1 Emergency Services Civil Commitment Process Mental Health Law Reform Donna Harris Rowe, LPC, Chesapeake Emergency Services Program Supervisor

2 Legislative Purposes To ensure that help is available for people and families who need help To promote consistent application of the law across the state To protect the public when there is a substantial likelihood of harm

3 Chesapeake Emergency Services WHAT ARE EMERGENCY SERVICES? WHAT ARE STATE MANDATES?

4 Chesapeake Emergency Services WHAT ARE BASIC GUIDELINES WHEN PROVIDING PREADMISSION SCREENING? How are petitions handled now?

5 Chesapeake Emergency Services FOR WHAT REASONS WILL FURTHER MEDICAL ASSESSMENT BE NECESSARY BEFORE, DURING OR AFTER THE PRESCREENING PROCESS? (§ H) Nothing herein shall preclude a law- enforcement officer from obtaining emergency medical treatment or further medical evaluation at any time for a person in his custody as provided in this section.

6 Chesapeake Emergency Services WHAT IS THE DIFFERENCE BETWEEN VOLUNTARY AND INVOLUNTARY? WHY IS INSURANCE AN IMPORTANT FACTOR IN THE DECISION MAKING PROCESS FOR EITHER OF THE ABOVE ISSUES?

7 Mental Health Law Reform Effective July 2008 CHANGES Criteria for: Emergency Custody Orders Temporary Detention Orders

8 The Old Law Imminent Danger to self or others due to substance abuse of mental illness or substantially unable to care for self due to SA or MI ECO lasts 4 hours, no continuation allowed No “teeth” to outpatient commitment Law Enforcement Officer maintains custody of the individual

9 Commitment Criteria “Imminent” Removed from Dangerous Criteria: “the person has a mental illness and there is a substantial likelihood that, as a result of mental illness, the person will, in the near future, (1) cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting, or threatening harm and other relevant information”.

10 “Danger” is dropped “Danger” is excessively vague. Does not tell how likely or how serious the harm must be. “Substantial likelihood of serious physical “harm” fills these gaps.

11 “Imminent” is Changed to “In the near future” “Imminent” is unduly narrow. Denies help when harm is preventable “In the future” broadens the time frame

12 Prediction is Anchored on Behavior Potential harm can be “evidenced by recent behavior” Recurrence of previous symptoms may justify commitment

13 Commitment Criteria Substantially Unable to Care for Self changed: “the person has a mental illness and there is a substantial likelihood that, as a result of mental illness, the person will, in the near future, (2) suffer serious harm due to his lack of capacity to protect himself from harm or to provide for his basic human needs”

14 ECOs/TDOs – Magistrate “shall issue” (§ ,809) Changes “may” to “shall”. A magistrate shall issue the order if the criteria are met. TDO still requires facility to be indicated on the form.

15 ECOs/TDOs – Information Considered (§ A &-809.C) Magistrate may consider the following: ° Recommendations of any examining or treating physician or psychologist, if available ° Any past actions of person ° Any past mental health treatment of person ° Any relevant hearsay evidence ° Any medical records available ° Any affidavits submitted, if the witness is unavailable and it so states in the affidavit ° Any other information available that magistrate considers relevant to determination of probable cause

16 ECOs – Renewals (§ ) Magistrate may renew 4-hour ECO for up to 2 additional hours (6 hours total) for good cause: ° For CSB to identify suitable TDO facility or ° Completion of medical evaluation

17 Magistrate may renew the 4 hour ECO for up to 2 additional hours for good cause Medical clearance CSB to find suitable facility May be renewed at the request of: Any family Treating Physician CSB Law Enforcement officer

18 ECOs – Renewals (§ ) ECO renewal may be requested by: ° Any family member ° CSB ° Treating physician ° Law-enforcement officer

19 ECOs and TDO’s Officers will receive more specific details about policy, procedure and field guide instruction during a CIT training module on Friday.

