Written by Shadoe Jones, Legislative and Policy Counsel, TAC
Proposed legislative language:
The proposed amendments aim to integrate psychiatric deterioration into existing statutes with a clear, practical amendment to 50 P.S. § 7301(b)(2).
[brackets indicate deletions of current language] underline text indicates proposed additions
A. Option one: Amend grave disability criteria to include psychiatric deterioration 50 P.S. § 7301 (b) Determination of clear and present danger. —
(2) Clear and present danger to himself shall be shown by establishing that [within the past 30 days] based on the person’s psychiatric history:
(i) the person has acted in such manner as to evidence that he would be unable, without care, supervision and the continued assistance 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 that the person would suffer [death] serious bodily injury, [or] serious physical debilitation, serious illness, or psychiatric deterioration [would ensue within 30 days] unless adequate treatment were afforded under this act; or
Option two: Adopt psychiatric deterioration in a new subsection (iv) 50 P.S. § 7301
(b) Determination of clear and present danger. —
(2) Clear and present danger to himself shall be shown by establishing that [within the past 30 days] based on the person’s psychiatric history:
(iv) the person has acted in such a manner as to evidence that he is incapable of making an informed medical decision and he would be unlikely to adhere to treatment and as a consequence the person’s condition would be likely to deteriorate until the person’s mental disability significantly impairs the person’s judgment, reason, behavior or capacity to recognize reality and has a reasonable probability of causing the person to suffer or continue to suffer severe psychiatric harm, deterioration, or serious illness unless adequate treatment were afforded under this act.
Supporting Information
A. TAC psychiatric deterioration policy recommendations:
• Criteria should not require unreasonably severe harm.
• Criteria should not force families to deny assistance to qualify.
• Criteria should allow consideration of treatment history in assessing the likelihood of future psychiatric deterioration without treatment.
B. Psychiatric deterioration informational resources:
• Untreated SMI | Treatment Advocacy Center
• TAC webinar: Psychiatric Deterioration Standard for Inpatient Commitment
• TAC. (2025, January). SMI Advocate, 6.
• Dailey, L., Gray, M., Johnson, B., Muhammad, S., Sinclair, E., & Stettin, B. (2020, September). Grading the states. An analysis of involuntary psychiatric treatment laws. Treatment Advocacy Center, 19-22.
C. Example statutory language from other states:
Disclaimer — State laws are individual and varied, with strengths and imperfections. The following could be considered when drafting language for a Pennsylvania Statute. State statutes:
• Minnesota: Minn. Stat. § 253B.02 Subd. 17a
• Louisiana: LA. Rev. Stat. § 28:2
• California: Cal. Welf. & Inst. Code § 5008(h) • CA Senate Bill No. 43 (Enacted 2023)
State bills:
• 2025 Iowa bill: House File 312
• 2023 Ohio bill: House Bill 249
Legislative landscape and neighboring states:
•As of December 2024, 34 states have psychiatric deterioration as a legal basis for involuntary treatment. In four of these states, this provision applies only to involuntary outpatient treatment. For details, see TAC. (2025, January). SMI Advocate, 6.
• Two of Pennsylvania’s surrounding states — Ohio and West Virginia— include psychiatric deterioration as part of their civil commitment criteria. Ohio limits the provision to involuntary outpatient commitment.