House Bill 1049

(As Passed the House)

AN ACT TO AMEND SECTION 41-21-61, MISSISSIPPI CODE OF 1972, TO DEFINE THE TERM "SUBSTANTIAL LIKELIHOOD OF BODILY HARM" FOR THE PURPOSES OF THE COMMITMENT LAWS FOR PERSONS IN NEED OF MENTAL TREATMENT; TO AMEND SECTION 41-21-67, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE SEVENTY-TWO-HOUR PERIOD FOR HOLDING PERSONS UNDER THE COMMITMENT LAWS MAY BE EXTENDED OR DISCONTINUED UNDER CERTAIN CONDITIONS; TO CREATE NEW SECTION 41-4-10, MISSISSIPPI CODE OF 1972, TO PROVIDE FOR IMPLEMENTATION OF CRISIS INTERVENTION TEAMS; TO PROVIDE THAT CRISIS INTERVENTION TEAMS BE OPERATED WITHIN LOCAL CATCHMENT AREAS SERVED BY CERTAIN LAW ENFORCEMENT AGENCIES; TO PROVIDE THAT ONLY ONE LICENSED MEDICAL FACILITY WILL SERVE AS A SINGLE POINT OF ENTRY FOR A CRISIS INTERVENTION TEAM CATCHMENT AREA; TO PROVIDE FOR LOCAL COMMUNITY MENTAL HEALTH CENTERS TO COORDINATE AND OVERSEE THE DEVELOPMENT OF CRISIS INTERVENTION TEAMS IN THE DISTRICT SERVED; TO AUTHORIZE CERTAIN TRAINED LAW ENFORCEMENT OFFICERS TO TAKE INTO CUSTODY PERSONS WITH SUBSTANTIAL LIKELIHOOD OF BODILY HARM FOR THE PURPOSE OF EMERGENCY TREATMENT IN A LICENSED MEDICAL FACILITY SERVING AS A SINGLE POINT OF ENTRY; TO EXEMPT LAW ENFORCEMENT OFFICERS FROM CIVIL AND CRIMINAL LIABILITY FOR DETAINING A MENTALLY ILL PERSON IN GOOD FAITH; TO AUTHORIZE CERTAIN LICENSED PSYCHIATRIC NURSE PRACTITIONERS TO HOLD A PATIENT FOR TREATMENT IN A LICENSED MEDICAL FACILITY SERVING AS A SINGLE POINT OF ENTRY; TO EXEMPT PSYCHIATRIC NURSE PRACTITIONERS FROM CIVIL AND CRIMINAL LIABILITY FOR DETAINING A MENTALLY ILL PERSON IN GOOD FAITH; TO PROVIDE FOR COMPREHENSIVE PSYCHIATRIC EMERGENCY SERVICES OPERATED BY A LICENSED MEDICAL FACILITY THAT IS SERVING AS THE SINGLE POINT OF ENTRY FOR A CRISIS INTERVENTION TEAM CATCHMENT AREA; TO REQUIRE THAT COMPREHENSIVE PSYCHIATRIC EMERGENCY SERVICES PROVIDE BEDS NEEDED FOR EXTENDED TREATMENT AND TO REQUIRE THAT THESE BEDS BE LICENSED BY THE STATE DEPARTMENT OF HEALTH; TO PROVIDE THAT A COMPREHENSIVE PSYCHIATRIC EMERGENCY SERVICE MAY PROVIDE TREATMENT OF A PERSON WITH MENTAL ILLNESS UP TO BUT NOT EXCEEDING SEVENTY-TWO HOURS; TO REQUIRE THAT THE STATE DEPARTMENT OF MENTAL HEALTH SHALL ENCOURAGE AND FACILITATE COMMUNITY MENTAL HEALTH CENTERS IN THE DEVELOPMENT OF CRISIS INTERVENTION TEAMS AND COMPREHENSIVE PSYCHIATRIC EMERGENCY SERVICES; TO ENCOURAGE COLLEGES AND UNIVERSITIES THAT HAVE CRIMINAL JUSTICE PROGRAMS TO COLLABORATE WITH LAW ENFORCEMENT AGENCIES IN TRAINING CRISIS INTERVENTION TEAM OFFICERS; AND FOR RELATED PURPOSES.

