substantial harm to his or her well-being; or

b. There is substantial likelihoodthat in the near future he or she will inflict serious bodily harm on himself or herselfor another person, as evidenced by recent behavior causing, attempting, or threateningsuch harm; and

(b) All available less restrictivetreatment alternatives which would offer an opportunity for improvement of his or hercondition have been judged to be inappropriate.

For outpatient:

FLA. STAT. ANN. §394.4655(1) A person may be ordered to involuntary outpatient placement upon a finding ofthe court that by clear and convincing evidence:

(a) The person is 18years of age or older;
(b) The person has a mental illness;
(c) The person is unlikely to survive safely in the community without supervision, basedon a clinical determination;
(d) The person has a history of lack of compliance with treatment for mental illness;
(e) The person has:

1. At least twice within the immediatelypreceding 36 months been involuntarily admitted to a receiving facility or treatmentfacility as defined in s. 394.455, or has received mental health services in a forensic orcorrectional facility. The 36-month period does not include any period during which theperson was admitted or incarcerated; or
2. Engaged in one or more acts of serious violent behavior toward self or others, orattempts at serious bodily harm to himself or herself or others, within the preceding 36months;

(f) The person is, as aresult of his or her mental illness, unlikely to voluntarily participate in therecommended treatment plan and either he or she has refused voluntary placement fortreatment after sufficient and conscientious explanation and disclosure of the purpose ofplacement for treatment or he or she is unable to determine for himself or herself whetherplacement is necessary;
(g) In view of the person’s treatment history and current behavior, the person is inneed of involuntary outpatient placement in order to prevent a relapse ordeterioration that would be likely to result in serious bodily harm to himself or herselfor others, or a substantial harm to his or her well-being as set forth in s. 394.463(1);
(h) It is likely that the person will benefit from involuntary outpatient placement; and
(i) All available less restrictive alternatives that would offer an opportunity forimprovement of his or her condition have been judged to be inappropriate or unavailable.

Florida reformed its Baker Act in June, 2004to allow for assisted outpatient treatment.  Therevised law is effective on January 1, 2005.

Georgia

For inpatient: 

GA. CODE ANN. § 37-3-1(9.1).”Inpatient” means a person who is mentally ill and:

(A)

(i) Who presents a substantial risk ofimminent harm to that person or others, as manifested by either recent overt acts orrecent expressed threats of violence which present a probability of physical injury tothat person or other persons; or

(ii) Who is so unable to care for thatperson’s own physical health and safety as to create an imminently life-endangeringcrisis; and

(B) Who is in need of involuntaryinpatient treatment.

For outpatient: 

GA. CODE ANN. § 37-3-1(12.1).”Outpatient” means a person who is mentally ill and:

(A) Who is not an inpatient but who,based on the person’s treatment history or current mental status, will require outpatienttreatment in order to avoid predictably and imminently becoming an inpatient;

(B) Who because of the person’scurrent mental status, mental history, or nature of the person’s mental illness is unablevoluntarily to seek or comply with outpatient treatment; and

(C) Who is in need of involuntarytreatment.

 Hawaii

For inpatient: 

HAW. REV. STAT. § 334-60.2. A personmay be committed to a psychiatric facility for involuntary hospitalization, if the courtfinds:

(1) That the person is mentally ill orsuffering from substance abuse.

(2) That the person is imminentlydangerous to self or others, is gravely disabled or is obviously ill; and

(3) That the person is in need of careor treatment, or both, and there is no suitable alternative available through existingfacilities and programs which would be less restrictive than hospitalization.

For outpatient: 

HAW. REV. STAT. § 334-121. A personmay be ordered to obtain involuntary outpatient treatment if the family court findsthat:

(1) The person is suffering from asevere mental disorder or from substance abuse; and

(2) The person is capable of survivingsafely in the community with available supervision from family, friends, or others;and

(3) The person, at some time in thepast:

(A) has received inpatient hospitaltreatment for a severe mental disorder or substance abuse, or

(B) has been imminently dangerous toself or others, or is gravely disabled, as a result of a severe mental disorder orsubstance abuse; and

(4) The person, based on the person’streatment history and current behavior, is now in need of treatment in order to prevent arelapse or deterioration which would predictably result in the person becoming imminentlydangerous to self or others, and

(5) The person’s current mental statusor the nature of the person’s disorder limits or negates the person’s ability to make aninformed decision to voluntarily seek or comply with recommended treatment; and

(6) There is a reasonable prospectthat the outpatient treatment ordered will be beneficial to the person.

HAW. REV. STAT. § 334-1.”Dangerous to others” means likely to do substantial physical or emotionalinjury on another, as evidenced by a recent act, attempt or threat.

“Dangerous to property”means inflicting, attempting or threatening imminently to inflict damage to any propertyin a manner which constitutes a crime, as evidenced by a recent act, attempt or threat.

“Dangerous to self” meansthe person recently has threatened or attempted suicide or serious bodily harm; or theperson recently has behaved in such a manner as to indicate that the person is unable,without supervision and the assistance of others, to satisfy the need for nourishment,essential medical care, shelter or self-protection, so that it is probable that death,substantial bodily injury, or serious physical debilitation or disease will result unlessadequate treatment is afforded.

“Gravely disabled” means acondition in which a person, as a result of a mental disorder,

(1) is unable to provide for thatindividual’s basic personal needs for food, clothing, or shelter;

(2) is unable to make or communicaterational or responsible decisions concerning the individual’s personal welfare; and

(3) lacks the capacity to understandthat this is so.

“Obviously ill” means acondition in which a person’s current behavior and previous history of mental illness, ifknown, indicate a disabling mental illness, and the person is incapable of understandingthat there are serious and highly probable risks to health and safety involved in refusingtreatment, the advantages of accepting treatment, or of understanding the advantages ofaccepting treatment and the alternatives to the particular treatment offered, after theadvantages, risks, and alternatives have been explained to the person.

Idaho

For inpatient: 

IDAHO CODE § 66-329(k). If, upon completion of the hearing and consideration of the record, the court finds by clear and convincing evidence that the proposed patient:

(1) is mentally ill; and

(2) is, because of such condition, likely to injure himself or others, or is gravely disabled due to mental illness;

the court shall order the proposed patient committed to the custody of the department director for an indeterminate period of time not to exceed one (1) year.

For outpatient: 

IDAHO CODE § 66-339A. A person may be committed to outpatient treatment for a period of up to one (1) year if, after a court hearing conducted substantially similar to the one outlined in section 66-329, Idaho Code, the court determines, on the basis of clear and convincing evidence that:

(1) The person is diagnosed as having a mental illness; and

(2) The person, without the requested treatment:

(a) Is likely to cause harm to himself or to suffer substantial mental or emotional deterioration, or become gravely disabled, or

(b) Is likely to cause harm to others; and

(3) The person lacks capacity to make an informed decision concerning his need for treatment; and

(4) The person has previously been hospitalized for treatment of mental illness and has by history substantially failed to comply on

one (1) or more occasions with the prescribed course of treatment outside the hospital; and

(5) A treatment plan has been prepared which includes specific conditions with which the patient is expected to comply, together with a detailed plan for reviewing the patient’s medical status and for monitoring his or her compliance with the required conditions of treatment; and

(6) There is a reasonable prospect that the patient’s disorder will respond to the treatment proposed in the treatment plan without having to be involuntarily committed to an inpatient facility if the patient complies with the treatment requirements specified in the court’s order; and

(7) The physician or treatment facility which is to be responsible for the patient’s treatment under the commitment order has agreed to accept the patient.

IDAHO CODE § 66-317. Definitions.

(11) “Likely to injure himself or others” means either:

(a) A substantial risk that physical harm will be inflicted by the proposed patient upon his own person, as evidenced by threats or attempts to commit suicide or inflict physical harm on himself; or

(b) A substantial risk that physical harm will be inflicted by the proposed patient upon another as evidenced by behavior which has caused such harm or which places another person or persons in reasonable fear of sustaining such harm.

(12) “Mentally ill” means a person, who as a result of a substantial disorder of thought, mood, perception, orientation, or memory, which grossly impairs judgment, behavior, capacity to recognize and adapt to reality, requires care and treatment at a facility.

(13) “Gravely disabled” means a person who, as the result of mental illness, is in danger of serious physical harm due to the person’s inability to provide for   any of his basic needs for nourishment, or essential medical care, or shelter or safety.

Illinois

For both inpatient and outpatient:

405 ILL. COMP. STAT. 5/1-119. Personsubject to involuntary admission; subject to involuntary admission § 1-119.

“Person subject to involuntaryadmission” or “subject to involuntary admission” means:

(1) A person with mental illness andwho because of his or her illness is reasonably expected to inflict serious physical harmupon himself or herself or another in the near future  which may includethreatening behavior or conduct that places another individual in reasonable expectationof being harmed; or;

(2) A person with mental illness andwho because of his or her illness is unable to provide for his basic physical needs so asto guard himself or herself from serious harm without theassistance of family or outside help.

In determining whether a personmeets the criteria specified in paragraph (1) or (2), the court may consider evidence ofthe person’s repeated past pattern of specific behavior and actions related to theperson’s illness.

Indiana

For both inpatient and outpatient (see below for additional outpatient criteria)

IND. CODE ANN. § 12-26-6-8(a) [temporary commitment, up to 90 days] and IND. CODE ANN. § 12-26-7-5(a) [regular commitment, beyond 90 days]. “If at the completion of the hearing . . . an individual is found to be mentally ill and either dangerous or gravely disabled . . . .”

For outpatient: 

IND. CODE ANN. § 12-26-14-1. If a hearing has been held under IC 12-26-6 or IC 12-26-7 and the court finds that the individual is:

(1) Mentally ill and either dangerous or gravely disabled;

(2)Llikely to benefit from an outpatient therapy program that is designed to decrease the individual’s dangerousness or disability;

(3) Not likely to be either dangerous or gravely disabled if the individual complies with the therapy program; and

(4) Recommended for an outpatient therapy program by the individual’s examining physician;

the court may order the individual to enter a therapy program as an outpatient.

