MISSISSIPPI LEGISLATURE

2005 Regular Session

To: Public Health and Human Services; Judiciary A

By: Representative Compretta (By Request)

House Bill 1453

AN ACT TO ESTABLISH A PROCEDURE FOR PROVIDING ASSISTED TREATMENT TO PERSONS WITH MENTAL ILLNESS; TO DEFINE CERTAIN TERMS; TO PROVIDE FOR VOLUNTARY TREATMENT AND FOR EMERGENCY TREATMENT/ OBSERVATION; TO SET OUT THE PROCEDURES FOR PETITIONING FOR ASSISTED TREATMENT AND FOR THE HEARING AND DISPOSITION; TO PROVIDE FOR APPEALS FROM THE HEARING DECISIONS; TO PROVIDE FOR CERTAIN SAFEGUARDS FOR PERSONS RECEIVING ASSISTED TREATMENT; TO PROVIDE FOR ASSISTED OUTPATIENT TREATMENT; TO PROVIDE FOR TRIAL RELEASE FROM INPATIENT ASSISTED TREATMENT; TO PROVIDE FOR RENEWALS OF ASSISTED TREATMENT ORDERS; TO PROVIDE THE PROCEDURES FOR DISCHARGE FROM ASSISTED TREATMENT; TO ESTABLISH A PATIENT BILL OF RIGHTS FOR PERSONS RECEIVING ASSISTED TREATMENT; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

ARTICLE 1

STATEMENT OF PURPOSE

SECTION 1.1. The Legislature finds and declares the following:

(a) The consequences of untreated mental illness are as apparent as they are devastating: homelessness, criminalization, suicide, violence, victimization, lost productivity, permanently decreased medication responses, and the incalculable costs of unnecessary suffering.

(b) Due to advances in recent years, treatment is now available that can eliminate or substantially alleviate the symptoms of mental illness for most who suffer from it. People with treated mental illness can now reclaim their lives, but first there must be treatment.

(c) Treatment voluntarily embraced is always preferable. However, mental illness is a biologically based disease that attacks the brain. As a result, mental illness renders many people incapable of voluntarily entering treatment because they are unable to make rational decisions or unaware that they are ill. When this occurs, those people may require assisted treatment to protect their lives as well as avoid tragic personal and societal consequences.

(d) This act is designed to be the legal framework for the provision of care to individuals who, due to the symptoms of severe mental illness, become either dangerous or incapable of making informed medical decisions concerning their treatment.

(d) The substantive and procedural components of this act create a flexible mechanism that can be used to secure treatment for those who most need it, while still distinguishing those for whom intervention is inappropriate. Paramount are the strict and plentiful safeguards that this act establishes to protect both the rights and well-being of those subject to it.

ARTICLE 2

DEFINITIONS

SECTION 2.1. As used in this act:

(a) "Assisted treatment" means the provision of treatment, in accordance with this act, to individuals who are either dangerous or incapable of making informed medical decisions because of the effects of severe mental illness.

(b) "Assisted outpatient treatment" means assisted treatment on an outpatient basis.

(d) "Certificate" means the form filed with the court by a psychiatrist or other physician to request an assisted treatment hearing for an individual currently in emergency treatment/observation.

(e) "Chronically disabled" may be shown by establishing that the person is incapable of making an informed medical decision and, based on the person’s psychiatric history, the person is unlikely to comply with treatment and, as a consequence, the person’s current condition is likely to deteriorate until his or her psychiatric disorder significantly impairs the person’s judgment, reason, behavior or capacity to recognize reality and has a substantial probability of causing him or her to suffer or continue to suffer severe psychiatric, emotional or physical harm.

(f) "Court" means the chancery court.

(g) "Danger to himself or herself" may be shown by establishing that, by his or her behavior, a person is in the reasonably foreseeable future likely to either attempt suicide, to inflict bodily harm on himself or herself or, because of his or her actions or inaction, to suffer serious physical harm in the near future. The person’s past behavior may be considered.

(h) "Danger to others" may be shown by establishing that, by his or her behavior, a person is in the reasonably foreseeable future likely to cause or attempt to cause harm to another. Evidence that a person is a danger to others may include, but is not limited to:

(i) That he or she has inflicted, attempted or threatened in an objectively serious manner to inflict bodily harm on another;

(ii) That by his or her actions or inactions, he or she has presented a danger to a person in his or her care; or

(iii) That he or she has recently and intentionally caused significant damage to the substantial property of others.

