PROPOSED CHANGES IN COLORADO’S CIVIL COMMITMENT LAWS Catherine Strode, MPA Health Care Advocacy Program 1

2 Moe Keller VP of Public Policy & Strategic Initiatives Mental Health America Amanda Kearney-Smith, MS Executive Director Colorado Mental Wellness Network PRESENTERS 2

3 BILL DRAFT February 18, 2013

4 INTRODUCTION Three Colorado Statutes Civil Commitment Holds Consolidation Extends Length of Mental Health Holds 4

5 PUBLIC AND PERSONAL SAFETY Adds “Substantial Probability” to Hold Criteria Problems for Law Enforcement Problems for Parents and Families 5

6 COLORADO’S SUBSTANCE USE RATES* Abuse Rates Higher Than National Average All Age Ranges *The Substance Abuse and Mental Health Services Administration 6

7 ] COLORADO’S MENTAL HEALTH INDICATORS* Serious Psychological Distress at National Average Major Depressive Episodes Abov e National Average *The Substance Abuse and Mental Health Services Administration 7

8 ACCESS CHALLENGES Lack of Coverage Lack of Resources Lack of Short Term Care Beds Lack of Community Supports Lack of Providers 8

9 CRISIS CARE NEEDS “Danger to Himself or Herself” Increased Victimization* Continuum of Care Increase Speed of Medicaid Approval * 9

10 GOVERNOR’S INITIATIVES ‘Right Services at the Right Time’: Streamline Statutes Statewide Hotline Expand Bed Capacity Housing Vouchers Community Supports/ACT Teams Medicaid Expanded For Substance Use Disorder Services 10

11 GOALS OF STATUTE CHANGE Quick Intervention and Stabilization Integration of Mental Health, Alcohol and Substance Use Disorders “Substantial Probability” Added As Third Criterion for Hold 11

12 INTERVENTION CHANGES 72-Hour Hold Increased to 5 Days Evaluation Required Within 24 Hours “Substantial Probability” Initiates Hold “Substantial Probability” in regards to harm to self “Probability” in regards to harm to others* *February 18 Draft 12

13 “SUBSTANTIAL PROBABILITY” VS “SUBSTANTIAL RISK” Bill Redrafted Language Changed

14 EVALUATION CHANGES Broadens Standard of Involuntary Commitment Creates New Definitions: ‘Professional Persons’ ‘Designated Facility’ ‘Gravely Disabled’ 14

15 REVISED DEFINITIONS Danger to Self or Others Family Member Gravely Disabled

16 CRISIS CARE SCENARIO Client Profile Client Condition Inclusion of an Advanced Directive (crisis plan) Maximum 5 Day Hold Period

17 CLIENT RIGHTS Opportunity for individuals to request an evaluation Ability to be advised of individual rights while under an involuntary hold

18 EXTENDED HOLD SCENARIO Short-term Civil Commitment Evaluation within 24 hours Legal procedures for reporting Least restrictive standards Advanced directives

19 STAKEHOLDER PERSPECTIVES Individual Family Provider

20 STATUTE CHALLENGES Communication barriers Translation into practice Client payment

21 PROVIDER CHANGES Who can initiate? Who can certify?

22 BILL PROPOSAL Sponsors/Timeline Involvement of State Departments Implementation

23 RESOURCES Colorado General Assembly Website Form Treatment Advocacy Center =article&id=201&Itemid=136 Colorado Department of Human Services Office of Behavioral Health BehavioralHealth/CBON/ National Resource Center on Psychiatric Advance Directives WEBINAR RECORDING 23

24 YOUR QUESTIONS AND INPUT 24