IND. CODE ANN. § 12-7-2-53. “Dangerous”, for purposes of IC 12-26, means a condition in which an individual as a result of mental illness, presents a substantial risk that the individual will harm the individual or others.

IND. CODE ANN. § 12-7-2-96. “Gravely disabled”, for purposes of IC 12-26, means a condition in which an individual, as a result of mental illness, is in danger of coming to harm because the individual:

(1) is unable to provide for that individual’s food, clothing, shelter, or other essential human needs; or

(2) has a substantial impairment or an obvious deterioration of that individual’s judgment, reasoning, or behavior that results in the individual’s inability to function independently.

Iowa

For both inpatient and outpatient: 

IOWA CODE § 229.1(15).”Seriously mentally impaired” or “serious mental impairment” describesthe condition of a person with mental illness and because of that illness lacks sufficientjudgment to make responsible decisions with respect to the person’s hospitalization ortreatment, and who because of that illness meets any of the following criteria:

a. Is likely to physically injure theperson’s self or others if allowed to remain at liberty without treatment.

b. Is likely to inflict seriousemotional injury on members of the person’s family or others who lack reasonableopportunity to avoid contact with the person with mental illness if the person with mentalillness is allowed to remain at liberty without treatment.

c. Is unable to satisfy the person’sneeds for nourishment, clothing, essential medical care, or shelter so that it is likelythat the person will suffer physical injury, physical debilitation, or death.

IOWA CODE § 229.1 (14).  “Seriousemotional injury” is an injury which does not necessarily exhibit any physicalcharacteristics, but which can be recognized and diagnosed by a licensed physician orother qualified mental health professional and which can be causally connected with theact or omission of a person who is, or is alleged to be, mentally ill.

Kansas

For both inpatient and outpatient (see below foradditional outpatient criteria)

KAN. STAT. ANN. § 59-2946(f)

(1) “Mentally ill person subjectto involuntary commitment for care and treatment” means a mentally ill person, asdefined in subsection (e), who also lacks capacity to make an informed decision concerningtreatment, is likely to cause harm to self or others, and whose diagnosis is not solelyone of the following mental disorders: Alcohol or chemical substance abuse; antisocialpersonality disorder; mental retardation; organic personality syndrome; or an organicmental disorder.

(2) “Lacks capacity to make aninformed decision concerning treatment” means that the person, by reason of theperson’s mental disorder, is unable, despite conscientious efforts at explanation, tounderstand basically the nature and effects of hospitalization or treatment or is unableto engage in a rational decision-making process regarding hospitalization or treatment, asevidenced by an inability to weigh the possible risks and benefits.

(3) “Likely to cause harm to selfor others” means that the person, by reason of the person’s mental disorder:

(a) Is likely, in the reasonablyforeseeable future, to cause substantial physical injury or physical abuse to self orothers or substantial damage to another’s property, as evidenced by behavior threatening,attempting or causing such injury, abuse or damage; except that if the harm threatened,attempted or caused is only harm to the property of another, the harm must be of such avalue and extent that the state’s interest in protecting the property from such harmoutweighs the person’s interest in personal liberty; or

(b) is substantially unable, exceptfor reason of indigency, to provide for any of the person’s basic needs, such as food,clothing, shelter, health or safety, causing a substantial deterioration of the person’sability to function on the person’s own.

Additional criteria foroutpatient: 

KAN. STAT. ANN. § 59-2967(a). Anorder for outpatient treatment may be entered by the court at any time in lieu of any typeof order which would have required inpatient care and treatment if the court finds thatthe patient is likely to comply with an outpatient treatment order and that the patientwill not likely be a danger to the community or be likely to cause harm to self or otherswhile subject to an outpatient treatment order.

Kentucky

For both inpatient and outpatient: 

KY. REV. STAT. ANN. § 202A.026. Noperson shall be involuntarily hospitalized unless such person is a mentally illperson:

(1) Who presents a danger or threat ofdanger to self, family or others as a result of the mental illness;

(2) Who can reasonably benefit fromtreatment; and

(3) For whom hospitalization is theleast restrictive alternative mode of treatment presently available.

KY. REV. STAT. ANN. § 202A.011(2).”Danger” or “threat of danger to self, family or others” meanssubstantial physical harm or threat of substantial physical harm upon self, family, orothers, including actions which deprive self, family, or others of the basic means ofsurvival including provision for reasonable shelter, food or clothing;

Louisiana

For both inpatient and outpatient: 

LA. REV. STAT. ANN. § 28:55(E)(1). Ifthe court finds by clear and convincing evidence that the respondent is dangerous to selfor others or is gravely disabled, as a result of substance abuse or mental illness, itshall render a judgment for his commitment.

LA. REV. STAT. ANN. § 28:2(3).”Dangerous to others” means the condition of a person whose behavior orsignificant threats support a reasonable expectation that there is a substantial risk thathe will inflict physical harm upon another person in the near future.

LA. REV. STAT. ANN. § 28:2(4).”Dangerous to self” means the condition of a person whose behavior, significantthreats or inaction supports a reasonable expectation that there is a substantial riskthat he will inflict physical or severe emotional harm upon his own person.

LA. REV. STAT. ANN. § 28:2(10).”Gravely disabled” means the condition of a person who is unable to provide forhis own basic physical needs, such as essential food, clothing, medical care, and shelter,as a result of serious mental illness or substance abuse and is unable to survive safelyin freedom or protect himself from serious harm; the term also includes incapacitation byalcohol, which means the condition of a person who, as a result of the use of alcohol, isunconscious or whose judgment is otherwise so impaired that he is incapable of realizingand making a rational decision with respect to his need for treatment.

Maine*

For inpatient*:

ME. REV. STAT. ANN. tit. 34-B, §3864(6)(A). The District Court shall so state in the record, if it finds upon completionof the hearing and consideration of the record:

(1) Clear and convincing evidence thatthe person is mentally ill and that the person’s recent actions and behavior demonstratethat the person’s illness poses a likelihood of serious harm;

(2) That inpatient hospitalization isthe best available means for treatment of the patient; and

(3) That it is satisfied with theindividual treatment plan offered by the hospital to which the applicant seeks thepatient’s involuntary commitment.

ME. REV. STAT. ANN. tit. 34B, §3801(4). “Likelihood of serious harm” means:

A. A substantial risk of physical harmto the person himself as manifested by evidence of recent threats of, or attempts at,suicide or serious bodily harm to himself and, after consideration of less restrictivetreatment settings and modalities, a determination that community resources for his careand treatment are unavailable;

B. A substantial risk of physical harmto other persons as manifested by recent evidence of homicidal or other violent behavioror recent evidence that others are placed in reasonable fear of violent behavior andserious physical harm to them and, after consideration of less restrictive treatmentsettings and modalities, a determination that community resources for his care andtreatment are unavailable; or

C. A reasonable certainty that severephysical or mental impairment or injury will result to the person alleged to be mentallyill as manifested by recent evidence of his actions or behavior which demonstrate hisinability to avoid or protect himself from such impairment or injury, and, afterconsideration of less restrictive treatment settings and modalities, a determination thatsuitable community resources for his care are unavailable.

* Maine does not have an assistedoutpatient treatment law.

Maryland*

For inpatient*: 

MD. CODE ANN., HEALTH-GEN. §10-632(e)(2).

(i) The individual has a mentaldisorder;

(ii) The individual needs in-patientcare or treatment;

(iii) The individual presents a dangerto the life or safety of the individual or of others;

(iv) The individual is unable orunwilling to be voluntarily admitted to the facility;

(v) There is no available lessrestrictive form of intervention that is consistent with the welfare and safety of theindividual; and

(vi) If the individual is 65 years oldor older and is to be admitted to a State facility, the individual has been evaluated by ageriatric evaluation team and no less restrictive form of care or treatment was determinedby the team to be appropriate.

*Maryland does not have an assistedoutpatient treatment law.

Massachusetts*

For inpatient*: 

MASS. GEN. LAWS ANN. ch. 123, § 8(a).After a hearing, unless such hearing is waived in writing, the district court or thedivision of the juvenile court department shall not order the commitment of a person at afacility or shall not renew such order unless it finds after a hearing that

(1) such person is mentally ill,and

(2) the discharge of such person froma facility would create a likelihood of serious harm.

MASS. GEN. LAWS ANN. ch. 123, § 1.”Likelihood of serious harm”,

(1) a substantial risk of physicalharm to the person himself as manifested by evidence of, threats of, or attempts at,suicide or serious bodily harm;

(2) a substantial risk of physicalharm to other persons as manifested by evidence of homicidal or other violent behavior orevidence that others are placed in reasonable fear of violent behavior and seriousphysical harm to them; or

(3) a very substantial risk ofphysical impairment or injury to the person himself as manifested by evidence that suchperson’s judgment is so affected that he is unable to protect himself in the community andthat reasonable provision for his protection is not available in the community.

* Massachusetts does not have anassisted outpatient treatment law.

Michigan

For both inpatient and outpatient (except that if the court relies exclusively on criteria in (1)(d), only outpatient may be ordered):  

MICH. COMP. LAWS ANN. § 330.1401. (1) As used in this chapter, “person requiring treatment” means (a), (b),(c), or (d):

(a) An individual who has mental illness, and who as a result of that mental illness can reasonably be expected within the near future to intentionally or unintentionally seriously physically injure himself, herself, or another individual, and who has engaged in an act or acts or made significant threats that are substantially supportive of the expectation.

(b) An individual who has mental illness, and who as a result of that mental illness is unable to attend to those of his or her basic physical needs such as food, clothing, or shelter that must be attended to in order for the individual to avoid serious harm in the near future, and who has demonstrated that inability by failing to attend to those basic physical needs.