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

SECTION 1. Section 41-21-61, Mississippi Code of 1972, is amended as follows:

41-21-61. As used in Sections 41-21-61 through 41-21-107, unless the context otherwise requires, the following terms defined have the meanings ascribed to them:

(a) "Chancellor" means a chancellor or a special master in chancery.

(b) "Clerk" means the clerk of the chancery court.

(c) "Director" means the chief administrative officer of a treatment facility or other employee designated by him as his deputy.

(d) "Interested person" means an adult, including but not limited to, a public official, and the legal guardian, spouse, parent, legal counsel, adult, child next of kin, or other person designated by a proposed patient.

(e) "Mentally ill person" means any person who has a substantial psychiatric disorder of thought, mood, perception, orientation, or memory which grossly impairs judgment, behavior, capacity to recognize reality, or to reason or understand, which (i) is manifested by instances of grossly disturbed behavior or faulty perceptions; and (ii) poses a substantial likelihood of physical harm to himself or others as demonstrated by (A) a recent attempt or threat to physically harm himself or others, or (B) a failure to provide necessary food, clothing, shelter or medical care for himself, as a result of the impairment. "Mentally ill person" includes a person who, based on treatment history and other applicable psychiatric indicia, is in need of treatment in order to prevent further disability or deterioration which would predictably result in dangerousness to himself or others when his current mental illness limits or negates his ability to make an informed decision to seek or comply with recommended treatment. "Mentally ill person" does not include a person having only one or more of the following conditions: (1) epilepsy, (2) mental retardation, (3) brief periods of intoxication caused by alcohol or drugs, (4) dependence upon or addiction to any alcohol or drugs, or (5) senile dementia.

(f) "Mentally retarded person" means any person (i) who has been diagnosed as having substantial limitations in present functioning, manifested before age eighteen (18), characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure and work, and (ii) whose recent conduct is a result of mental retardation and poses a substantial likelihood of physical harm to himself or others in that there has been (A) a recent attempt or threat to physically harm himself or others, or (B) a failure and inability to provide necessary food, clothing, shelter, safety, or medical care for himself.

(g) "Physician" means any person licensed by the State of Mississippi to practice medicine in any of its branches.

(h) "Psychologist" when used in Sections 41-21-61 through 41-21-107, means a licensed psychologist who has been certified by the State Board of Psychological Examiners as qualified to perform examinations for the purpose of civil commitment.

(i) "Treatment facility" means a hospital, community mental health center, or other institution qualified to provide care and treatment for mentally ill, mentally retarded, or chemically dependent persons.

(j) "Substantial likelihood of bodily harm" means that:

(i) The person has threatened or attempted suicide or to inflict serious bodily harm to himself; or

(ii) The person has threatened or attempted homicide or other violent behavior; or

(iii) The person has placed others in reasonable fear of violent behavior and serious physical harm to them; or

(iv) The person is unable to avoid severe impairment or injury from specific risks; and

(v) There is substantial likelihood that serious harm will occur unless the person is placed under emergency treatment.

SECTION 2. Section 41-21-67, Mississippi Code of 1972, is amended as follows:

41-21-67. (1) Whenever the affidavit provided for in Section 41-21-65 is filed with the chancery clerk, the clerk, upon direction of the chancellor of the court, shall issue a writ directed to the sheriff of the proper county to take into his or her custody the person alleged to be in need of treatment and to bring the person before the clerk or chancellor, who shall order pre-evaluation screening and treatment by the appropriate community mental health center established under Section 41-19-31 and for examination as set forth in Section 41-21-69. However, when the affidavit fails to set forth factual allegations and witnesses sufficient to support the need for treatment, the chancellor shall refuse to direct issuance of the writ. Reapplication may be made to the chancellor. If a pauper's affidavit is filed by a guardian for commitment of the ward of the guardian, the court shall determine if the ward is a pauper and if the ward is determined to be a pauper, the county of the residence of the respondent shall bear the costs of commitment, unless funds for those purposes are made available by the state.

(2) Upon issuance of the writ, the chancellor shall immediately appoint and summon two (2) reputable, licensed physicians or one (1) reputable, licensed physician and either one (1) psychologist, nurse practitioner or physician assistant to conduct a physical and mental examination of the person at a place to be designated by the clerk or chancellor and to report their findings to the clerk or chancellor. Provided, however, that any nurse practitioner or physician assistant conducting the examination shall be independent from, and not under the supervision of, the other physician conducting the examination. In all counties in which there is a county health officer, the county health officer, if available, may be one (1) of the physicians so appointed. Neither of the physicians nor the psychologist, nurse practitioner or physician assistant selected shall be related to that person in any way, nor have any direct or indirect interest in the estate of that person nor shall any full-time staff of residential treatment facilities operated directly by the Department of Mental Health serve as examiner.

