Psychiatric Treatment of Minors Act 2010 Revisions

SB 65 and HB 248. Senator Louise Lucas carried SB 65 in the Senate, and Delegate Terry Kilgore carried HB 248 in the House, both of which passed unanimously. The two bills were identical and were recommendations of the Mental Health Law Reform Commission’s Task Force on Children and Adolescents.

Goals of SB 65 and HB 248. To make the juvenile commitment code more user friendly by eliminating the cross-references to the adult commitment code, and To fill the procedural gaps in the juvenile commitment process that have resulted in confusion and different practices across the Commonwealth.

Title Change. The title has been changed from “Psychiatric Inpatient Treatment of Minors Act” to “Psychiatric Treatment of Minors Act” to better reflect the contents of this article, which now permits both inpatient and outpatient treatment.

Definitions. The following terms have been added to the definition section or amended: –“designee of the local community services board” –“employee of the local community services board” –“investment interest” –“qualified evaluator”

“Qualified Evaluator” Licensed psychiatrist or psychologist, or if unavailable: Any mental health professional licensed through DHP as: –Clinical Social Worker –Professional Counselor –Marriage and Family Therapist –Psychiatric Nurse Practitioner –Clinical Nurse Specialist; or Any mental health professional employed by a CSB

Admission Forms. A new section has been added to clarify that the Office of the Executive Secretary (OES) is responsible for preparing the petitions, orders, and other legal forms for this article, and the Department of Behavioral Health and Development Services (DBHDS) shall prepare the preadmission screening report and other clinical forms.

ECOs and TDOs. The old language in section has been deleted. The ECO and TDO statutes from the adult code ( and 809) have been imported into this article, with minor changes, to eliminate the need to refer to the adult code.

ECOs and TDOs cont. The provisions for issuing an ECO are now in The provisions for issuing a TDO are now in and Alternative transportation is permitted for both ECOs and TDOs.

Release of Minor Prior to Commitment Hearing. This section give the director of the facility where the minor is being treated the authority to release the minor prior to the commitment hearing if it appears, based on an evaluation conducted by the treating psychiatrist or psychologist, that the minor does not meet commitment criteria.

Release of minor cont. This section also gives a judge the authority to release a minor to his parent prior to a hearing, if it appears from all evidence readily available that the minor does not meet commitment criteria. This authority existed previously for judges and facility directors but has been clarified and consolidated into one new section.

Preadmission Screening Report. This new section specifies that the following information must be contained in a preadmission screening report: –Whether the minor meets commitment criteria, –Whether the minor needs compulsory treatment and is likely to benefit from such treatment, –Whether inpatient treatment is the least restrictive alternative, and –Specific recommendations for the minor’s placement, care, and treatment, and where appropriate, recommendations for MOT.

Preadmission Screening Report cont. Preadmission screening reports must be provided to the court prior to the commitment hearing. These reports shall be admitted into evidence and made a part of the record. Prepared by CSB where minor resides, or, if impractical, where minor is located.

Service of the Petition. Language has been added to (B) to clarify that the person responsible for serving the petition on the minor and the minor’s parents is the sheriff of the jurisdiction in which the minor and the minor’s parents are located.

Involuntary commitment; clinical evaluation. Language has been added to specify that the qualified evaluator cannot be excluded from the hearing pursuant to an order of sequestration. The evaluation must be conducted in private, and should be conducted in person –Two-way electronic means acceptable

Clinical evaluation cont. The clinical evaluation shall consist of; –A clinical assessment that includes a mental status examination (including determination of current use of medications and a medical and psychiatric history), –A substance abuse screening if indicated, –A risk assessment, –An assessment of the minor’s capacity to consent to treatment for minors 14 and older,

Clinical evaluation cont. –A review of the minor’s records from the TDO facility, if the minor was previously subject to a TDO, –A discussion of treatment preferences with the minor or his parents, –An assessment of alternatives to involuntary inpatient treatment, and –Recommendations for the placement, care and treatment of the minor.

(B). Voluntary Admission. At the commencement of the hearing involving a minor 14 years of age or older, the court shall inform the minor of his right to be voluntarily admitted for inpatient treatment, and shall afford the minor an opportunity for voluntary admission, provided that the minor’s parent consents and the minor is capable of consenting.