(c) An individual who has mental illness, whose judgment is so impaired that he or she is unable to understand his or her need for treatment and whose continued behavior as the result of this mental illness can reasonably be expected, on the basis of competent clinical opinion, to result in significant physical harm to himself, herself, or others. This individual shall receive involuntary mental health treatment initially only under the provisions of sections 434 through 438.

(d) An individual who has mental illness, whose understanding of the need for treatment is impaired to the point that he or she is unlikely to participate in treatment voluntarily, who is currently noncompliant with treatment that has been recommended by a mental health professional and that has been determined to be necessary to prevent a relapse or harmful deterioration of his or her condition, and whose noncompliance with treatment has been a factor in the individual’s placement in a psychiatric hospital, prison, or jail at least 2 times within the last 48 months or whose noncompliance with treatment has been a factor in the individual’s committing 1 or more acts, attempts, or threats of serious violent behavior within the last 48 months. An individual under this subdivision is only eligible to receive assisted outpatient treatment under section 433 or 469a.

Minnesota*

For inpatient: 

MINN. STAT. ANN. § 253B.09(1)”If the court finds by clear and convincing evidence that the proposed patient is aperson who is mentally ill, developmentally disabled, or chemically dependent and after carefulconsideration of reasonable alternative dispositions . . . it finds that there is nosuitable alternative to judicial commitment, the court shall commit the patient to theleast restrictive treatment program or alternative programs which can meet the patient’streatment needs . . . .”

For outpatient: 

MINN. STAT. ANN. § 253B.065(5)

(a) A court shall order earlyintervention treatment of a proposed patient who meets the criteria under paragraph (b).The early intervention treatment must be less intrusive than long-term inpatientcommitment and must be the least restrictive treatment program available that can meet thepatient’s treatment needs.

(b) The court shall order earlyintervention treatment if the court finds all of the elements of the following factors byclear and convincing evidence:

(1) the proposed patient is mentallyill;

(2) the proposed patient refuses toaccept appropriate mental health treatment; and

(3) the proposed patient’s mentalillness is manifested by instances of grossly disturbed behavior or faulty perceptions andeither:

(i) the grossly disturbed behavior orfaulty perceptions significantly interfere with the proposed patient’s ability to care forself and the proposed patient, when competent, would have chosen substantially similartreatment under the same circumstances; or

(ii) due to the mental illness, theproposed patient received court-ordered inpatient treatment under section 253B.09 at leasttwo times in the previous three years; the patient is exhibiting symptoms or behaviorsubstantially similar to those that precipitated one or more of the court-orderedtreatments; and the patient is reasonably expected to physically or mentally deteriorateto the point of meeting the criteria for commitment under section 253B.09 unless treated.

MINN. STAT. ANN. § 253B.02(13)(a). A“person who is mentally ill” means any person who has an organic disorder of thebrain or a substantial psychiatric disorder of thought, mood, perception, orientation, ormemory which grossly impairs judgment, behavior, capacity to recognize reality, or toreason or understand, which is manifested by instances of grossly disturbed behavior orfaulty perceptions and poses a substantial likelihood of physical harm to self or othersas demonstrated by:

(1)     a failure to obtain necessary food, clothing,shelter, or medical care as a result of the impairment; or

(2)    an inability for reasons other than indigence toobtain necessary food, clothing, shelter, or medical care as a result of the impairmentand it is more probable than not that the person will suffer substantial harm, significantpsychiatric deterioration or debilitation, or serious illness, unless appropriatetreatment and services are provided;

(3)       arecent attempt or threat to physically harm self or others.

(4)      recentand volitional conduct involving significant damage to substantial property.

 

MINN. STAT. ANN. § 253B.02(17). A”person mentally ill and dangerous to the public” is a person

(a) who is mentally ill; and

(b) who as a result of that mentalillness presents a clear danger to the safety of others as demonstrated by the factsthat

(i) the person has engaged in an overtact causing or attempting to cause serious physical harm to another and

(ii) there is a substantial likelihoodthat the person will engage in acts capable of inflicting serious physical harm onanother. A person committed as a sexual psychopathic personality or sexually dangerousperson as defined in subdivisions 18a and 18b is subject to the provisions of this chapterthat apply to persons mentally ill and dangerous to the public.

Note: The distinction made betweena person committed as a “mentally ill person” and a “person mentally illand dangerous to the public” is that the latter is not permitted to transfer tovoluntary status per 253B.10(5). Both satisfy conditions for assisted treatment.

Mississippi

For both inpatient and outpatient: 

MISS. CODE ANN. § 41-21-73(4).”If the court finds by clear and convincing evidence that the proposed patient is amentally ill . . . person and, if after careful consideration of reasonable alternativedispositions . . . the court finds that there is no suitable alternative to judicialcommitment. . . .  A nonresident of the statemay be committed for treatment or confinement in the county where such person was found.

Alternatives to commitment to inpatient care may include, but shall not be limited to:voluntary or court-ordered outpatient commitment for treatment with specific reference toa treatment regimen, day treatment in a hospital, night treatment in a hospital, placementin the custody of a friend or relative or the provision of home health services.

For persons committed as mentally ill… the initial commitment shall not exceed three(3) months.”

MISS. CODE ANN. § 41-21-61(e).”Mentally ill person” means any person who has a substantial psychiatricdisorder of thought, mood, perception, orientation, or memory which grossly impairsjudgment, behavior, capacity to recognize reality, or to reason or understand, which

(i) is manifested by instances ofgrossly disturbed behavior or faulty perceptions; and

(ii) poses a substantial likelihood ofphysical harm to himself or others as demonstrated by

(A) a recent attempt or threat tophysically harm himself or others, or

(B) a failure to provide necessaryfood, clothing, shelter or medical care for himself, as a result of the impairment.

“Mentally ill person”includes a person who, based on treatment history and other applicable psychiatricindicia, is in need of treatment in order to prevent further disability or deteriorationwhich would predictably result in dangerousness to himself or others when his currentmental illness limits or negates his ability to make an informed decision to seek orcomply with recommended treatment.

 Missouri

For both inpatient and outpatient: 

MO. ANN. STAT. 632.350(5) ” Atthe conclusion of the hearing, if the court or jury finds that the respondent, as theresult of mental illness, presents a likelihood of serious harm to himself or to others,and the court finds that a program appropriate to handle the respondent’s condition hasagreed to accept him, the court shall order the respondent to be detained for involuntarytreatment in the least restrictive environment for a period not to exceed ninety days orfor outpatient detention and treatment under the supervision of a mental health program inthe least restrictive environment for a period not to exceed one hundred eightydays.”

MO. ANN. STAT. § 632.005(9).”Likelihood of serious harm” means any one or more of the following but does notrequire actual physical injury to have occurred:

(a) A substantial risk that seriousphysical harm will be inflicted by a person upon his own person, as evidenced by recentthreats, including verbal threats, or attempts to commit suicide or inflict physical harmon himself. Evidence of substantial risk may also include information about patterns ofbehavior that historically have resulted in serious harm previously being inflicted by aperson upon himself;

(b) A substantial risk thatserious physical harm to a person will result or is occurring because of an impairment inhis capacity to make decisions with respect to his hospitalization and need for treatmentas evidenced by his current mental disorder or mental illness which results in aninability to provide for his own basic necessities of food, clothing, shelter, safety ormedical care or his inability to provide for his own mental health care which may resultin a substantial risk of serious physical harm. Evidence of that substantial risk may alsoinclude information about patterns of behavior that historically have resulted in seriousharm to the person previously taking place because of a mental disorder or mental illnesswhich resulted in his inability to provide for his basic necessities of food, clothing,shelter, safety or medical or mental health care; or

(c) A substantial risk that serious physical harm will be inflicted by a person uponanother as evidenced by recent overt acts, behavior or threats, including verbal threats,which have caused such harm or which would place a reasonable person in reasonable fear ofsustaining such harm. Evidence of that substantial risk may also include information aboutpatterns of behavior that historically have resulted in physical harm previously beinginflicted by a person upon another person;

Montana

For both inpatient and outpatient (except that if thecourt relies exclusively on criteria in (1)(d), only outpatient may be ordered)

MONT. CODE ANN. § 53-21-126(1). Ifthe court determines that the respondent is suffering from a mental disorder, the courtshall then determine whether the respondent requires commitment. In determining whetherthe respondent requires commitment, the court shall consider the following:

(a) whether the respondent, because ofa mental disorder, is substantially unable to provide for the respondent’s own basic needsof food, clothing, shelter, health, or safety;

(b) whether the respondent hasrecently, because of a mental disorder and through an act or an omission, causedself-injury or injury to others;

(c) whether, because of a mentaldisorder, there is an imminent threat of injury to the respondent or to others because ofthe respondent’s acts or omissions; and

(d) whether the respondent’s mentaldisorder, as demonstrated by the respondent’s recent acts or omissions, will, ifuntreated, predictably result in deterioration of the respondent’s mental condition to thepoint at which the respondent will become a danger to self or to others or will be unableto provide for the respondent’s own basic needs of food, clothing, shelter, health, orsafety. Predictability may be established by the respondent’s relevant medicalhistory.

MONT. CODE ANN. § 53-21-127 (7)  Satisfaction of any one of the criteria listed in53-21-126(1) justifies commitment pursuant to this chapter. However, if the court reliessolely upon the criterion provided in 53-21-126(1)(d), the court may require commitmentonly to a community facility and may not require commitment at the state hospital.

MONT. CODE ANN. § 53-21-102(9)(a).”Mental disorder” means any organic, mental, or emotional impairment that hassubstantial adverse effects on an individual’s cognitive or volitional functions.

Nebraska

For both inpatient and outpatient: 

NEB. REV. STAT. § 71-925(1). Thestate has the burden to prove by clear and convincing evidence that (a) the subject ismentally ill and dangerous and (b) neither voluntary hospitalization nor other treatmentalternatives less restrictive of the subject’s liberty than inpatient or outpatienttreatment ordered by the mental health board are available or would suffice to prevent theharm described in section 71-908.