(i) "Gravely disabled" may be shown by establishing that a person is incapable of making an informed medical decision and has behaved in such a manner as to indicate that he or she is unlikely, without supervision and the assistance of others, to satisfy his or her need for either nourishment, personal or medical care, shelter, or self-protection and safety so that it is probable that substantial bodily harm, significant psychiatric deterioration or debilitation, or serious illness will result unless adequate treatment is afforded.

(j) "Incapable of making an informed medical decision" means that a person is unaware of the effects of his or her psychiatric disorder or that the person lacks the capacity to make a well-reasoned, willful, and knowing decision concerning his or her medical or psychiatric treatment. Any history of the person’s noncompliance with treatment or of criminal acts related to his or her mental illness shall, if available, be considered.

(k) "Petition" means the form filed with a court to request an assisted treatment hearing based on the good faith belief of the petitioner that the subject of the petition is eligible for assisted treatment under the provisions of this act.

(l) "Psychiatric Treatment Board" or "board" means a judicially empowered decision-making body that shall consist of a physician (preferably a psychiatrist), a lawyer, and a third member, who either must be or has been a recipient of treatment for mental illness or either be or has been a close relative of such a person. All decisions of the board must be approved by a majority of its members.

(m) "Severe psychiatric disorder" means a substantial impairment of a person's thought processes (e.g., delusions), sensory input (e.g., hallucinations), mood balance (e.g., mania or severe depression), memory (e.g., dementia), or ability to reason that substantially interferes with a person’s ability to meet the ordinary demands of living. Severe psychiatric disorders are distinguished from:

(i) Conditions that are primarily due to drug abuse or alcoholism, although severe psychiatric disorders may coexist with these disorders;

(ii) Other known neurological disorders such as epilepsy, multiple sclerosis, Parkinson's disease, or Alzheimer's disease, although those neurological disorders also may have psychotic features similar to those found in severe psychiatric disorders;

(iii) Normal age-related changes in the brain;

(iv) Brain changes related to terminal medical conditions;

(v) Personality disorders as defined by the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" (APA-DSM);

(vi) Moderate, severe and profound mental retardation as defined by the APA-DSM; and

(vii) Pervasive developmental disorders, including autistic disorder, Rett's disorder and Asperger's disorder as defined by the APA-DSM.

(n) "Treating professional" means a psychiatrist, psychologist or other licensed professional whose scope of practice includes providing care and evaluation of individuals with psychiatric disorders.

(o) "Trial release" means a procedure that allows a patient placed in an inpatient facility under an assisted treatment order to receive treatment while living in the community and remaining subject to the authority of the inpatient facility.

ARTICLE 3

VOLUNTARY TREATMENT

SECTION 3.1. Admission to voluntary treatment.

A person in need of psychiatric care should be admitted into treatment voluntarily whenever possible.

SECTION 3.2. Discharge from voluntary treatment.

A voluntary patient may seek discharge at any time. Unless properly invoking provisions of this act allowing for their retention, the psychiatric treatment facility must release voluntary patients who request to be discharged within forty-eight (48) hours, not including Saturdays, Sundays or holidays.

ARTICLE 4

EMERGENCY TREATMENT/OBSERVATION-CERTIFICATION

SECTION 4.1. Emergency treatment initiated by law enforcement officers.

Any law enforcement officer with the power of arrest or any person generally designated to do so by the state, county or Department of Mental Health may bring to a designated facility for evaluation any person the officer has reasonable cause to believe has a severe psychiatric disorder and, because of the disorder, is a danger to himself, herself or to others or is gravely disabled.

SECTION 4.2. Emergency treatment initiated by others.

Any psychiatrist, other physician, psychologist, or person who has been generally designated to do so by the state, county or Department of Mental Health may initiate emergency treatment/observation based on a good faith belief that because of a severe psychiatric disorder, a person is either a danger to himself or herself, a danger to others or gravely disabled. Any such person who determines the need for emergency treatment/observation but who is not authorized to transport those individuals to a psychiatric facility may direct any person enumerated in Section 4.3 to do so.

SECTION 4.3. Transportation to emergency facility.

Protesting individuals may only be transported by either law enforcement officers with the power of arrest or others who have been designated to perform this function by the state, county or Department of Mental Health.

SECTION 4.4. Evaluation.

