During the 1960s and 1970s, state mental health laws governing treatment of severe mental illnesses, such as schizophrenia and manic-depression, for individuals who refused it underwent sweeping reform. Most notably, assisted treatment laws were changed to require a court finding of dangerousness before treatment could be provided to those incapable of recognizing their need for it. While well intentioned, efforts meant to protect people with mental illness resulted in many of the most severely ill going without needed treatment and, in too many cases, becoming homeless, incarcerated, suicidal, victimized or prone to violent episodes.

As the consequences of non-treatment continue to build, a new wave of reforms is under way in many states. States are abandoning dangerousness as the sole standard for assisted treatment.   Instead they are facilitating needed intervention before tragedy occurs.  These states are enacting and utilizing standards based on the need for treatment.

Another important reform happening in many states is to encourage the use of assisted outpatient treatment as a way to prevent repeated hospitalizations and other consequences of non-treatment.  When appropriate, assisted outpatient treatment fosters treatment compliance in the community through a court-ordered treatment plan. Not only does the court commit the patient to the treatment system, it also commits the treatment system to the patient.

Progressive assisted treatment laws must be crafted to reflect the significant advances that have been made in the last two decades in our understanding and ability to treat severe mental illnesses. We now know that these conditions are treatable biological brain diseases and not lifestyle choices, as was the prevailing thought four decades ago. Research shows that at least 40 percent of those diagnosed with schizophrenia and manic-depressive illness lack insight into their illness because of a biologically based symptom known as anosognosia. A person suffering from this symptom does not believe he or she is ill and is likely to refuse treatment reasoning, "Why should I take medication if there is nothing wrong with me?" Additionally, for those who previously refused treatment because of unpleasant or dangerous side-effects of medication, a much broader array of medications is now available so that possible adverse effects of treatment can be more effectively mitigated.