(4) If the subject admits theallegations of the petition or the mental health board finds that the subject is mentallyill and dangerous and that neither voluntary hospitalization nor other treatmentalternatives less restrictive of the subject’s liberty than inpatient or outpatienttreatment ordered by the board are available or would suffice to prevent the harmdescribed in section 71-908, the board shall, within forty-eight hours, (a) order thesubject to receive outpatient treatment or (b) order the subject to receive inpatienttreatment.

NEB. REV. STAT. § 71-908. Mentallyill and dangerous person means a person who is mentally ill. . . and because of suchmental illness… presents:

(1) A substantial risk of serious harmto another person or persons within the near future as manifested by evidence of recentviolent acts or threats of violence or by placing others in reasonable fear of such harm;or

(2) A substantial risk of serious harmto himself or herself within the near future as manifested by evidence of recent attemptsat, or threats of, suicide or serious bodily harm or evidence of inability to provide forhis or her basic human needs, including food, clothing, shelter, essential medical care,or personal safety.

Nevada*

For inpatient*: 

NEV. REV. STAT. § 433A.310(1).”If the district court finds, after proceedings for the involuntary court-orderedadmission of a person to a . . . mental health facility: . . . (b) That there is clear andconvincing evidence that the person . . . is mentally ill and, because of that illness, islikely to harm himself or others if allowed  his  liberty, the court may order the involuntaryadmission of the person for the most appropriate course of treatment.”

NEV. REV. STAT. § 433A.115″Mentally ill person” defined.

1. As used . . . unless the contextotherwise requires, “mentally ill person” means any person whose capacity toexercise self-control, judgment and discretion in the conduct of his affairs and socialrelations or to care for his personal needs is diminished, as a result of a mentalillness, to the extent that he presents a clear and present danger of harm to himself orothers, but does not include any person in whom that capacity is diminished by epilepsy,mental retardation, Alzheimer’s disease, brief periods of intoxication caused by alcoholor drugs, or dependence upon or addiction to alcohol or drugs, unless a mental illnessthat can be diagnosed is also present which contributes to the diminished capacity of theperson.

2. A person presents a clear andpresent danger of harm to himself if, within the next preceding 30 days, he has, as aresult of a mental illness:

(a) Acted in a manner from which itmay reasonably be inferred that, without the care, supervision or continued assistance ofothers, he will be unable to satisfy his need for nourishment, personal or medical care,shelter, self-protection or safety, and if there exists a reasonable probability that hisdeath, serious bodily injury or physical debilitation will occur within the next following30 days unless he is admitted to a mental health facility . . . and adequate treatment isprovided to him;

(b) Attempted or threatened to commitsuicide or committed acts in furtherance of a threat to commit suicide, and if thereexists a reasonable probability that he will commit suicide unless he is admitted to amental health facility . . . and adequate treatment is provided to him; or

(c) Mutilated himself, attempted orthreatened to mutilate himself or committed acts in furtherance of a threat to mutilatehimself, and if there exists a reasonable probability that he will mutilate himself unlesshe is admitted to a mental health facility . . . and adequate treatment is provided tohim.

3. A person presents a clear andpresent danger of harm to others if, within the next preceding 30 days, he has, as aresult of a mental illness, inflicted or attempted to inflict serious bodily harm on anyother person, or made threats to inflict harm and committed acts in furtherance of thosethreats, and if there exists a reasonable probability that he will do so again unless heis admitted to a mental health facility . . . and adequate treatment is provided to him.

* Nevada does not have an assistedoutpatient treatment law.

 New Hampshire

For inpatient and outpatient: 

N.H. REV. STAT. ANN. § 135-C:34.Involuntary Treatment Standard. – The standard to be used by a court, physician, orpsychiatrist in determining whether a person should be admitted to a receiving facilityfor treatment on an involuntary basis shall be whether the person is in such mentalcondition as a result of mental illness as to create a potentially serious likelihood ofdanger to himself or to others.

N.H. REV. STAT. ANN. §135-C:27.

I. As used in this section”danger to himself” is established by demonstrating that:

(a) Within 40 days of the completionof the petition, the person has inflicted serious bodily injury on himself or hasattempted suicide or serious self-injury and there is a likelihood the act or attemptedact will recur if admission is not ordered;

(b) Within 40 days of the completionof the petition, the person has threatened to inflict serious bodily injury on himself andthere is likelihood that an act or attempt of serious self-injury will occur if admissionis not ordered; or

(c) The person’s behavior demonstratesthat he so lacks the capacity to care for his own welfare that there is a likelihood ofdeath, serious bodily injury, or serious debilitation if admission is not ordered.

(d) The person meets all of thefollowing criteria:

(1) The person has been determined tobe severely mentally disabled in accordance with rules authorized by RSA 135-C:61 for aperiod of at least one year;

(2) The person has had at least oneinvoluntary admission, within the last 2 years, pursuant to RSA 135-C:34-54;

(3) The person has no guardian of theperson appointed pursuant to RSA 464-A;

(4) The person is not subject to aconditional discharge granted pursuant to RSA 135-C:49, II;

(5) The person has refused thetreatment determined necessary by a mental health program approved by the department;and

(6) A psychiatrist at a mental healthprogram approved by the department has determined, based upon the person’s clinicalhistory, that there is a substantial probability that the person’s refusal to acceptnecessary treatment will lead to death, serious bodily injury, or serious debilitation ifadmission is not ordered.

II. As used in this section”danger to others” is established by demonstrating that within 40 days of thecompletion of the petition, the person has inflicted, attempted to inflict, or threatenedto inflict serious bodily harm on another.

 New Jersey*

For inpatient*: 

N.J. STAT. ANN. § 30:4-27.2(m).”In need of involuntary commitment”: means that an adult who is mentally ill,whose mental illness causes the person to be dangerous to self or dangerous to others orproperty and who is unwilling to be admitted to a facility voluntarily for care, and whoneeds care at a short-term care, psychiatric facility or special psychiatric hospitalbecause other services are not appropriate or available to meet the person’s mental healthcare needs.

N.J. STAT. ANN. § 30:4-27.2(r).”Mental illness” means a current, substantial disturbance of thought, mood,perception or orientation which significantly impairs judgment, capacity to controlbehavior or capacity to recognize reality, but does not include simple alcoholintoxication, transitory reaction to drug ingestion, organic brain syndrome ordevelopmental disability unless it results in the severity of impairment described herein.The term mental illness is not limited to “psychosis” or “activepsychosis,” but shall include all conditions that result in the severity ofimpairment described herein.

N.J. STAT. ANN. § 30:4-27.2(h).”Dangerous to self” means that by reason of mental illness the person hasthreatened or attempted suicide or serious bodily harm, or has behaved in such a manner asto indicate that the person is unable to satisfy his need for nourishment, essentialmedical care or shelter, so that it is probable that substantial bodily injury, seriousphysical debilitation or death will result within the reasonably foreseeable future;however, no person shall be deemed to be unable to satisfy his need for nourishment,essential medical care or shelter if he is able to satisfy such needs with the supervisionand assistance of others who are willing and available.

N.J. STAT. ANN. § 30:4-27.2(i)”Dangerous to others or property” means that by reason of mental illness thereis a substantial likelihood that the person will inflict serious bodily harm upon anotherperson or cause serious property damage within the reasonably foreseeable future. Thisdetermination shall take into account a person’s history, recent behavior and any recentact or threat.

* New Jersey does not have anassisted outpatient treatment law.

 New Mexico*

For inpatient*: 

N.M. STAT. ANN. § 43-1-11(C). Uponcompletion of the hearing, the court may order a commitment for evaluation and treatmentnot to exceed thirty days if the court finds by clear and convincing evidence that:

(1) as a result of a mental disorder,the client presents a likelihood of serious harm to himself or others;

(2) the client needs and is likely tobenefit from the proposed treatment; and

(3) the proposed commitment isconsistent with the treatment needs of the client and with the least drastic meansprinciple.

N.M. STAT. ANN. § 43-1-3(M).”likelihood of serious harm to oneself” means that it is more likely than notthat in the near future the person will attempt to commit suicide or will cause seriousbodily harm to himself by violent or other self-destructive means, including but notlimited to grave passive neglect;

N.M. STAT. ANN. § 43-1-3(N).”likelihood of serious harm to others” means that it is more likely than notthat in the near future the person will inflict serious, unjustified bodily harm onanother person or commit a criminal sexual offense, as evidenced by behavior causing,attempting or threatening such harm, which behavior gives rise to a reasonable fear ofsuch harm from the person;

* New Mexico does not have anassisted outpatient treatment law.

New York

For inpatient: 

60-day involuntary treatment based onmedical certification:

N.Y. MENTAL HYG. LAW § 9.05(b) Acertificate, as required by this article, must show that the person is mentally ill . . .[and] the condition of the person examined is such that he needs involuntary care andtreatment in a hospital . . . .

N.Y. MENTAL HYG. LAW § 9.37(a) Thedirector of a hospital, upon application by a director of community services or anexamining physician duly designated by him or her, may receive and care for in suchhospital as a patient any person who, in the opinion of the director of community servicesor the director’s designee, has a mental illness for which immediate inpatient care andtreatment in a hospital is appropriate and which is likely to result in serious harm tohimself or herself or others.

If a hearing on the patient’s need fortreatment during the 60-day involuntary treatment:

N.Y. MENTAL HYG. LAW § 9.31(c). If itbe determined [by the court] that the patient is in need of retention, the court shalldeny the application for the patient’s release. If it be determined that the patient isnot mentally ill or not in need of retention, the court shall order the release of thepatient.

N.Y. MENTAL HYG. LAW § 9.01. As usedin this article: “in need of care and treatment” means that a person has amental illness for which in-patient care and treatment in a hospital is appropriate.”in need of involuntary care and treatment” means that a person has a mentalillness for which care and treatment as a patient in a hospital is essential to suchperson’s welfare and whose judgment is so impaired that he is unable to understand theneed for such care and treatment.