(B). Voluntary Admission cont. In determining whether a minor is capable of consenting to voluntary admission, the court may consider evidence of past compliance or noncompliance with treatment. The purpose of this new paragraph was to clarify that special justices do have the authority to permit voluntary admission of minors 14 and older when the minor and parent both consent. The goal is to promote voluntary treatment whenever possible.

(C). CSB Representative. Employee or designee of CSB that arranged for the evaluation shall attend the hearing in person –If “impractical,” may attend through two-way A/V The CSB employee or designee attending or participating in the hearing can no longer be excluded from hearing pursuant to an order of sequestration of witnesses.

(C). CSB Representative, cont. If the minor doesn’t reside in jurisdiction served by J&DR court doing the hearing and the minor is being considered for MOT, employee or designee of CSB serving the area where minor resides shall also attend the hearing in person (or through A/V), or make arrangements for the evaluating CSB to present MOT recommendations on its behalf

Involuntary commitment. The commitment criteria remain unchanged. However, before deciding whether a minor meets the criteria, the judge must now observe the minor and consider the following: –Recommendations of any treating or examining physician or psychologist, –Any past actions of the minor, –Any past mental health treatment of the minor, –Any qualified evaluator’s report, –Any medical records available, –The preadmission screening report, and –Any other evidence admitted.

Involuntary commitment cont. Language implying that a special justice could issue a removal or protective order when a parent is not willing to approve commitment has been revised (3) now reads: –If a special justice believes that issuance of a removal or protective order may be in the child’s best interest, the special justice shall report the matter to the local department of social services for the county or city where the minor resides.

Post-commitment hearing transportation. When a judge or special justice commits a minor under this section, the judge or special justice may order that the minor be transported by either the sheriff or an alternative transportation provider (ATP). The ATP may be a parent, family member, friend, CSB representative, representative of the facility where the minor was detained, or any other provider trained to provide transportation in a safe manner.

Post-commitment hearing transportation cont. Transportation must commence no later than six hours after notification to the sheriff or the ATP of the judge’s order.

Minors in Detention. Language has been added throughout this section which states that anytime a minor in detention or shelter care has completed inpatient treatment, the sheriff serving the jurisdiction where the minor was detained must return the minor to detention or shelter care within 24 hours following completion of treatment.

Mandatory Outpatient Treatment After observing minor and considering: –Recommendations of any treating or examining physician or psychologist; –Any past actions of the minor; –Any past mental health treatment of the minor; –Any evaluation of the minor; –Any medical records available; –The pre-admission screening report; and –Any other relevant evidence that may have been admitted…

Mandatory Outpatient Treatment, cont. Court shall order MOT for up to 90 days if it finds by clear and convincing evidence that the MOT commitment criteria are met

(B) MOT Review (JDR judges only) When creating the procedures for enforcing compliance with an MOT order for juveniles, the intent was to have a civil show cause summons issued, not to create a procedure comparable to the capias that is issued for adults. In order to resolve confusion over this issue, (B) has been revised. Language about keeping a minor in custody for up to four hours until a TDO is issued has been deleted.

(B) MOT Review cont. If a minor fails to report for a court-ordered examination under this section, the court shall issue a mandatory examination order and a civil show cause summons. The return date for the civil show cause summons shall be set on a date prior to the review hearing and the examination shall be conducted immediately afterwards.

Appeals. A new section has been added that clarifies the procedures for appealing a commitment order under this article. A minor wishing to appeal a final order of commitment must file a notice of appeal within 10 days of the date of the final order. The JDR court shall appoint an attorney and a GAL to represent any minor desiring to appeal.

Appeals cont. Venue shall be in the circuit court of the jurisdiction in which the final order was issued. The circuit court clerk shall provide written notification of the appeal to the person who initiated the petition for commitment. The appeal shall be held de novo in accordance with the provisions set forth in this article, but any order of the circuit court shall not extend the period of commitment or MOT set forth in the order appealed from.

Appeals cont. A petition for or the pendency of an appeal shall not suspend any order unless so ordered by the court. However, a minor may still be released during the pendency of an appeal pursuant to (B) (when they no longer meet commitment criteria).

Payment for qualified evaluators. This section has been amended to clarify that qualified evaluators shall be compensated for all evaluations conducted pursuant to this article, and not just evaluations conducted under