EMERGENCY RESPONSE AND TREATMENT VIA THE MENTAL HEALTH PROCEDURES ACT Presented by: Scott Pino Sharon Regional Behavioral Health Services

LEARNING OBJECTIVES: Obtain basic understanding of the development of current commitment processes. Identify the basic criteria and requirements, under the MHPA and subsequent Acts, for Voluntary Evaluation and Treatment. Identify the basic criteria and requirements, under the MHPA, for Involuntary Evaluation and Treatment. Understanding / clarification of required documentation, signatures, and timing as required by the MHPA.

Mental Health/Mental Retardation Act of 1966 Establishes County Mental Health/Intellectual Development (MH/ID) Board. Requires County Administrator appointment. Requires provision of services for individuals with MH/ID needs. State centers. State hospitals. Local systems with defined services.

LOCAL SYSTEMS TO INCLUDE, AT A MINIMUM: Short-term inpatient. Outpatient. Partial hospitalization. Emergency services (24 hours/day). Consultation and education. Aftercare services following release from state/county facilities. Sheltered workshop. Rehabilitative/training. Unified intake procedures.

Mental Health/Mental Retardation Act of 1966 Requires provision of services for individuals with MH/ID needs. Establishes process for entering treatment, via both Voluntary and Involuntary basis. Outlines persons subject to the provisions of the Act. Provides for limited rights to be provided to individuals subject to the Act.

VOLUNTARY ADMISSION UNDER MH/MR ACT Any individual 18 or older. Parent, Guardian, Person standing in Loco Parentis. Signed form required. Requires physician examination. No longer than 30 days. No longer than 10 days following written notice of withdrawal. Provides for rights of the individual.

INVOLUNTARY ADMISSION UNDER MH/MR ACT Relative, guardian, friend, police, physician, person standing in Loco Parentis, government or recognized non-profit health/welfare agency. Requires written petition. Requires 2 physician certifications. Must occur within 30 days of petition. No longer than 10 days. Provides for minimal rights of the individual.

MENTAL HEALTH PROCEDURES ACT Enacted in 1976, amended in 1978. Designed to assure “adequate treatment” for individuals with mental illness. Identifies exclusionary groups. Provides for: Voluntary and involuntary treatment. Inpatient and outpatient treatment. Rights to individuals subject to treatment.

MENTAL HEALTH PROCEDURES ACT Changes from the MH/MR Act were needed for a number of reasons: Multiple judicial decisions against the MH/MR Act. Need for Due Process under the 14th Amendment. Establishes/provides clear guidelines surrounding examination and treatment standards. Moved from “medical model” toward the “recovery-oriented” system we see today. Focused on rights to individuals subject to treatment.

MENTAL HEALTH PROCEDURES ACT The MHPA holds several key principles as a basis for the rationale for Involuntary commitment: There is presence of Mental Illness There is presence of “Clear and Present Danger.” Adequate treatment, if afforded to the individual, can improve the symptoms and remove the danger.

ADEQUATE TREATMENT “…a course of treatment designed and administered to alleviate a person’s pain and distress, and to maximize the probability of his recovery from mental illness...”

ADEQUATE TREATMENT: “It may include inpatient treatment, partial hospitalization, or outpatient treatment. Adequate inpatient treatment shall include such accommodations, diet, heat, light, sanitary facilities, clothing, recreation, education and medical care as necessary to maintain decent, safe and healthful living conditions.”

MENTAL HEALTH PROCEDURES ACT Treatment on a voluntary basis preferred. § 7102. Statement of policy “Treatment on a voluntary basis shall be preferred to involuntary treatment; and in every case, the least restrictions consistent with adequate treatment shall be employed.”

LEAST RESTRICTIVE SERVICES PA Code, Title 55, Chapter 5100.3 (b):  It is the policy of the Commonwealth to seek to assure that adequate treatment is available with the least restrictions necessary to meet each client’s needs. While this policy remains a shared responsibility between State, county, and facility personnel, the accountability for recommending the transfer to the least restrictive alternatives available remains a responsibility of those directing treatment. Adequate treatment provided in an individual’s own community or as close as possible to his own home shall be preferred.

MENTAL HEALTH PROCEDURES ACT Identifies exclusionary groups: Mentally Retarded Senile (Dementia or Organic) Alcoholic or Drug Dependent UNLESS they are also diagnosed as mentally ill, or there is reasonable probability that the results of the examination would result in such diagnosis.