N.Y. MENTAL HYG. LAW § 9.01.”need for retention” means that a person who has been admitted to a hospitalpursuant to this article is in need of involuntary care and treatment in a hospital for afurther period.

N.Y. MENTAL HYG. LAW § 9.01.”likelihood to result in serious harm” or “likely to result in seriousharm” means

(1) a substantial risk of physicalharm to the person as manifested by threats of or attempts at suicide or serious bodilyharm or other conduct demonstrating that the person is dangerous to himself or herself,or

(2) a substantial risk of physicalharm to other persons as manifested by homicidal or other violent behavior by which othersare placed in reasonable fear of serious physical harm.

Case Law. Although not explicitly inthe state’s code, a strong majority of the New York courts addressing the issue haveheld that in order to retain a patient for involuntary psychiatric care under New York lawa hospital must establish that the patient is (1) mentally ill; (2) in need of continued,supervised care and treatment; and (3) that the patient poses a substantial threat of physical harm tohimself and/or others. E.g., Anonymous v. Carmichael, 727 N.Y.S.2d (N.Y. App. Div. 2001)

For outpatient: 

N.Y. MENTAL HYG. LAW § 9.60(C).Criteria for Assisted Outpatient Treatment. A patient may be ordered to obtain assistedoutpatient treatment if the court finds that:

(1) The patient is eighteen years ofage or older; and

(2) The patient is suffering from amental illness; and

(3) The patient is unlikely to survivesafely in the community without supervision, based on a clinical determination; and

(4) The patient has a history of lackof compliance with treatment for mental illness that has:

(I) At least twice within the lastthirty-six months been a significant factor in necessitating hospitalization in ahospital, or receipt of services in a forensic or other mental health unit of acorrectional facility, not including any period during which the person was hospitalizedor incarcerated immediately preceding the filing of the petition or;

(II) Resulted in one or more acts ofserious violent behavior toward self or others or threats of, or attempts at, seriousphysical harm to self or others within the last forty-eight months, not including anyperiod in which the person was hospitalized or incarcerated immediately preceding thefiling of the petition; and

(5) The patient is, as a result of hisor her mental illness, unlikely to voluntarily participate in the recommended treatmentpursuant to the treatment plan; and

(6) In view of the patient’s treatmenthistory and current behavior, the patient is in need of assisted outpatient treatment inorder to prevent a relapse or deterioration which would be likely to result in seriousharm to the patient or others as defined in section 9.01 of this article; and

(7) It is likely that the patient willbenefit from assisted outpatient treatment; and

(8) If the patient has executed ahealth care proxy as defined in article 29-C of the Public Health Law, that any directionsincluded in such proxy shall be taken into account by the court in determining the writtentreatment plan.

North Carolina

For inpatient: 

N.C. GEN. STAT. § 122C-268(j). Tosupport an inpatient commitment order, the court shall find by clear, cogent, andconvincing evidence that the respondent is mentally ill and dangerous to self, as definedin G.S. 122C-3(11)a., or dangerous to others, as defined in G.S. 122C-3(11)b. The courtshall record the facts that support its findings.

N.C. GEN. STAT. § 122C-3(11).”Dangerous to himself or others” means:

a. “Dangerous to himself”means that within the relevant past:

1. The individual has acted in such away as to show:

I. That he would be unable,without care, supervision, and the continued assistance of others not otherwise available,to exercise self-control, judgment, and discretion in the conduct of his dailyresponsibilities and social relations, or to satisfy his need for nourishment, personal ormedical care, shelter, or self-protection and safety; and

II. That there is a reasonable probability of his suffering serious physicaldebilitation within the near future unless adequate treatment is given pursuant to thisChapter. A showing of behavior that is grossly irrational, of actions that the individualis unable to control, of behavior that is grossly inappropriate to the situation, or ofother evidence of severely impaired insight and judgment shall create a prima facieinference that the individual is unable to care for himself; or

2. The individual has attempted suicide or threatened suicide and that there is areasonable probability of suicide unless adequate treatment is given pursuant to thisChapter; or

3. The individual has mutilated himself or attempted to mutilate himself and thatthere is a reasonable probability of serious self-mutilation unless adequate treatment isgiven pursuant to this Chapter.

Previous episodes of dangerousness to self, when applicable, may be considered whendetermining reasonable probability of physical debilitation, suicide, or self-mutilation.

b. “Dangerous toothers” means that within the relevant past, the individual has inflicted orattempted to inflict or threatened to inflict serious bodily harm on another, or has actedin such a way as to create a substantial risk of serious bodily harm to another, or hasengaged in extreme destruction of property; and that there is a reasonable probabilitythat this conduct will be repeated. Previous episodes of dangerousness to others, whenapplicable, may be considered when determining reasonable probability of future dangerousconduct. Clear, cogent, and convincing evidence that an individual has committed ahomicide in the relevant past is prima facie evidence of dangerousness to others.

For outpatient: 

N.C. GEN. STAT. § 263. (d) After the conclusion of the examination thephysician or eligible psychologist shall make the following determinations:

(1) If the physician or eligiblepsychologist finds that:

a. The respondent is mentally ill;

b. The respondent is capable ofsurviving safely in the community with available supervision from family, friends, orothers;

c. Based on the respondent’spsychiatric history, the respondent is in need of treatment in order to prevent furtherdisability or deterioration that would predictably result in dangerousness as defined byG.S. 122C-3(11); and

d. The respondent’s current mentalstatus or the nature of the respondent’s illness limits or negates the respondent’sability to make an informed decision to seek voluntarily or comply with recommendedtreatment.

The physician or eligible psychologistshall so show on the examination report and shall recommend outpatient commitment.

N.C. GEN. STAT. § 122C-271.Disposition.

(a) If an examining physician oreligible psychologist has recommended outpatient commitment and the respondent has beenreleased pending the district court hearing, the court may make one of the followingdispositions:

(1) If the court finds by clear,cogent, and convincing evidence that the respondent is mentally ill; that he is capable ofsurviving safely in the community with available supervision from family, friends, orothers; that based on respondent’s treatment history, the respondent is in need oftreatment in order to prevent further disability or deterioration that would predictablyresult in dangerousness as defined in G.S. 122C-3(11); and that the respondent’s currentmental status or the nature of his illness limits or negates his ability to make aninformed decision to seek voluntarily or comply with recommended treatment, it may orderoutpatient commitment for a period not in excess of 90 days.

(b) If the respondent has beenheld in a 24-hour facility pending the district court hearing pursuant to G.S. 122C-268, the court may make one of the following dispositions:

(1) If the court finds by clear, cogent, and convincing evidence that the respondentis mentally ill; that the respondent is capable of surviving safely in the community withavailable supervision from family, friends, or others; that based on respondent’spsychiatric history, the respondent is in need of treatment in order to prevent furtherdisability or deterioration that would predictably result in dangerousness as defined by G.S. 122C-3(11); and that the respondent’s current mental status orthe nature of the respondent’s illness limits or negates the respondent’s ability to makean informed decision voluntarily to seek or comply with recommended treatment, it mayorder outpatient commitment for a period not in excess of 90 days.

North Dakota

For inpatient and outpatient: 

N.D. CENT. CODE § 25-03.1-07. Aperson may be involuntarily admitted under this chapter to the state hospital or anothertreatment facility only if it is determined that the individual is a person requiringtreatment.

N.D. CENT. CODE § 25-03.1-02( 12).”Person requiring treatment” means a person who is mentally ill or chemicallydependent, and there is a reasonable expectation that if the person is not treated thereexists a serious risk of harm to that person, others, or property. “Serious risk ofharm” means a substantial likelihood of:

a. Suicide, as manifested by suicidalthreats, attempts, or significant depression relevant to suicidal potential;

b. Killing or inflicting seriousbodily harm on another person or inflicting significant property damage, as manifested byacts or threats;

c. Substantial deterioration inphysical health, or substantial injury, disease, or death, based upon recent poorself-control or judgment in providing one’s shelter, nutrition, or personal care; or

d. Substantial deterioration in mentalhealth which would predictably result in dangerousness to that person, others, orproperty, based upon evidence of objective facts to establish the loss of cognitive orvolitional control over the person’s thoughts or actions or based upon acts, threats,or patterns in the person’s treatment history, current condition, and other relevantfactors, including the effect of hte person’s mental condition on the person’s ability to consent.

Ohio

For both inpatient and outpatient: 

OHIO REV. CODE ANN. § 5122.15(C). If, upon completionof the hearing, the court finds by clear and convincing evidence that the respondent is amentally ill person subject to hospitalization by court order, the court shall order therespondent for a period not to exceed ninety days to any of the following [placement options include state or privatepsychiatric facilities and assisted outpatient treatment]. OHIO REV. CODE ANN. §5122.01(B). “Mentally ill person subject to hospitalization by court order”means a mentally ill person who, because of the person’s illness:

(1) Represents a substantial risk ofphysical harm to self as manifested by evidence of threats of, or attempts at, suicide orserious self-inflicted bodily harm;

(2) Represents a substantial risk ofphysical harm to others as manifested by evidence of recent homicidal or other violentbehavior, evidence of recent threats that place another in reasonable fear of violentbehavior and serious physical harm, or other evidence of present dangerousness;

(3) Represents a substantial andimmediate risk of serious physical impairment or injury to self as manifested by evidencethat the person is unable to provide for and is not providing for the person’s basicphysical needs because of the person’s mental illness and that appropriate provision forthose needs cannot be made immediately available in the community; or

(4) Would benefit from treatment in ahospital for his mental illness and is in need of such treatment as manifested by evidenceof behavior that creates a grave and imminent risk to substantial rights of others orhimself.

 Oklahoma

For both inpatient and outpatient: 

OKLA. STAT. ANN. tit. §43A-1-103(13)(a). “Person requiring treatment” means:

 (1)a person who because of a mental illness of the person represents a risk of harm to selfor others,

(2) a person who is a drug- oralcohol-dependent person and who as a result of dependency represents a risk of harm toself or others.