A psychiatrist or other physician shall evaluate an individual in emergency treatment/observation within six (6) hours of the individual’s placement in a designated psychiatric facility.

SECTION 4.5. Immediate release.

An individual shall be released from emergency treatment/ observation unless the psychiatrist or other physician who performs the evaluation determines that the individual is either a danger to himself, herself or others or is gravely disabled.

SECTION 4.6. Certification.

If the examining psychiatrist or other physician who performs the evaluation determines, in his or her clinical opinion, that the individual is a danger to himself, herself or to others or is gravely disabled, he or she must file, or cause to be filed by another psychiatrist or other physician who has also examined the individual, a certificate with the court. The certificate must be filed with the court within twenty-four (24) hours of the initial examination, not including Saturdays, Sundays or holidays.

SECTION 4.7. Requirements of certificate.

The certificate shall be in writing, executed under oath, and shall include the following information:

(a) The name and address, if known, of the respondent;

(b) The name and address, if known, of the respondent's spouse, legal counsel, conservator or guardian and next-of-kin;

(d) The names and addresses, if known, of other persons with knowledge of respondent's mental illness who may be called as witnesses at the assisted treatment hearing;

(e) The name and work address of the certifying psychiatrist or other physician;

(f) The name and address of the facility in which the respondent is undergoing emergency treatment/observation;

(g) The certifying psychiatrist or other physician’s statement that he or she has examined the respondent since the respondent was placed in emergency treatment/observation; and

(h) The certifying psychiatrist or other physician’s statement that, in his or her clinical opinion, the respondent is a danger to himself, herself or to others or gravely disabled and the clinical basis for this opinion.

SECTION 4.8. Criminal penalty.

It shall be a misdemeanor to knowingly file, or cause to be filed, a certificate that contains a false material statement or information.

SECTION 4.9. Initial responsibilities of court after certificate is filed.

After the filing of the certificate, the court must:

(a) Schedule a hearing on the certificate that will occur no more than seventy-two (72) hours, not including Saturdays, Sundays and holidays, after the initial examination; and

(b) Designate counsel for the respondent no less than twenty-four (24) hours before the hearing.

SECTION 4.10. Notice of hearing on certificate.

The court shall notify the certifying psychiatrist or other physician, respondent, and the respondent’s legal guardian or conservator, if known, of the scheduled hearing on the certificate at least twenty-four (24) hours in advance. The court also must attempt to notify of the pending hearing, at least twenty-four (24) hours in advance, an adult member of respondent’s household, if known, and up to five (5) individuals of the respondent’s choice. Notice may be either by mail, personal delivery, telephone, or reliable electronic means. Timely actual notice shall fulfill the notice requirement for any given individual.

SECTION 4.11. Duration of emergency treatment/observation.

Absent the exercise of other applicable provisions of this act, the period of emergency treatment/observation may last no more than seventy-two (72) hours after the initial examination, not including Saturdays, Sundays or holidays. Anyone who is determined by the examining or a treating physician not to be a danger to himself, herself, or others or gravely disabled must be released from emergency treatment/observation. The initial assisted treatment hearing shall take place before the end of the treatment/observation period.

SECTION 4.12. Treatment during emergency treatment/ observation.

During the emergency treatment/observation period, treatment may be administered if the person is, in the clinical opinion of a treating professional, a danger to himself, herself, or others or is gravely disabled.

ARTICLE 5

PETITION FOR ASSISTED TREATMENT

SECTION 5.1. Petition.

Any adult may file a petition for the assisted treatment of another person based on a good faith belief that, due to the effects of a severe psychiatric disorder, the person is either a danger to himself or herself, a danger to others, gravely disabled, or chronically disabled.

The petition shall be in writing, executed under oath, and shall include the following information:

(a) The petitioner’s name, address and, if any, relationship to the respondent;

(b) The name and address, if known, of the respondent;

(d) The name and address, if known, of anyone currently providing psychiatric care to the respondent;

(e) That the petitioner has reason to believe the respondent meets the criteria for assisted treatment in Section 7.3 (these criteria shall be described in simple language in the petition form);

(f) That the beliefs of the petitioner are based on specific behavior, acts, attempts, or threats, which shall be specified and described in detail; and

(g) The names and addresses, if known, of other persons with knowledge of respondent's mental illness who may be called as witnesses.

SECTION 5.2. Request for temporary treatment order.