(3) The clerk shall ascertain whether the respondent is represented by an attorney, and if it is determined that respondent does not have an attorney, the clerk shall immediately notify the chancellor of that fact. If the chancellor determines that respondent for any reason does not have the services of an attorney, the chancellor shall immediately appoint an attorney for the respondent at the time the examiners are appointed.

(4) If the chancellor determines that there is probable cause to believe that the respondent is mentally ill and that there is no reasonable alternative to detention, the chancellor may order that the respondent be retained as an emergency patient at any available regional mental health facility or any other available suitable location as the court may so designate pending an admission hearing and may, if necessary, order a peace officer or other person to transport the respondent to that mental health facility or suitable location. Any respondent so retained may be given such treatment by a licensed physician as is indicated by standard medical practice. However, the respondent shall not be held in a hospital operated directly by the Department of Mental Health, and shall not be held in jail unless the court finds that there is no reasonable alternative.

(5) Whenever a licensed physician or psychologist certified to complete examinations for the purpose of commitment has reason to believe that a person poses an immediate substantial likelihood of physical harm to himself or others or is gravely disabled and unable to care for himself by virtue of mental illness, as defined in Section 41-21-61(e), then the physician or psychologist may hold the person or the physician may admit the person to and treat the person in a licensed medical facility, without a civil order or warrant for a period not to exceed seventy-two (72) hours or the end of the next business day of the chancery clerk's office. However, if the seventy-two-hour period begins when the chancery clerk's office is closed, or within three (3) hours of closing, and the chancery clerk's office will be continuously closed for a time that exceeds seventy-two (72) hours, then the seventy-two-hour period is extended until the end of the next business day that the chancery clerk's office is open. The person may be held and treated as an emergency patient at any licensed medical facility, available regional mental health facility, or crisis intervention center. The physician or psychologist who holds the person shall certify in writing the reasons for the need for holding. If a person is being held and treated in a licensed medical facility and that person decides to continue treatment by voluntarily signing consent for admission and treatment, the seventy-two-hour hold may be discontinued without filing an affidavit for commitment. Any respondent so held may be given such treatment by a licensed physician as indicated by standard medical practice. Persons acting in good faith in connection with the detention of a person believed to be mentally ill shall incur no liability, civil or criminal, for those acts.

     SECTION 3. The following shall be codified as Section
41—4—10, Mississippi Code of 1972:
     41—4—10. (1) As used in this section:
          (a) "Crisis intervention team" means a community partnership among a law enforcement agency, a community mental health center, a hospital, other mental health providers, consumers and family members of consumers.
          (b) "Participating partner" means a law enforcement agency, a community mental health center or a hospital that have each entered into collaborative agreements needed to implement a crisis intervention team.
          (c) "Catchment area" means a geographical area in which a crisis intervention team operates and is defined by the jurisdictional boundaries of the law enforcement agency that is the participating partner.
          (d) "Crisis intervention team officer" means a law enforcement officer who is authorized to make arrests under Section 99-3-1 and who is trained and certified in crisis intervention and who is working for a law enforcement agency that is a participating partner in a crisis intervention team.
          (e) "Substantial likelihood of bodily harm" means that:

(i) The person has threatened or attempted suicide or to inflict serious bodily harm to himself; or

(ii) The person has threatened or attempted homicide or other violent behavior; or

(iii) The person has placed others in reasonable fear of violent behavior and serious physical harm to them; or

(iv) The person is unable to avoid severe impairment or injury from specific risks; and

(v) There is substantial likelihood that serious harm will occur unless the person is placed under emergency treatment.