PA Code, Title 55 Chapter 5100.3  (c)  Persons who are mentally retarded, senile, alcoholic or drug dependent shall be afforded mental health examination or treatment if they are also diagnosed as mentally ill, or if there is a reasonable probability that upon examination such diagnosis will be established.  (d)  Persons in treatment under the act shall be afforded necessary diagnostic or treatment procedures as defined in their treatment plan for conditions of mental retardation, senility, alcohol, or drug abuse when it is determined that the absence of such procedures will be detrimental to the progress of the person accomplishing the goals of treatment.

PA BULLETIN: OMHSAS – 06-02 Issued Februay 1, 2006. Identifies Pennsylvania as having the third largest population over age 60, and anticipates the fastest growing age range in next 2 decades will be in the 85 + age group. States “A diagnosis of dementia should never be a reason to deny mental health crisis intervention or community based treatment to a person when it is accompanied by a mental health disorder.”

MENTAL HEALTH PROCEDURES ACT VOLUNTARY ADMISSIONS

MENTAL HEALTH PROCEDURES ACT Section 7201 – Voluntary Admission Any person 14 years of age or over, however, parents must be notified if the individual is between 14 and 18 years of age. Under 14, must be Parent, Guardian, or Person standing in Loco Parentis Believes they are in need of treatment Substantially understands the nature of the voluntary commitment Decision to do so is voluntary  

PA CODE, TITLE 55, CHAPTER 5100.71  (a)  Persons 14 years of age or older may seek voluntary inpatient treatment if they substantially understand the nature of such treatment and the treatment setting. Parents or guardians who decide to seek voluntary inpatient treatment for persons under 14 years of age may do so only in accordance with the act and applications regulations.  (b)  The test of a person’s substantial understanding for inpatient treatment is met if the person gives consent to the information and explanations outlined in section 203 of the act (50 P. S. §  4203).  

PA ACT 147 Enacted in 2004, implemented in 2005. Actually amends what is known as the Medical Consent Act, in conjunction with the Juvenile Act. Addresses legal consent of a minor between the ages of 14 and 18 years of age. Allows parent to provide consent for minor between the ages of 14 and 18. Provides for addressing differences between parents and minor child between the ages of 14 and 18.

MENTAL HEALTH PROCEDURES ACT Section 7203 – Explanation and Consent Explanation of treatment, inclusive of any restraints or restrictions to be imposed. Statement of rights to be provided. Consent in writing upon DHS-approved form, including the following items: Statement that individual understands treatment is inpatient setting. Name of approved facility. Consent is voluntary. Explanation of notification to withdraw may require individual to stay up to 72 hours. Becomes part of the medical record.

MENTAL HEALTH PROCEDURES ACT Section 7203 – Explanation and Consent Notice to parents for minors (14-18 years). Director of facility shall promptly notify minor’s parents, guardian, or person standing in loco parentis, and inform them of right to be heard upon the filing of an objection. When objection is filed, hearing shall be held within 72 hours. Heard by a Mental Health Review Officer or Judge.

PA CODE, TITLE 55, CHAPTER 5100.71  (c)  Behavorial consent, as defined in §  5100.2 (relating to definitions) shall be sufficient consent for persons presently receiving treatment at a facility to remain at that facility and to participate in treatment which is explained to him. Behavioral consent shall be documented under §  5100.73 (relating to explanation and consent to inpatient treatment). Behavorial consent shall not be relied upon for admission to or transfer from a facility.

MENTAL HEALTH PROCEDURES ACT Section 7207 – Transfer of Person in Voluntary Treatment “A person who is in voluntary treatment may not be transferred from one facility to another without his written consent.”

MENTAL HEALTH PROCEDURES ACT INVOLUNTARY ADMISSIONS

MENTAL HEALTH PROCEDURES ACT Section 7301 – Persons Who May Be Subject to Involuntary Examination and Treatment Person must be “severely mentally disabled” Must be “in need of immediate treatment” Must present “clear and present danger of harm to others or to himself.”