 Oregon

For both inpatient and outpatient: 

OR. REV. STAT. § 426.005(1)(d).”Mentally ill person” means a person who, because of a mental disorder, is oneor more of the following:

(A) Dangerous to self or others.

(B) Unable to provide for basicpersonal needs and is not receiving such care as is necessary for health or safety.

(C) A person who:

(i) Is chronically mentally ill, asdefined in ORS 426.495;

(ii) Within the previous three years,has twice been placed in a hospital or approved inpatient facility by the division underORS 426.060;

(iii) Is exhibiting symptoms orbehavior substantially similar to those that preceded and led to one or more of thehospitalizations or inpatient placements referred to in sub-subparagraph (ii) of thissubparagraph; and

(iv) Unless treated, will continue, toa reasonable medical probability, to physically or mentally deteriorate so that the personwill become a person described under either or both subparagraph (A) or (B) of thisparagraph.

 Pennsylvania

For both inpatient and outpatient: 

50 PA CONS. STAT. ANN. § 7304(a).  A person who is severely mentally disabled and inneed of treatment, as defined in section 301(a), may be made subject to court-orderedinvoluntary treatment upon a determination of clear and present danger under section301(b)(1) (serious bodily harm to others), or section 301(b)(2)(i) (inability to care forhimself, creating a danger of death or serious harm to himself), or 301(b)(2)(ii)(attempted suicide), or 301(b)(2)(iii) (self-mutilation).

50 PA. CONS. STAT. ANN. § 7304(f).”Upon a finding by clear and convincing evidence that the person is severely mentallydisabled and in need of treatment and subject to subsection (a), an order shall be entereddirecting treatment of the person in an approved facility as an inpatient or anoutpatient, or a combination of such treatment . . . .”

50 PA. CONS. STAT. ANN. § 7301.

(a) Whenever a person is severelymentally disabled and in need of immediate treatment, he may be made subject toinvoluntary emergency examination and treatment. A person is severely mentally disabledwhen, as a result of mental illness, his capacity to exercise self-control, judgment anddiscretion in the conduct of his affairs and social relations or to care for his ownpersonal needs is so lessened that he poses a clear and present danger of harm to othersor to himself.

(b) Determination of Clear and PresentDanger.

(1) Clear and present danger to othersshall be shown by establishing that within the past 30 days the person has inflicted orattempted to inflict serious bodily harm on another and that there is a reasonableprobability that such conduct will be repeated. If, however, the person has been foundincompetent to be tried or has been acquitted by reason of lack of criminal responsibilityon charges arising from conduct involving infliction of or attempt to inflict substantialbodily harm on another, such 30-day limitation shall not apply so long as an applicationfor examination and treatment is filed within 30 days after the date of such determinationor verdict. In such case, a clear and present danger to others may be shown byestablishing that the conduct charged in the criminal proceeding did occur, and that thereis a reasonable probability that such conduct will be repeated. For the purpose of thissection, a clear and present danger of harm to others may be demonstrated by proof thatthe person has made threats of harm and has committed acts in furtherance of the threat tocommit harm.

(2) Clear and present danger tohimself shall be shown by establishing that within the past 30 days:

(i) the person has acted in suchmanner as to evidence that he would be unable, without care, supervision and the continuedassistance of others, to satisfy his need for nourishment, personal or medical care,shelter, or self-protection and safety, and that there is a reasonable probability thatdeath, serious bodily injury or serious physical debilitation would ensue within 30 daysunless adequate treatment were afforded under this act; or

(ii) the person has attempted suicideand that there is the reasonable probability of suicide unless adequate treatment isafforded under this act. For the purposes of this subsection, a clear and present dangermay be demonstrated by the proof that the person has made threats to commit suicide andhas committed acts which are in furtherance of the threat to commit suicide; or

(iii) the person has substantiallymutilated himself or attempted to mutilate himself substantially and that there is thereasonable probability of mutilation unless adequate treatment is afforded under this act.For the purposes of this subsection, a clear and present danger shall be established byproof that the person has made threats to commit mutilation and has committed acts whichare in furtherance of the threat to commit mutilation.

Rhode Island*

For both inpatient and outpatient*: 

R.I. GEN. LAWS § 40.1-5-8(j). If thecourt at a final hearing finds by clear and convincing evidence that the subject of thehearing is in need of care and treatment in a facility, and is one whose continuedunsupervised presence in the community would, by reason of mental disability, create alikelihood of serious harm, and that all alternatives to certification have beeninvestigated and deemed unsuitable, it shall issue an order committing the person to thecustody of the director for care and treatment or to an appropriate facility.

R.I. GEN. LAWS § 40.1-5-2

(7). “Likelihood of seriousharm” means:

(i) A substantial risk of physicalharm to the person himself or herself as manifested by behavior evidencing serious threatsof, or attempts at, suicide,

(ii) A substantial risk of physicalharm to other persons as manifested by behavior or threats evidencing homicidal or otherviolent behavior, or

(iii) A substantial risk of physicalharm to the mentally disabled person as manifested by behavior which has created a grave,clear, and present risk to his or her physical health and safety.

(iv) In determining whether thereexists a likelihood of serious harm the physician and the court may consider previousacts, diagnosis, words or thoughts of the patient. If a patient has been incarcerated, orinstitutionalized, or in a controlled environment of any kind, the court may give greatweight to such prior acts, diagnosis, words, or thoughts.

(8). “Mental disability”means a mental disorder in which the capacity of a person to exercise self control orjudgment in the conduct of his or her affairs and social relations, or to care for his orher own personal needs, is significantly impaired.

Note: The Rhode Island law does notspecify independent criteria for commitment to outpatient treatment and yet it considerscourt-ordered outpatient treatment to be an “alternative to certification.”

South Carolina

For both inpatient and outpatient: 

S.C. CODE ANN. § 44-17-580. If, uponcompletion of the hearing and consideration of the record, the court finds upon clear andconvincing evidence that the person is mentally ill, needs treatment and because of hiscondition:

(1) lacks sufficient insight orcapacity to make responsible decisions with respect to his treatment; or

(2) there is a likelihood of seriousharm to himself or others, it shall order in-patient or out-patient treatment at a mentalhealth facility, public or private, designated or licensed by the Department of MentalHealth.

S.C. CODE ANN. § 44-23-10

(1) “Mentally ill person”means a person afflicted with a mental disease to such an extent that, for his own welfareor the welfare of others or of the community, he requires care, treatment orhospitalization;

(2) “Likelihood of seriousharm” means because of mental illness there is (1) a substantial risk of physicalharm to the person himself as manifested by evidence of threats of, or attempts at,suicide or serious bodily harm; (2) a substantial risk of physical harm to other personsas manifested by evidence of homicidal or other violent behavior and serious harm to themor (3) a very substantial risk of physical impairment or injury to the person himself asmanifested by evidence that such person’s judgment is so affected that he is unable toprotect himself in the community and that reasonable provision for his protection is notavailable in the community.

South Dakota

For both inpatient and outpatient: 

S.D. CODIFIED LAWS § 27A-1-2. Aperson is subject to involuntary commitment if:

(1) The person has a severe mentalillness;

(2) Due to the severe mental illness,the person is a danger to self or others; and

(3) The individual needs and is likelyto benefit from treatment.

S.D. CODIFIED LAWS § 27A-1-1

(4) “Danger to others,” areasonable expectation that the person will inflict serious physical injury upon anotherperson in the near future, due to a severe mental illness, as evidenced by the person’streatment history and the person’s recent acts or omissions which constitute a danger ofserious physical injury for another individual. Such acts may include a recently expressedthreat if the threat is such that, if considered in the light of its context or in lightof the person’s recent previous acts or omissions, it is substantially supportive of anexpectation that the threat will be carried out;

(5) “Danger to self,”

(a) A reasonable expectation that theperson will inflict serious physical injury upon himself or herself in the near future,due to a severe mental illness, as evidenced by the person’s treatment history and theperson’s recent acts or omissions which constitute a danger of suicide or self-inflictedserious physical injury. Such acts may include a recently expressed threat if the threatis such that, if considered in the light of its context or in light of the person’s recentprevious acts or omissions, it is substantially supportive of an expectation that thethreat will be carried out; or

(b) A reasonable expectation of dangerof serious personal harm in the near future, due to a severe mental illness, as evidencedby the person’s treatment history and the person’s recent acts or omissions whichdemonstrate an inability to provide for some basic human needs such as food, clothing,shelter, essential medical care, or personal safety, or by arrests for criminal behaviorwhich occur as a result of the worsening of the person’s severe mental illness.

 Tennessee*

For inpatient*: 

TENN. CODE ANN. § 33-6-501. “Substantial likelihood of serious harm” defined – Standardsfor commitment to involuntary care and treatment.

(a) IF AND ONLY IF

(1)

(A) a person hasthreatened or attempted suicide or to inflict serious bodily harm on such person, OR

(B) the person hasthreatened or attempted homicide or other violent behavior, OR

(C) the person has placedothers in reasonable fear of violent behavior and serious physical harm to them, OR

(D) the person is unableto avoid severe impairment or injury from specific risks, AND

(2) there is a substantiallikelihood that such harm will occur unless the person is placed under involuntarytreatment, THEN

(3) the person poses a”substantial likelihood of serious harm” for purposes of § 33-6-103 and thissection.

* Tennessee does not have anassisted outpatient treatment law.

Texas

For inpatient: 

TEX. HEALTH & SAFETY CODE ANN. §574.034. Order for Temporary Mental Health Services.