20 ECOs – Custody Transfers (§ E; HB 401/SB 81) Law-enforcement may transfer custody to facility or location, if facility is: ° Licensed to provide level of security necessary to protect person and others from harm ° Is actually capable of providing that security, and ° Has entered into MOU with law-enforcement setting forth terms and conditions under which it will accept custody transfer – no fee may be charged law- enforcement

21 TDOs – Electronic evaluation (§ B) CSB evaluation may also be performed by two- way electronic video and audio communication system: ° Persons communicating must simultaneously see and speak to one another ° Signal transmission must be live, real time ° Signal transmission must be secure from interception through lawful means by anyone other that persons communicating

22 TDOs – CSB Notice (§ K) If CSB conducting evaluation for magistrate recommends against TDO, CSB must inform Petitioner and an on- site treating physician of recommendation! Physician or family member may request name of nearest magistrate

23 TDOs Information Considered (§ C) Information magistrate may consider in addition to petition: ° Recommendations of any treating or examining physician, if available ° Any past actions of person ° Any past mental health treatment person

24 TDOs – Duration – Hearing Timeframe (§ H and -814) Still shall not exceed 48 hours or until close of business on next day that is not Sat., Sun., or holiday No minimum time – but sufficient time to allow for completion of examiner’s report, preadmission screening report and initiation of treatment to stabilize person’s psychiatric condition to avoid involuntary commitment where possible

25 Preadmission Screening Report (§ ) CSB must provide preadmission screening report to court prior to hearing

26 CSB Attendance at Hearing (§ B) CSB preparing preadmission screening report must attend hearing in-person, or if impracticable, by telephone or two-way electronic video and audio communication system Court must provide time and location of hearing to CSB 12 hours prior to hearing

27 CSB Attendance at Hearing (§ B) CSB of person’s residence (preparing pre-admission screening report) remains responsible for person Attending CSB must inform CSB of disposition of hearing immediately upon conclusion of hearing Attending CSB must transmit disposition (order) through certified mail, personal delivery, facsimile with return receipt acknowledged or other electronic means

28 Length of Inpatient Treatment (§ C) Any order for involuntary inpatient treatment shall not exceed 30 days Any subsequent order for involuntary inpatient treatment shall not exceed 180 days

29 Mandatory Outpatient Treatment Criteria (§ D) (a) Same commitment criteria as for inpatient treatment; (b) Less restrictive alternatives that would offer an opportunity for improvement of person’s condition have been investigated and are determined to be appropriate, and

30 Mandatory Outpatient Treatment Criteria (§ D) The person ° 1) Has sufficient capacity to understand stipulations of his treatment. ° 2) Has expressed interest in living in community and agreed to abide by his treatment plan ° 3) Is deemed to have capacity to comply with treatment plan and understand and adhere to conditions and requirements of treatment and services, and ° 4) Ordered treatment can be delivered on outpatient basis by CSB or designated provider

31 Mandatory Outpatient Treatment Criteria (§ D) Less restrictive alternatives shall not be determined to be appropriate unless: ° Services are actually available in community, and ° Providers of services have actually agreed to deliver the services

32 Mandatory Outpatient Treatment Duration (§ E) MOT duration determined by court, based upon recommendation of CSB Not to exceed 90 days Any continuance of MOT not to exceed 180 days

33 Privacy Disclosures (§§ ; ; :03D(12)(13); ) Requires all providers to disclose, upon request, all information for a person involved in juvenile or adult commitment hearings, or jail transfer hearings to one another and to: ° Magistrate, juvenile intake officer ° Court ° Attorney, guardian ad litem ° Evaluator, examiner ° CSB ° Law enforcement officer

34 Privacy - Disclosures to Law Enforcement Health records disclosed to law enforcement limited to information necessary to: ° To protect officer, person and public from physical injury, or ° To address health care needs of person ° Shall not be used for any other purpose, disclosed to others or retained

35 Court Records – Tapes (§ ) Tape recording of hearing filed with clerk in confidential file Only one hearing shall be recorded per tape (SB 142) Person entitled to copy upon request

36 Court Records – Confidential (§ ) All court documents confidential unless waived in writing by person Access provided to dispositional order only upon motion of any person setting fort why access needed Court may order access if disclosure in best interest of person or public

37 Reports to CCRE (§ ; HB 815/SB 216) Clerk must forward prior to close of business on day of receipt, any order for ° Involuntary admission to facility ° Mandatory outpatient treatment ° Any person volunteering for admission who was subject of TDO, or ° Found incompetent to stand trial under

38 FIREARMS UNDER WHAT CIRCUMSTANCE DOES A RESPONDENT INVOLVED IN THIS PROCESS LOSE THE RIGHT TO POCESS A FIREARM?

39 Reports to CCRE – Advice (§ )(HB 815; SB 216) Judge or special justice required to advise person at beginning of commitment hearing: ° If he chooses to accept voluntary admission, he will lose right to possess firearm

40 Reports to CCRE – Restoration (§ :3)(HB 815; SB 216) Following release from involuntary admission or voluntary treatment, person may petition general district court for restoration of right to possess firearm De novo right of appeal to circuit court

41 DISCUSSION Question and Answer Session