A request for an ex parte order placing the respondent under care and treatment in an inpatient facility until the assisted treatment hearing may be included in the petition. The court may issue a temporary treatment order if it finds that the health or safety of the respondent will be placed in jeopardy absent immediate treatment. However, any treatment under the court’s order must be later determined necessary by a treating professional. On granting a temporary treatment order, the court shall direct the transport of the respondent to a designated treatment facility by either law enforcement officers with the power of arrest or others who have been designated to perform this function by the state, county or Department of Mental Health. The temporary treatment order shall be in effect until either the assisted treatment hearing or the petition is dismissed or withdrawn, whichever occurs first.

SECTION 5.3. Initial responsibilities of court after petition is filed.

Within twenty-four (24) hours, not including Saturdays, Sundays or holidays, of the filing of a petition for assisted treatment, the court must:

(a) Determine whether the petition is sufficient to establish the reasonable belief that the respondent may be subject to assisted treatment and dismiss without prejudice those that do not;

(b) Schedule a hearing on any petition it does not dismiss within ten (10) calendar days of when the petition was filed;

(d) If necessary, issue an order for the respondent to be examined under Section 5.8;

(e) Designate counsel for the respondent of any petition it does not dismiss; and

(f) Forward a copy of any petition it does not dismiss to the agency designated by the county to evaluate petitions as described in Section 5.4.

SECTION 5.4. Designated counsel.

The respondent shall have court-designated counsel. The county shall investigate, with due diligence, the basis for any petition not dismissed by the court under Section 5.3. An attorney will be designated for the petitioner by the county if its investigation, performed with due diligence, finds probable cause that the respondent is eligible for assisted treatment under Section 7.3. The county shall either designate counsel or notify petitioner of its decision not to designate counsel within seventy-two (72) hours of receiving the petition from the court. If the county does not designate an attorney, petitioner still may file the petition. Both petitioner and respondent have the option of engaging counsel of his or her choice.

SECTION 5.5. Notice of hearing on petition.

Within twenty-four (24) hours, not including Saturdays, Sundays and holidays, of scheduling a hearing on a petition, the court shall mail notice of the hearing, which shall include a copy of the petition, to the respondent; respondent’s legal guardian or conservator, if known; petitioner; petitioner’s counsel, if known; an adult member of respondent’s household, if known; and up to five (5) individuals of the respondent’s choice. The court shall, in addition, attempt to notify the respondent; respondent’s legal guardian or conservator, if known; petitioner; and petitioner’s counsel, if known, during that period by either telephone or other reliable electronic means. Timely actual notice shall fulfill the notice requirement for any given individual.

SECTION 5.6. Criminal penalty for false petition.

It shall be a misdemeanor to knowingly file, or cause to be filed, a petition that contains a false material statement or information.

SECTION 5.7. Evaluation.

Except as otherwise delineated in this act, the respondent must be examined by a treating professional before the hearing but not more than seven (7) calendar days before the petition is filed.

SECTION 5.8. Petition filed without evaluation.

A petition may be filed that is unsupported by an evaluation so long as the petition presents sufficient evidence to establish the reasonable belief that the respondent may be subject to assisted treatment. The court shall order the person who is the subject of the petition to be examined by a treating professional assigned by the Department of Mental Health, or its designee, no less than seventy-two (72) hours before the assisted treatment hearing.

ARTICLE 6

ASSISTED TREATMENT HEARING PROCEDURES

SECTION 6.1. Ten-day treatment option.

The respondent has the option of choosing ten (10) calendar days of inpatient treatment in lieu of being subject to the assisted treatment proceeding. This option is available to the respondent from the time he or she is served with the petition until the end of the petitioner’s presentation of evidence at the hearing. At that point, the Psychiatric Treatment Board shall give the respondent a final chance to accept ten (10) days of treatment before it forecloses him or her from doing so, clearly expressing that it is the respondent’s final opportunity to exercise this option. The respondent may select the ten-day treatment option before the hearing, in which case the treating facility shall file an affidavit of this election, signed by the respondent, with the court within forty-eight (48) hours, not including Saturdays, Sundays or holidays. During the ten-day treatment period, the respondent may be discharged on the signature of both the treating medical professional and the medical director of the facility. At the expiration of the ten-day period, a respondent placed in treatment in accordance with this section shall be transferred to voluntary status, but may be subject to additional periods of assisted treatment under this act.

