1. GOOD MORNING!

2. The Answers to Big Questions
Who am I?
Why am I here?

3. TWO WORDS
SANDY HOOK
NEWTON, CT
AURORA, CO

4. PROBATE COURTS CAN Order testing for TB and HIV
Order treatment for substance abuse over objection with a Doctor’s order

5. Areas of the Probate Court that Address the Mentally Ill:
Guardianships
S.B. 43
Civil Commitments

6. What is S.B. 43?
Senate Bill 43 allows people bring their mentally ill loved one to Court
The petitioner asks the Court to order the mentally ill, non-complaint person into treatment
There are a lot of rules

7. “Mentally ill person subject to hospitalization by court order”
Senate Bill 43 (eff )
“Mentally ill person subject to hospitalization by court order”
Why did they take out “hospitalization”?

8. Emergency Hospitalization: Who can issue a Pink Slip?
Police Officer
Psychiatrist
Licensed Clinical Psychologist
Medical Doctor
Parole Officer
Health Officer*
*any public health doctor, nurse, or person authorized by a city or ADM board to perform the duties of a health officer.

9. The Criteria for the Affidavit:
Substantial risk of physical harm to self
Substantial risk of physical harm to others
Substantial immediate risk of serious physical injury to self via evidence of not providing for basic needs
Would benefit from tx due to a history of lack of compliance with mental health tx and either:
Two hospitalizations within thirty-six months prior to filing the affidavit; OR
Lack of compliance with tx within forty eight months prior to the filing of the affidavit resulted in one or more acts of serious violent behavior toward self or others

10. The Civil Commitment Process Step 1
Examination by a Doctor within 24 Hours
If found to meet the definition of “mentally ill person subject to court order” the person may be held up to three days
The medical director can file an Affidavit of Mental Illness with the Probate Court

11. “I think the dosage needs adjusting
“I think the dosage needs adjusting. I'm not as happy as the people in the ads.”

12. The Civil Commitment Process Step 2
The Probate Court then issues a temporary order of detention and schedules a hearing
No more than two days after receiving the affidavit, the Probate Court must refer the affidavit to the ADM board to assist the Court in determining whether the person is subject to court order, or if there are less intrusive alternatives available
An attorney from the ADM board appears at the hearing to represent the board, who is seeking the commitment

13. The Civil Commitment Process Step 3
If the Court finds, by clear and convincing evidence, that a person is “mentally ill subject to court order” the court must order the person for a period not to exceed 90 days to ANY of the following:
A state mental hospital
A nonpublic hospital
The Veterans’ Administration or other agency of the United States Government
An ADM board or agency the board designates
Receive private psychiatric or psychological care
Any other suitable facility or person consistent with the diagnosis, prognosis, and treatment needs of the person

14. Summit County Commits its Residents to the County’s ADM Board
If the Court finds, by clear and convincing evidence, that a person is “mentally ill subject to court order” the Summit County Probate Court orders the person committed to the ADM board for 90 days
Upon release from the hospital
CSS
New Day Court

15. Requires Treatment Plan for Outpatient Commitments
The “treatment plan” means a written statement of reasonable objectives and goals for a person established by a treatment team, with specific criteria to evaluate progress towards achieving those objectives.
The participation of the person in establishing the objectives and goals must be documented. The treatment plan must include services to be provided to the person while hospitalized, after discharge, or in an outpatient setting.
The treatment plan must address services to be provided which include, but are not limited to:
Community psychiatric supportive treatment;
Assertive community treatment;
Medications;
Individual or group therapy;
Peer support services;
Financial services;
Housing or supervised living services;
Alcohol or substance abuse treatment, and
Any other service prescribed to treat the patient’s mental illness and help them to function in the community and prevent relapse.

16. Non-Compliance with Treatment
If the person receiving court ordered outpatient treatment fails to comply with the treatment plan, or begins to decompensate, the treatment provider may submit a report to the court.
The court will schedule a hearing to review the case and notify the ADM board.
At the hearing, the treatment provider must submit a report to the court with a plan for appropriate alternative treatment, if any, or recommend that the court discontinue the court-ordered treatment.
The court must consider available and appropriate alternative placements but cannot impose criminal sanctions that result in confinement in a jail or other local correctional facility based solely on the person’s failure to comply with the treatment plan.

17. Continued Commitment
After the expiration of the court’s 90 day order, an application for continued treatment can be filed if there is a reason to believe the person still meets the criteria for court ordered outpatient treatment
The court holds a hearing on the continued commitment and if it finds by clear and convincing evidence that the person is “mentally ill subject to court order” the Court may order continued commitment
If continued commitment is ordered, the Court must hold a full hearing at least every two years after the expiration of the first 90 day period

18. New Day Court
Proposes to work with those who have been civilly committed to a hospital and are going home
Modeled on the mental health court
Would involve the court in assisting patients to remain medication compliant
C.I.T, Psychiatric Emergency Services, ADM Board and CSS
Treatment plan in real life

19. How it Works:
Patient is in court within 14 days of release from a hospital. All participants are seen in the Court together
Judge is on the bench in a robe. There is no formal record
Patient appears with case manager and family if present
Chat with patient about progress and problems
Those doing well are seen first, then those with difficulties and last are the new patients
Rewards include longer time between court visits and movie tickets or other “treats”
Senior representatives from CSS and ADM are present

20. Court Liaison Employed by the Probate Court Works with other agencies
Handbook for new patients
Schedules appearances
Orders/monitors capiases
Most importantly: Collects information and collates it into a briefing sheet, or informal docket for the Judge

21. The Role of the Judge Why do I sit on the bench in a robe?
Superior Guardian role
Affirmation and coaching
Problem solving

22. And Now…3 Minutes of Shameless Promotion

23. Why we LOVE our model Reproducible using current community resources
We are very fortunate to have many resources, but the model can be built anywhere there is a mental health service provider with case management
It does not require a dedicated judge or additional staff at the Court or in the other agencies
Does require billing flexibility and additional support from our ADM board
Satisfaction for stakeholders who are seeing success

24. …and it’s about Recovery
Based on therapeutic jurisprudence concepts
There is a beginning and an end
Individualized plan through steps
Black Robe effect is only one part
Public Acceptance
Peer success is visible
HOPE!!
PS. There is NO problem with HIPPA

25. CURRENT STATISTICS
275 PATIENTS HAVE ENTERED THE PROGRAM SINCE INCEPTION
168 HAVE GRADUATED AND 12 HAVE GONE THROUGH THE PROGRAM TWICE
34 HAVE GRADUATED SINCE JANUARY
21 PATIENTS JOINED THE PROGRAM IN MARCH, 2018
A HANDFUL ARE COMING FROM THE CRIMINAL MISDEMEANOR SYSTEM.

26. Our Model is not Perfect
Continued Commitment issues
Psychiatrist shortage
Some patients take off
Some will never be able to understand or accept their illness
We are now a victim of too much success

27. Summit County Statistics
Since the start of New Day Court in January 2016, we have had a total of 152 clients.
Released after 90-day commitment expired: 84
Hospitalized while on OPC: 14
Hospitalized and recommitted after OPC expired: 7
Current Active clients – 58
We have yet to use the 5th criteria.

28. QUESTIONS?

29. Judge Elinore Marsh Stormer
SUMMIT COUNTY PROBATE COURT 209 South High Street Akron, Ohio
Phone: (330)