(a) The judge may order a proposedpatient to receive court-ordered temporary inpatient mental health services only if thejudge or jury finds, from clear and convincing evidence, that:

(1) the proposed patient is mentallyill; and

(2) as a result of that mental illnessthe proposed patient:

(A) is likely to cause serious harm tohimself;

(B) is likely to cause serious harm toothers; or

(C) is:

(i) suffering severe and abnormalmental, emotional, or physical distress;

(ii) experiencing substantial mentalor physical deterioration of the proposed patient’s ability to function independently,which is exhibited by the proposed patient’s inability, except for reasons of indigence,to provide for the proposed patient’s basic needs, including food, clothing, health, orsafety; and

(iii) unable to make a rational andinformed decision as to whether or not to submit to treatment.

TEX. HEALTH & SAFETY CODE ANN. §574.035. Order for Extended Mental Health Services.

(a) The judge may order a proposedpatient to receive court-ordered extended inpatient mental health services only if thejury, or the judge if the right to a jury is waived, finds, from clear and convincingevidence, that:

(1) the proposed patient is mentallyill;

(2) as a result of that mental illnessthe proposed patient:

(A) is likely to cause serious harm tohimself;

(B) is likely to cause serious harm toothers; or

(C) is:

(i) suffering severe and abnormalmental, emotional, or physical distress;

(ii) experiencing substantial mentalor physical deterioration of the proposed patient’s ability to function independently,which is exhibited by the proposed patient’s inability, except for reasons of indigence,to provide for the proposed patient’s basic needs, including food, clothing, health, orsafety; and

(iii) unable to make a rational andinformed decision as to whether or not to submit to treatment;

(3) the proposed patient’s conditionis expected to continue for more than 90 days; and

(4) the proposed patient has receivedcourt-ordered inpatient mental health services under this subtitle or under Article 46.02,Code of Criminal Procedure, for at least 60 consecutive days during the preceding 12months.

For outpatient: 

TEX. HEALTH & SAFETY CODE ANN. §574.034. Order for Temporary Mental Health Services

(b) The judge may order a proposedpatient to receive court-ordered temporary outpatient mental health services onlyif:

(1) the judge finds that appropriatemental health services are available to the patient; and

(2) the judge or jury finds, fromclear and convincing evidence, that:

(A) the proposed patient is mentallyill;

(B) the nature of the mental illnessis severe and persistent;

(C) as a result of the mental illness,the proposed patient will, if not treated, continue to:

(i) suffer severe and abnormal mental,emotional, or physical distress; and

(ii) experience deterioration of theability to function independently to the extent that the proposed patient will be unableto live safely in the community without court-ordered outpatient mental health services;and

(D) the proposed patient has aninability to participate in outpatient treatment services effectively and voluntarily,demonstrated by:

(i) any of the proposed patient’sactions occurring within the two-year period which immediately precedes the hearing;or

(ii) specific characteristics of theproposed patient’s clinical condition that make impossible a rational and informeddecision whether to submit to voluntary outpatient treatment.

TEX. HEALTH & SAFETY CODE ANN. §574.035. Order for Extended Mental Health Services.

(b) The judge may order a proposedpatient to receive court-ordered extended outpatient mental health services only if:

(1) the judge finds that appropriatemental health services are available to the patient; and

(2) the jury, or the judge if theright to a jury is waived, finds from clear and convincing evidence that:

(A) the proposed patient is mentallyill;

(B) the nature of the mental illnessis severe and persistent;

(C) as a result of the mental illness,the proposed patient will, if not treated, continue to:

(i) suffer severe and abnormal mental,emotional, or physical distress; and

(ii) experience deterioration of theability to function independently to the extent that the proposed patient will be unableto live safely in the community without court-ordered outpatient mental healthservices;

(D) the proposed patient has aninability to participate in outpatient treatment services effectively or voluntarily,demonstrated by:

(i) any of the proposed patient’sactions occurring within the two-year period which immediately precedes the hearing;or

(ii) specific characteristics of theproposed patient’s clinical condition that make impossible a rational and informeddecision whether to submit to voluntary outpatient treatment;

(E) the proposed patient’s conditionis expected to continue for more than 90 days; and

(F) the proposed patient has receivedcourt-ordered inpatient mental health services under this subtitle or under Subchapter Dor E, Chapter 46B, Code of Criminal Procedure for at least 60 consecutive days during thepreceding 12 months.

Utah

For both inpatient and outpatient: 

UTAH CODE ANN. § 62A –15–631(10). The court shallorder commitment of an individual who is 18 years of age or older to a local mental healthauthority if, upon completion of the hearing and consideration of the informationpresented in accordance with Subsection (9)(e), the court finds by clear and convincingevidence that:
(a) the proposed patient has a mental illness;
(b) because of the proposed patient’s mental illness he poses asubstantial danger, as defined in Section 62A-15-602, of physical injury to others orhimself, which may include the inability to provide the basic necessities of life such asfood, clothing, and shelter, if allowed to remain at liberty;
(c) the patient lacks the ability to engage in a rationaldecision-making process regarding the acceptance of mental treatment as demonstrated byevidence of inability to weigh the possible risks of accepting or rejecting treatment;
(d) there is no appropriate less-restrictive alternative to acourt order of commitment; and
(e) the local mental health authority can provide the individualwith treatment that is adequate and appropriate to his conditions and needs. In theabsence of the required findings of the court after the hearing, the court shall forthwithdismiss the proceedings.

§ 62A-15-602 (13)”Substantial danger” means the person, by his or her behavior, due to mentalillness:
(a) is at serious risk to:

(i) commit suicide,
(ii) inflict serious bodily injury on himself or herself; or
(iii) because of his or her actions or inaction, suffer seriousbodily injury because he or she is incapable of providing the basic necessities of life,such as food, clothing, and shelter;
(b) is at serious risk to cause or attempt to cause seriousbodily injury; or
(c) has inflicted or attempted to inflict serious bodily injuryon another.

§ 62A-15-602 (12)”Serious bodily injury” means bodily injury which involves a substantial risk ofdeath, unconsciousness, extreme physical pain, protracted and obvious disfigurement, orprotracted loss or impairment of the function of a bodily member, organ, or mentalfaculty.

Vermont

For both inpatient and outpatient (called”non-hospitalization): 

VT. STAT. ANN. tit. 18, § 7611. Noperson may be made subject to involuntary treatment unless he is found to be a person inneed of treatment or a patient in need of further treatment.

VT. STAT. ANN. tit. 18, § 7101(17).”A person in need of treatment” means a person who is suffering from mentalillness and, as a result of that mental illness, his capacity to exercise self-control,judgment, or discretion in the conduct of his affairs and social relations is so lessenedthat he poses a danger of harm to himself or others;

(A) A danger of harm to others may beshown by establishing that:

(i) he has inflicted or attempted toinflict bodily harm on another; or

(ii) by his threats or actions he hasplaced others in reasonable fear of physical harm to themselves; or

(iii) by his actions or inactions hehas presented a danger to persons in his care.

(B) A danger of harm to himself may beshown by establishing that:

(i) he has threatened or attemptedsuicide or serious bodily harm; or

(ii) he has behaved in such a manneras to indicate that he is unable, without supervision and the assistance of others, tosatisfy his need for nourishment, personal or medical care, shelter, or self-protectionand safety, so that it is probable that death, substantial physical bodily injury, seriousmental deterioration or serious physical debilitation or disease will ensue unlessadequate treatment is afforded;

VT. STAT. ANN. tit. 18, § 7101(16).”A patient in need of further treatment” means:

(A) A person in need of treatment,or

(B) A patient who is receivingadequate treatment, and who, if such treatment is discontinued, presents a substantialprobability that in the near future his condition will deteriorate and he will become aperson in need of treatment.

Virginia

For inpatient: 

VA. CODE ANN.§ 37.2-817(B).  After observing the person and obtaining thenecessary positive certification and any other relevant evidence which may have beenoffered, if the judge finds specifically

(i) that the person presents animminent danger to himself or others as a result of mental illness or has been proven tobe so seriously mentally ill as to be substantially unable to care for himself, and

(ii) that alternatives to involuntaryconfinement and treatment have been investigated and deemed unsuitable and there is noless restrictive alternative to institutional confinement and treatment . . . .”

For outpatient: 

VA. CODE ANN.§ 37.2-817(C).  After observing the person and obtaining the necessary positive certification and considering any other relevant evidence that may have been offered, if the judge or special justice finds by clear and convincing evidence that:

(i) the person presents an imminent danger to himself or others as a result of mental illness or has been proven to be so seriously mentally ill as to be substantially unable to care for himself, (ii) less restrictive alternatives to involuntary inpatient treatment have been investigated and are deemed suitable, (iii) the person (a) has the degree of competency necessary to understand the stipulations of his treatment, (b) expresses an interest in living in the community and agrees to abide by his treatment plan, and (c) is deemed to have the capacity to comply with the treatment plan, and (iv) the ordered treatment can be delivered on an outpatient basis and be monitored by the community services board, behavioral health authority or designated provider, the judge or special justice shall order outpatient treatment, which may include day treatment in a hospital, night treatment in a hospital, outpatient involuntary treatment with anti-psychotic medication pursuant to Chapter 11 (§ 37.2-1100 et seq.), or other appropriate course of treatment as may be necessary to meet the needs of the person.

 Washington

For inpatient: 

WASH. REV. CODE ANN. § 71.05.240.”[I]f the court finds . . . that such person, as the result of mental disorder,presents a likelihood of serious harm, or is gravely disabled, and, after considering lessrestrictive alternatives to involuntary detention and treatment, find that no suchalternatives are in the best interests of such person or others, the court shall orderthat such person be detained for involuntary treatment not to exceed fourteen days in afacility certified to provide treatment by the department.”

For outpatient: 

WASH. REV. CODE ANN. § 71.05.240.”If the court finds that such person, as the result of a mental disorder, presents alikelihood of serious harm, or is gravely disabled, but that treatment in a lessrestrictive setting than detention is in the best interest of such person or others, thecourt shall order an appropriate less restrictive course of treatment . . . .”