SECTION 6.2. Continuance.

The Psychiatric Treatment Board or the court may, for good cause, order a continuance of up to forty-eight (48) hours or, if this period ends on a Saturday, Sunday or holiday, to the end of the next day on which the court is open. The continuance shall extend the emergency treatment/observation period or any temporary treatment order until the time of the hearing.

SECTION 6.3. Location of assisted treatment hearing.

For those currently admitted to an inpatient facility operated by the Department of Mental Health, or its designee, assisted treatment hearings shall be held at the respondent’s psychiatric facility.

SECTION 6.4. Attendance at hearing.

The hearing shall be open to anyone unless the respondent requests that it be closed, at which point only parties and their counsels, witnesses, members and staff of the Psychiatric Treatment Board, and court personnel may be present. However, the court may approve a motion of an individual to attend the trial upon a showing that the person has a substantial interest in the proceeding.

SECTION 6.5. Expert testimony required at hearing.

For a hearing on a certificate, a treating professional who has examined respondent since he or she was placed under emergency treatment/observation shall testify.

For a hearing on a petition, the testimony of a treating professional who has examined the respondent more recently than seven (7) calendar days before the petition was filed is required. That testimony may be presented by affidavit, unless respondent’s counsel requests of the petitioner or petitioner’s counsel, in writing, the presence of such a treating professional at the assisted treatment hearing. A copy of this request must be filed with the court and made at least seventy-two (72) hours, excluding Saturdays, Sundays and holidays, before the hearing. If planning to present the examining treating professional’s testimony by affidavit, counsel for the petitioner must present a copy of the affidavit either to respondent’s counsel or at the office of respondent’s counsel at least twenty-four (24) hours, excluding Saturdays, Sundays and holidays, before the hearing. The procedures applicable when the respondent has not been examined before the hearing are set forth in Section 7.1.

SECTION 6.6. Evidence admissible at hearing.

The Psychiatric Treatment Board may review any information it finds relevant, material, and reliable, even if normally excluded under rules of evidence.

SECTION 6.7. Record of hearing.

No transcript is required to be kept of hearings before psychiatric treatment boards.

SECTION 6.8. Rights of family members.

A family member may file a motion for participation in the hearing. The Psychiatric Treatment Board may approve the preliminary motion of such an individual to participate in the hearing upon a showing that the person has a substantial interest in the proceeding. If the board so approves, the family member may have the right to representation by counsel at his or her own expense, present evidence, cross-examine witnesses, and appeal.

ARTICLE 7

ASSISTED TREATMENT HEARING DISPOSITION

SECTION 7.1. Procedure after failure to comply with ordered evaluation.

If the respondent presents good and credible reason why he or she was not present for an ordered evaluation, the Psychiatric Treatment Board shall continue the proceeding and issue another order for examination. A hearing concerning an individual who fails to comply, without good reason, with a court’s evaluation order still shall proceed. At the conclusion of the argument of the parties, the board may either order the respondent released, into treatment, or continue the proceedings so that the respondent may be evaluated. An individual’s refusal, without good reason, to comply with an evaluation order may be used as evidence of his or her need for treatment and incapability of making an informed medical decision. If a continuance is ordered, the respondent shall be placed in a designated psychiatric facility and evaluated by a treating professional. The continuance shall be for no more than seventy-two (72) hours or, if this period ends on a Saturday, Sunday or holiday, until the end of the next day on which the court is open.

SECTION 7.2. Consent order.

At the hearing, the petitioner and respondent may proffer a mutually agreed upon proposed assisted treatment order. The terms of the order must be consistent with those of an initial order for assisted treatment made under this act. The proposed order must be accompanied by the testimony, which may be by affidavit, of a treating professional qualifying under Section 6.5 that the suggested order is clinically appropriate for the respondent. At its discretion, the court may enter the proposed order without a full hearing. Once entered, the consent order has the same effect as an assisted treatment order issued under Section 7.3.

SECTION 7.3. Criteria for assisted treatment order.

After reviewing the evidence presented at the hearing, the Psychiatric Treatment Board shall only order assisted treatment, which can be on either an inpatient or outpatient basis, if it finds the following by clear and convincing evidence:

(a) That the person has a severe psychiatric disorder;

(b) That the person is either a danger to himself or herself, a danger to others, gravely disabled, or chronically disabled; and

SECTION 7.4. Assisted treatment order.

