1. LAW ENFORCEMENT TRAINING Highlights and Points of Emphasis for Chapter 51 and 55 Issues October 22, 2009

2. ADDITION TO 51.20(2) Change in law requires WCDHHS approval of all Chapter 51.20 Emergency Detentions 51.15(2) now reads that Detention can only occur if the County Department in the County in which the individual was taken into custody approves the need for Detention

3. APPROVAL PROCEDURE -Call made to Charge Nurse at MHC -Briefly explain the facts and circumstances -Charge Nurse will likely approve Detention -Then ask: 1)Whether medical clearance is required 2)Whether the MHC has a bed available

4. IF NO INITIAL APPROVAL If the Charge Nurse will not initially approve the Detention, then: 1)Ask Charge Nurse to reconsider 2)Ask Charge Nurse to consult with Psychiatrist on callCharge Nurse will be trained to do this before denying the request. 3)Ask Charge Nurse to consult with Corporation Counsel Attorney on call

5. IF NO ULTIMATE APPROVAL If Charge Nurse will not ultimately approve the Detention, consult with your Shift Supervisor, who may recommend one of the following: 1)Arranging for voluntary treatment 2)Release to a responsible family member 3)Arrest, if applicable 4)Return to point of origin in community 5)Refer family to Corp. Counsel for possible 3- party Petition

6. DETENTION APPROVAL EFFECTIVE DATE *The Effective Date for the above procedure to have the Waukesha County Department of Health and Human Services/Charge Nurse approve Chapter 51 Detentions is: NOVEMBER 1, 2009

7. MEDICAL CLEARANCE Three Possibilities: 1)No Medical Clearance needed 2)Need Clearance, but no ADMISSION to medical clearance facility 3)Subject must be ADMITTED to medical facility for clearance/treatment

8. NO CLEARANCE NECESSARY If No Medical Clearance Necessary: 1)Transport to MHC or other facility as directed by the MHC 2)Deliver Subject to that facility 3)That facility is the facility that should be indicated on the Emergency Detention Paperwork

9. CLEARANCE, NO ADMISSION If Medical Clearance Needed, But Subject Not Admitted to Medical Clearance Facility: 1)Remain with Subject at medical clearance facility 2)When medical clearance is complete, transport Subject to MHC or other facility as directed by MHC 3)The MHC or other ED facility is the facility indicated on the Emergency Detention Paperwork

10. ADMISSION FOR MEDICAL TX If Subject Must Be ADMITTED For Medical Clearance or Treatment: 1)Fill out Medical Police Hold form and Hospitals form 2)Complete 51 paperwork with medical facility as receiving facility 3)When notified that Subject is cleared, call MHC Charge Nurse to determine receiving facility for 51Detention

11. STATEMENT OF EMER. DET.

12. MEDICAL HOLD FORM

13. CRIMINAL HOLDS Subject may have police hold arising out of the 51 ED or a previous matter: 1)Determine if there are any holds for Probation, other charges, warrants, etc. 2)If any holds exist, fill out the Criminal Hold form in the packet 3)Indicate any holds clearly in paperwork 4)Failure to follow may cause release!

14. CRIMINAL HOLD FORM

15. DETAINING FACILITYA REVIEW Remember: Key is ADMISSION!!! -If Subject is ADMITTED for medical treatment/clearance, that date/time/place of that Admission goes on the 51 ED -If Subject is treated at but not Admitted to the medical treatment facility, the date/time/place of Admission to the Mental Health Facility goes on the ED

16. 51.45 ALCOHOL DETENTIONS Procedure Is Much The Same: -Medical Clearance issue is the same -Criminal Hold issue is the same Two Main Differences: 1)No approval for Detention 2)No prospect of PC Hearing

17. CHANGE IN CHAPTER 55 LAW -55.12(2) now reads that Protective Placement may not be made to units for the acutely Mentally Ill -We used to be able, for a limited period of time, to admit Subjects under Chapter 55 to psychiatric units or facilities…not any more!

18. 55 PROCEDURE Again, Much Is The Same as a 51: -Medical Clearance issue is the same -Criminal Hold issue is the same

19. NO 55 APPROVAL Like 51.45s, there is no requirement in the 55 law that the WCDHHS approve Detentions…but, there is a catch.

20. RECEIVING FACILITY FOR 55S -It will almost always be WMH, I have never known of a 55 EPP to go elsewhere because they are going to a medical floor -Call WMH, if they will not admit -Subject can then be admitted to the nearest medical hospital that will accept them -WMH has not turned down a Chapter 55 admission in at least 15 years!!!

21. DIRECTION FROM FACILITY Do a 51 or a 55? -Key to give facility all information when calling to check availability of bed -Facility will give you direction on whether to initiate a 51 or a 55 -If Subject is combative or otherwise needs care on psychiatric unit, YOU CANNOT DO A 55! -If ED began as a 55 but Subject now needs a 51, you must do the 51

22. KEEP IN MIND -No approval for Detention necessary in a 55but if the matter ultimately must go forward as a 51, you must follow that procedure…including getting approval from the MHC Charge Nurse for Detention

23. THANK YOU!!! Thank you all for coming and listening. Please feel free to call me at 262-548-7432 with questions or concerns. Want copies of the outlines that were handed out today, they will shortly be at: www.waukeshacounty.gov