MENTAL HEALTH PROCEDURES ACT Section 7301—Persons Who May Be Subject to Involuntary Examination and Treatment Clear and present danger to others shall be shown by establishing that within the past 30 days the person has inflicted or attempted to inflict serious bodily harm on another and that there is reasonable probability that such conduct will be repeated. A clear and present danger of harm to others may be demonstrated by proof that the person has made threats of harm and has committed acts in furtherance of the threat to commit harm;

MENTAL HEALTH PROCEDURES ACT Section 7301—Persons Who May Be Subject to Involuntary Examination and Treatment Clear and present danger to himself shall be shown by establishing that within the past 30 days; (i) the person has acted in such manner as to evidence that he/she would be unable, without care, supervision and the continued assistance of others, to satisfy his/her need for nourishment, personal or medical care, shelter, or self-protection and safety, and that there is reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within 30 days unless adequate treatment were afforded under the act; or

MENTAL HEALTH PROCEDURES ACT Section 7301—Persons Who May Be Subject to Involuntary Examination and Treatment (ii) the person has attempted suicide and that there is reasonable probability of suicide unless adequate treatment is afforded under this act. For the purpose of this subsection, a clear and present danger may be demonstrated by the proof that the person has made threats to commit suicide and has committed acts which are in furtherance of the threat to commit suicide; or

MENTAL HEALTH PROCEDURES ACT Section 7301—Persons Who May Be Subject to Involuntary Examination and Treatment (iii) the person has substantially mutilated himself/herself or attempted to mutilate himself/herself substantially and that there is the reasonable probability or multilation unless adequate treatment is afforded under this act. For the purposes of this subsection, a clear and present danger shall be established by proof that the person has made threats to commit multilation and has committed acts which are in furtherance of the threat to commit mutilation.

PA CODE TITLE 55, CHAPTER 5100.85 (1)  The application of the standards in section 301 of the act, for emergency commitment, including the requirement of overt behavior, shall be based at least upon the following factors:      (i)   There is a definite need for mental health intervention without delay to assist a person on an emergency basis;      (ii)   The clear and present danger is so imminent that mental health intervention without delay is required to prevent injury or harm from occurring;     

PA CODE TITLE 55, CHAPTER 5100.85  (iii)   There is reasonable probability that if intervention is unduly delayed the severity of the clear and present danger will increase; or  (iv)   There is reasonable probability that the person, with his presently available supports, cannot continue to adequately meet his own needs if mental health intervention is unduly delayed.

MENTAL HEALTH PROCEDURES ACT Section 7302—Involuntary Examination and Treatment, not to exceed 120 Hours May occur with or without a warrant. Physician in a facility, or Physician, Police Officer, County Administrator or Delegate may order exam without warrant Request for warrant by physician, “other responsible party setting forth facts constituting reasonable grounds to believe a person is severely mentally disabled and in need of immediate treatment”. Application required to be completed for exam with or without warrant. (Keep in mind the issues related to Due Process)

MENTAL HEALTH PROCEDURES ACT Section 7302 – Involuntary Examination and Treatment, not to exceed 120 Hours Individual must be informed of his rights upon arrival to the facility where the examination is to occur. Notification of interested parties identified by the person, and “reasonable” use of the telephone by the person. Take any “reasonable steps” to assure health and safety of dependents and personal property while the individual is detained.

MENTAL HEALTH PROCEDURES ACT Section 7302-Involuntary Examination and Treatment, not to exceed 120 Hours Person taken to a facility must be examined by a physician within 2 hours of arrival. If treatment is deemed necessary, it is to begin immediately. If treatment not deemed necessary, person is to be returned to such a place as he “may reasonably direct.” No “double jeopardy” – if previous application has been granted, there must be new behavior.

MENTAL HEALTH PROCEDURES ACT Sections 7109 – 7112 Outline the written application and required DHS forms. Discuss unsworn statements in the petition, and legal implications – unsworn falsification to authorities is criminally liable. Consent required for release of confidential information, except for release to those providing treatment, the County Administrator, Courts during proceedings required under the Act, or unless otherwise allowed by Federal law.

MENTAL HEALTH PROCEDURES ACT Section 7114 Holds harmless any Administrator, Director, Physician or other Authorized Person involved in the process, in the “absence of willful misconduct or gross negligence.” Harmless against either Criminal or Civil liability. Harmless regardless of decision to either approve or deny.

PENNSYLVANIA ACT 77 Requires County Administrator or designee to file information with PA State Police for anyone committed to inpatient under Sections 302, 303, and 304. Refers to 18 C.S. 6105 – prohibits the individual “to posses, use, control, sell, transfer, or manufacture a firearm in this Commonwealth.” Offers “reasonable period of time, not to exceed 60 days” for the individual “to sell or transfer that person’s firearms to another eligible person who is not a member of the prohibited person’s household.”

ADDITIONAL RESOURCES & QUESTIONS