WASH. REV. CODE ANN. § 71.05.020(2b).”‘Likelihood of serious harm’ means:

(a) A substantial risk that:

(i) Physical harm will be inflicted byan individual upon his or her own person, as evidenced by threats or attempts to commitsuicide or inflict physical harm on oneself;

(ii) physical harm will be inflictedby an individual upon another, as evidenced by behavior which has caused such harm orwhich places another person or persons in reasonable fear of sustaining such harm;or

(iii) physical harm will be inflictedby an individual upon the property of others, as evidenced by behavior which has causedsubstantial loss or damage to the property of others; or

(b)The individual has threatened the physical safety of another and has a history of one ormore violent acts.”

WASH. REV. CODE ANN. § 71.05.020(16).”‘Gravely disabled’ means a condition in which a person, as a result of a mentaldisorder:

(a) Is in danger of serious physicalharm resulting from a failure to provide for his or her essential human needs of health orsafety; or

(b) manifests severe deterioration inroutine functioning evidenced by repeated and escalating loss of cognitive or volitionalcontrol over his or her actions and is not receiving such care as is essential for his orher health or safety”

WASH. REV. CODE ANN. § 71.05.020(18).”History of one or more violent acts” refers to the period of time ten yearsprior to the filing of a petition under this chapter, excluding any time spent, but notany violent acts committed, in a mental health facility or in confinement as a result of acriminal conviction;

WASH. REV. CODE ANN. § 71.05.020(36).”Violent act” means behavior that resulted in homicide, attempted suicide,nonfatal injuries, or substantial damage to property.

West Virginia

For both inpatient and outpatient: 

W. VA. CODE § 27-5-4(j).

(1) “[T]he individual is mentallyill and because of illness is likely to cause serious harm to himself or herself or toothers if allowed to remain at liberty or is addicted and is a resident of the county inwhich the hearing is held or currently is a patient at a mental health facility in suchcounty.”

(2) The circuit court or mentalhygiene commissioner shall also make a finding as to whether or not there is a lessrestrictive alternative than commitment appropriate for the individual.

W. VA. CODE §27-1-12.

(a) “Likely to cause seriousharm” means an individual is exhibiting behaviors consistent with a medicallyrecognized mental disorder . . . and as a result of the mental disorder . . . :

(1) The individual has inflicted orattempted to inflict bodily harm on another; or

(2) The individual, by threat oraction, has placed others in reasonable fear of physical harm to themselves; or

(3) The individual, by action orinaction, has presented a danger to others in his or her care; or

(4) The individual has threatened orattempted suicide or serious bodily harm to himself or herself; or

(5) The individual is behaving in sucha manner as to indicate that he or she is unable, without supervision and the assistanceof others, to satisfy his or her need for nourishment, medical care, shelter orself-protection and safety so that there is a substantial likelihood that death, seriousbodily injury, serious physical debilitation, serious mental debilitation orlife-threatening disease will ensue unless adequate treatment is afforded.

(b) In making the “likely tocause serious harm” determination, judicial, medical, psychological and otherevaluators and decisionmakers should utilize all available information, includingpsychosocial, medical, hospitalization and psychiatric information and including thecircumstances of any previous commitments or convalescent or conditional releases that arerelevant to a current situation, in addition to the individual’s current overt behavior.

Wisconsin

For both inpatient and outpatient: 

WIS. STAT. ANN. § 51.20(1)(a)1. Theindividual is mentally ill, drug dependent or developmentally disabled and is a propersubject for treatment.

WIS. STAT. ANN. § 51.20(1)(a)2. Theindividual is dangerous because he or she does any of the following:

a. Evidences a substantial probabilityof physical harm to himself or herself as manifested by evidence of recent threats of orattempts at suicide or serious bodily harm.

b. Evidences a substantial probabilityof physical harm to other individuals as manifested by evidence of recent homicidal orother violent behavior, or by evidence that others are placed in reasonable fear ofviolent behavior and serious physical harm to them, as evidenced by a recent overt act,attempt or threat to do serious physical harm. In this subd. 2. b. , if the petition isfiled under a court order under s. 938.30 (5) (c) 1. or (d) 1. , a finding by the courtexercising jurisdiction under chs. 48 and 938 that the juvenile committed the act or actsalleged in the petition under s. 938.12 or 938.13 (12) may be used to prove that thejuvenile exhibited recent homicidal or other violent behavior or committed a recent overtact, attempt or threat to do serious physical harm.

c. Evidences such impaired judgment,manifested by evidence of a pattern of recent acts or omissions, that there is asubstantial probability of physical impairment or injury to himself or herself. Theprobability of physical impairment or injury is not substantial under this subd. 2. c. ifreasonable provision for the subject individual’s protection is available in the communityand there is a reasonable probability that the individual will avail himself or herself ofthese services, if the individual is appropriate for protective placement under s. 55.06or, in the case of a minor, if the individual is appropriate for services or placementunder s. 48.13 (4) or (11) or 938.13 (4) . The subject individual’s status as a minor doesnot automatically establish a substantial probability of physical impairment or injuryunder this subd. 2. c. Food, shelter or other care provided to an individual who issubstantially incapable of obtaining the care for himself or herself, by a person otherthan a treatment facility, does not constitute reasonable provision for the subjectindividual’s protection available in the community under this subd. 2. c.

d. Evidences behavior manifested byrecent acts or omissions that, due to mental illness, he or she is unable to satisfy basicneeds for nourishment, medical care, shelter or safety without prompt and adequatetreatment so that a substantial probability exists that death, serious physical injury,serious physical debilitation or serious physical disease will imminently ensue unless theindividual receives prompt and adequate treatment for this mental illness. No substantialprobability of harm under this subd. 2. d. exists if reasonable provision for theindividual’s treatment and protection is available in the community and there is areasonable probability that the individual will avail himself or herself of theseservices, if the individual is appropriate for protective placement under s. 55.06 or, inthe case of a minor, if the individual is appropriate for services or placement under s.48.13 (4) or (11) or 938.13 (4) . The individual’s status as a minor does notautomatically establish a substantial probability of death, serious physical injury,serious physical debilitation or serious disease under this subd. 2. d. Food, shelter orother care provided to an individual who is substantially incapable of obtaining the carefor himself or herself, by any person other than a treatment facility, does not constitutereasonable provision for the individual’s treatment or protection available in thecommunity under this subd. 2. d.

e. For an individual, other than anindividual who is alleged to be drug dependent or developmentally disabled, after theadvantages and disadvantages of and alternatives to accepting a particular medication ortreatment have been explained to him or her and because of mental illness, evidenceseither incapability of expressing an understanding of the advantages and disadvantages ofaccepting medication or treatment and the alternatives, or substantial incapability ofapplying an understanding of the advantages, disadvantages and alternatives to his or hermental illness in order to make an informed choice as to whether to accept or refusemedication or treatment; and evidences a substantial probability, as demonstrated by boththe individual’s treatment history and his or her recent acts or omissions, that theindividual needs care or treatment to prevent further disability or deterioration and asubstantial probability that he or she will, if left untreated, lack services necessaryfor his or her health or safety and suffer severe mental, emotional or physical harm thatwill result in the loss of the individual’s ability to function independently in thecommunity or the loss of cognitive or volitional control over his or her thoughts oractions. The probability of suffering severe mental, emotional or physical harm is notsubstantial under this subd. 2. e. if reasonable provision for the individual’s care ortreatment is available in the community and there is a reasonable probability that theindividual will avail himself or herself of these services or if the individual isappropriate for protective placement under s. 55.06 . Food, shelter or other care that isprovided to an individual who is substantially incapable of obtaining food, shelter orother care for himself or herself by any person other than a treatment facility does notconstitute reasonable provision for the individual’s care or treatment in the communityunder this subd. 2. e.

Wyoming

For inpatient and outpatient (see below foradditional outpatient criteria):

WYO. STAT. ANN. § 25-10-110(j).”If, upon completion of the hearing and consideration of the record, the court or thejury finds by clear and convincing evidence that the proposed patient is mentally ill thecourt shall consider the least restrictive and most therapeutic alternatives . . . .”

WYO. STAT. ANN. § 25-10-101(a)(ix).”Mental illness” and “mentally ill” mean a physical, emotional, mentalor behavioral disorder which causes a person to be dangerous to himself or others andwhich requires treatment

WYO. STAT. ANN. § 25-10-101(a)(ii).”Dangerous to himself or others” means that, as a result of mental illness, aperson:

(A) Evidences a substantialprobability of physical harm to himself as manifested by evidence of recent threats of orattempts at suicide or serious bodily harm; or

(B) Evidences a substantialprobability of physical harm to other individuals as manifested by a recent overthomicidal act, attempt or threat or other violent act, attempt or threat which placesothers in reasonable fear of serious physical harm to them; or

(C) Evidences behavior manifested byrecent acts or omissions that, due to mental illness, he is unable to satisfy basic needsfor nourishment, essential medical care, shelter or safety so that a substantialprobability exists that death, serious physical injury, serious physical debilitation,serious mental debilitation, destabilization from lack of or refusal to take prescribedpsychotropic medications for a diagnosed condition or serious physical disease willimminently ensue, unless the individual receives prompt and adequate treatment for thismental illness. No person, however, shall be deemed to be unable to satisfy his need fornourishment, essential medical care, shelter or safety if he is able to satisfy thoseneeds with the supervision and assistance of others who are willing and available.

Additional outpatient criteria:

WYO. STAT. ANN. § 25-10-110(j)(ii).”If the court finds that the proposed patient does not require continuous inpatienthospitalization, would be more appropriately treated in an outpatient treatment program ora combination of outpatient and inpatient treatment or will be able to appropriatelycontrol his illness by following a prescribed treatment plan, the court shall considersuch treatment options. If the court finds that the proposed patient does not requirecontinuous hospitalization and the funding is available, it shall consider conditionaloutpatient treatment . . . and may designate an outpatient care provider, including mentalhealth centers.”

This summary was prepared by The Treatment Advocacy Center in Arlington, VA.