An order for assisted treatment, for its duration, subordinates the individual’s right to refuse the administration of medication or other minor medical treatment to the Department of Mental Health, its designee, or any other medical provider obligated to care for the person by the Psychiatric Treatment Board in its order. The treatment setting shall be the least restrictive possible appropriate alternative. An initial assisted treatment order requiring inpatient placement may be for up to thirty (30) calendar days. An order for assisted treatment on an outpatient basis may be for up to one hundred eighty (180) calendar days.

SECTION 7.5. Services included in order for assisted outpatient treatment.

An initial assisted treatment order directing care on an outpatient basis must include provisions for intensive case management, assertive community treatment, or a program for assertive community treatment. The order also may require the patient make use of and care providers to supply any or all of the following categories of services to the individual:

(a) Medication;

(b) Periodic blood tests or urinalysis to determine compliance with treatment;

(d) Day or partial day programming activities;

(e) Educational and vocational training or activities;

(f) Alcohol or substance abuse treatment and counseling, and periodic tests for the presence of alcohol or illegal drugs for persons with a history of alcohol or substance abuse;

(g) Supervision of living arrangements; and

(h) Any other services prescribed to treat the person’s mental illness and to assist the person in living and functioning in the community, or to attempt to prevent a relapse or deterioration.

Any material modifications of the provisions of the assisted treatment order to which the patient does not agree must be approved by the court.

SECTION 7.6. Effect of assisted treatment determination on other rights.

The determination that a person is in need of assisted treatment, either as an inpatient or outpatient, is not a determination that the patient is legally incompetent or incapacitated for any purpose other than those set out in this act.

ARTICLE 8

APPEALS

SECTION 8.1. Appeal or review of assisted treatment decision or status.

Except where specifically prohibited by this act, a decision of the Psychiatric Treatment Board may be appealed to an appropriate court of record within ten (10) calendar days of being entered. The hearing of an appeal is de novo and must be held within seven (7) calendar days of the filing of the appeal. The subject of the assisted treatment decision, the petitioner, and family members allowed as parties under Section 6.8 have the right to appeal. The court of record may review any information it finds relevant, material, and reliable, even if normally excluded under rules of evidence.

ARTICLE 9

SAFEGUARDS

SECTION 9.1. Thirty-day review for medication side effects.

Each patient in an inpatient treatment facility receiving medication under an assisted treatment order shall be examined every thirty (30) days for serious side effects by a psychiatrist or physician other than his or her treating psychiatrist.

SECTION 9.2. Recommendation for alternative appropriate treatment.

After an examination described in Section 9.1, a nontreating psychiatrist or other physician who determines, in his or her clinical judgment, that the patient has serious side effects from his or her current medication shall suggest, if available, an alternative appropriate treatment that will have fewer side effects. The treating psychiatric professional shall either comply with this recommendation or bring the nontreating psychiatrist or other physician’s written version of it to the facility’s medical director, who shall then determine the patient’s treatment. If the treating psychiatrist is the facility’s medical director, the final decision shall be made by a medical professional generally appointed for this purpose by the Department of Mental Health or its designee.

SECTION 9.3. Grievance procedure.

There shall be a one-step grievance procedure made available to patients on inpatient status. Grievances concerning treatment may be made to the medical director of each inpatient facility. Grievances about a patient’s treatment regimen may be brought by the patient or on the patient’s behalf by his or her legal guardian or conservator; his or her patient advocate; any party at a hearing for the institution of or renewal of assisted treatment; or his or her spouse, parent, adult child or, if there is no relative of that degree, his or her closest living relative. The grievance of a patient whose treating psychiatrist is the facility’s medical director shall be ruled on by a medical professional generally appointed for this purpose by the Department of Mental Health or its designee.

SECTION 9.4. Appeal of grievance to Psychiatric Treatment Board.

Grievances that are disallowed may be appealed to the Psychiatric Treatment Board, which shall hear the appeal within fourteen (14) calendar days. All rulings on appeals of grievances by the board are final. If the appeal of a grievance is denied, the patient it was brought either by or for is barred from appealing, and others from doing so on his or her behalf, any other grievances to the board for a period of ninety (90) days. This limitation of appeal does not otherwise alter the patient’s right to bring grievances in accordance with the provisions of Section 9.3.

ARTICLE 10

ASSISTED OUTPATIENT TREATMENT

SECTION 10.1. Enforcement of assisted outpatient treatment order.

An assisted outpatient treatment order’s requirement to maintain treatment can be enforced for noncompliance. On the signature of a supervising psychiatrist, the order may be enforced either at the patient’s residence or a treatment center designated by the Department of Mental Health or its designee, whichever the patient chooses. Patients who physically resist or fail to select a treatment location shall be treated at a designated treatment center.

SECTION 10.2. Transfer to inpatient care.

The procedures used to determine whether a patient under an assisted treatment order who is on outpatient status should be placed in inpatient care are the same as those for initial placement in assisted treatment. A patient who meets the criteria for emergency treatment shall immediately be given care in an inpatient facility, but a hearing is still necessary to confirm this transfer to inpatient status. At the hearing, the Psychiatric Treatment Board shall order the patient’s transfer to or continued placement in inpatient care, depending on his or her status pending the hearing, if the treatment setting is the least restrictive form that will meet the patient’s clinical needs. A patient’s failure to comply with an order for assisted treatment while in the community may be used as evidence that outpatient placement is not an appropriate treatment setting for that individual.

ARTICLE 11

TRIAL RELEASE

SECTION 11.1. Authorization for trial release.

When appropriate, a treating physician may allow an inpatient under an assisted treatment order to receive care in the community by placing the patient on trial release. Trial release is subject to the patient’s condition and compliance with a treatment plan developed before his or her release. The care of a patient on trial release will continue to be supervised by the releasing hospital. The trial release period may last until the expiration of the order for assisted inpatient treatment. The trial release period may not be extended. If appropriate, before the expiration of the trial release period, a petition should be filed requesting the renewal of the assisted treatment order and that the patient be placed on outpatient status.

SECTION 11.2. Notice of trial release.

Notice of a patient being placed on a trial release anticipated to exceed seventy-two (72) hours shall be mailed at least seventy-two (72) hours in advance by the patient’s inpatient facility to the petitioner; patient’s legal guardian or conservator, if known; patient’s counsel, if known; an adult member of the patient’s household, if known; and anyone recognized as a party at the initial assisted treatment hearing or any later renewal hearings.

SECTION 11.3. Revocation of trial release.

A treating psychiatrist shall revoke a patient’s trial release if he or she makes the determination that the patient has either substantially violated the conditions of his or her release or is in need of inpatient care. There is no hearing necessary to revoke trial release. After determining a patient should be removed from trial release, the treating psychiatrist may direct either law enforcement officers with the power of arrest or others who have been designated to perform this function by the state, county or Department of Mental Health to return the patient to the releasing hospital.

ARTICLE 12

REVIEW OF STATUS

SECTION 12.1. Request for review of assisted treatment status.

If the time for appeal of his or her most recent assisted treatment order or renewal has expired, a patient may request a review of his or her assisted treatment status by the Psychiatric Treatment Board. The board must review the request within fourteen (14) calendar days. A patient may request a review of status hearing no more than once every ninety (90) days.

SECTION 12.2. Notice of status review hearing.

Notice of the status review hearing shall be mailed at least seven (7) calendar days in advance to the patient; patient’s legal guardian or conservator, if known; patient’s counsel, if known; an adult member of the patient’s household, if known; and anyone recognized as a party at the initial assisted treatment hearing or any later renewal hearings. Timely actual notice shall fulfill the notice requirement for any given individual.

ARTICLE 13

RENEWALS

SECTION 13.1. Renewal of assisted treatment order.

The process for renewing an assisted treatment order is the same as for the application for an original assisted treatment order by petition, except that notice of the renewal hearing, as provided in Section 5.5, also shall be sent to anyone recognized as a party at the initial assisted treatment hearing or any later renewal hearings.

SECTION 13.2. Duration of renewal period.

The first renewal for an assisted inpatient treatment period may last up to one hundred eighty (180) days and later renewals up to three hundred sixty (360) days thereafter. A later renewal for an assisted outpatient treatment period may last up to three hundred sixty (360) days.

ARTICLE 14

PROCEDURES FOR DISCHARGE

SECTION 14.1. Discharge prior to the expiration of assisted treatment period.

A patient in assisted inpatient treatment or on trial release may be discharged on the signature of both the treating medical professional and the medical director of the facility. A patient under an assisted treatment order who is on outpatient status may be discharged on the signature of the treating medical professional and the director of the outpatient program.

SECTION 14.2. Notice of discharge.

Notice of discharge from an assisted treatment order shall be mailed at least seventy-two (72) hours before the planned discharge to the petitioner; patient’s legal guardian or conservator, if known; patient’s counsel, if known; an adult member of the patient’s household, if known; and anyone recognized as a party at the initial assisted treatment hearing or any later renewal hearings.

SECTION 14.3. Discharge plan requirement.

Any patient placed on assisted treatment must be given a treatment plan at the time of discharge from inpatient care or an outpatient program or when placed on trial release for a period anticipated being greater than seventy-two (72) hours. A treatment plan may include, but is not limited to suggested medication; individual or group therapy; day or partial day programming activities; services and training, including educational and vocational activities; residential supervision; intensive case management services; and living arrangements.

SECTION 14.4. Early discharge hearing.

A hearing before the Psychiatric Treatment Board to determine the appropriateness of the discharge of a patient before the expiration of his or her assisted treatment period may be demanded as a matter of right by the petitioner; the patient’s legal guardian or conservator, if known; an adult member of the patient’s household, if known; and anyone recognized as a party at the initial assisted treatment hearing or any later renewal hearings.

ARTICLE 15

ACCOUNTABILITY

SECTION 15.1. Treatment provider liability.

In addition to other limitations on liability provided by state law, persons providing care to patients placed in assisted treatment under this act only shall be liable for harm later caused by or to individuals who are either discharged from assisted treatment, placed on outpatient status, or given trial release if the discharge or placement of the individual was not within the scope of the person’s employment, or was reckless or grossly negligent.

ARTICLE 16

PATIENT BILL OF RIGHTS

SECTION 16.1. Rights of all individuals in assisted treatment.

All patients placed in assisted treatment under this act shall have the following rights:

(a) The right to appointed counsel at the initial assisted treatment hearing, reviews of status, later renewal hearings of orders for assisted treatment, and appeals of these proceedings.

(b) The right for the patient and his or her legal guardian or conservator, if known, to receive a written list of all rights enumerated in this act.

(c) The right to appropriate treatment, which shall be administered skillfully, safely, and humanely. Each patient placed in assisted treatment under this act shall receive treatment suited to his or her needs, which shall include such medical, vocational, social, educational, and rehabilitative services as the patient’s condition requires.

(d) The right at all times to be treated with consideration and respect for his or her privacy and dignity.

SECTION 16.2. Additional rights of individuals in assisted inpatient treatment.

In addition to those guaranteed in Section 16.1, patients placed in assisted inpatient treatment shall have the following rights:

(a) The right to have preserved and safeguarded his or her personal property.

(b) The right to communicate freely with and be visited at reasonable times by his or her legal counsel or advocate and, unless prior court restriction has been obtained, to communicate freely with and be visited at reasonable times by his or her personal physician or psychologist.

(c) The right to communicate freely with others, unless specifically restricted in the patient's treatment plan because that communication is likely to be harmful to the patient or others.

(d) The right to receive visitors at reasonable times, unless specifically restricted in the patient's treatment plan because the contact is likely to be harmful to the patient or others.

(e) The right to have reasonable access to telephones, and to make and receive confidential calls, unless specifically restricted in the patient's treatment plan because that communication is likely to be harmful to the patient or others. This shall include a reasonable number of free calls if the patient is unable to pay for them and assistance in calling if requested and needed.

(f) The right to have ready access to letter writing materials, unless specifically restricted in the patient's treatment plan because that communication is likely to be harmful to the patient or others. This shall include, if the patient is unable to pay for them, a reasonable number of stamps without cost, the right to mail and receive unopened correspondence, and assistance in writing if requested and needed.

(g) The right to be provided with an adequate allotment of neat, clean, and seasonable clothing.

(h) The right to maintain personal appearance according to the patient’s personal taste, including head and body hair, unless inconsistent with health and safety.

(i) The right to keep and spend a reasonable sum of his or her own money for expenses and small purchases.

(j) The right to vote if otherwise eligible to do so. Voter registration forms, applications for absentee ballots, and absentee ballots shall be made available to patients.

SECTION 17. If there is any conflict between the provisions of this act and any other provisions of law, the provisions of this act shall control to the extent of the conflict.

SECTION 18. This act shall take effect and be in force from and after July 1, 2005.