          (f) "Single point of entry" means a specific hospital that is the participating partner in a crisis intervention team and that has agreed to provide psychiatric emergency services and triage and referral services.
          (g) "Psychiatric emergency services" means services designed to reduce the acute psychiatric symptoms of a person who is mentally ill and, when possible, to stabilize that person so that continuing treatment can be provided in the local community.
          (h) "Triage and referral services" means services designed to provide evaluation of a person with mental illness in order to direct that person to a mental health facility or other mental health provider that can provide appropriate treatment.
          (i) "Comprehensive psychiatric emergency service" means a specialized psychiatric service, operated by the single point of entry and located in or near the hospital emergency department that can provide psychiatric emergency services for a period of time greater than can be provided in the hospital emergency department.
          (j) "Extended observation bed" means a hospital bed that is utilized by a comprehensive psychiatric emergency service and is licensed by the State Department of Health for that purpose.
          (k) "Psychiatric nurse practitioner" means a registered nurse who has completed the educational requirements specified by the Mississippi Board of Nursing, has successfully passed either the adult or family psychiatric nurse practitioner examination and is licensed by the Board of Nursing to work under the supervision of a physician at a single point of entry following protocols approved by the Board of Nursing.
     (2) The intent of the Legislature in establishing crisis intervention teams is to provide for psychiatric emergency services and triage and referral services for persons who are at substantial likelihood of bodily harm as a more humane alternative to confinement in a jail.
     (3) The intent of the Legislature in establishing a single point of entry is to require that a crisis intervention team have one (1) designated hospital within the specified catchment area that has agreed to provide psychiatric emergency services, triage and referral services and other appropriate medical services for persons in custody of a crisis intervention team officer (CIT officer) or referred by the community mental health center within the specified catchment area.
     (4) The intent of the Legislature in establishing comprehensive psychiatric emergency services is to provide psychiatric emergency services to a person with mental illness for a period of time greater than allowed in a hospital emergency department, when, in the opinion of the treating physician or psychiatric nurse practitioner, that person likely can be stabilized within seventy-two (72) hours so that continuing treatment can be provided in the local community rather than a crisis intervention center or state psychiatric hospital.
     (5) Community mental health centers shall have oversight of crisis intervention teams operating within their service area. Proposals for crisis intervention teams must include the necessary collaborative agreements among the community mental health center, a law enforcement agency and a hospital that will serve as the single point of entry for the crisis intervention team catchment area.
     (6) The collaborative agreements shall specify that the hospital acting as the single point of entry shall accept all persons who are in custody of a CIT officer operating within the catchment area, when custody has been taken because of substantial likelihood of bodily harm, and shall accept all persons with mental illness who are referred by the community mental health center serving the catchment area, when a qualified staff member of the community mental health center has evaluated the person and determined that the person needs acute psychiatric emergency services that are beyond the capability of the community mental health center.
     (7) The director of the community mental health center shall determine if all collaborative agreements address the needs of the proposed crisis intervention team, including generally accepted standards for law enforcement training, as specified by the State Department of Mental Health, before authorizing operation of the plan. Those generally accepted standards for law enforcement training shall be specified by the State Department of Mental Health.
     (8) If the director of the community mental health center has reason to believe that an authorized crisis intervention team is not operating in accordance with the collaborative agreements and within general acceptable guidelines and standards, the director has the authority to review the operation of the crisis intervention team and, if necessary, suspend operation until corrective measures are taken.
     (9) The director of the community mental health center shall establish a process by which complaints from the public regarding the operation of a crisis intervention team can be evaluated and addressed and provide for the inclusion of consumer representatives in that process.
     (10) The internal operation of a single point of entry shall be governed by the administration of the hospital and regulated by the State Department of Health, the Joint Commission on Accreditation of Healthcare Organizations and other state and federal agencies that have regulatory authority over hospitals. All collaborative agreements must be in compliance with these governing authorities.
     (11) Notwithstanding any other provision of law, nothing in this section shall be interpreted to create an entitlement for any individual to receive psychiatric emergency services at a single point of entry.
     (12) A hospital operating as a single point of entry for a crisis intervention team shall appoint a medical director to oversee the operation of the hospital-based service. The medical director shall assure that the services provided are within the guidelines established by collaborative agreements.
     (13) If a CIT officer determines that a person has a substantial likelihood of bodily harm, that officer may take the person into custody for the purpose of transporting the person to the designated single point of entry serving the catchment area in which the officer works. The CIT officer shall certify in writing the reasons for taking the person into custody.
     (14) A CIT officer shall have no further legal responsibility or other obligations once a person taken into custody has been transported and received at the single point of entry.
     (15) A CIT officer acting in good faith in connection with the detention of a person believed to have a substantial likelihood of bodily harm shall incur no liability, civil or criminal, for those acts.
     (16) Only CIT officers authorized to operate within a catchment area may bring persons in custody to the single point of entry for that catchment area. Law enforcement officers working outside the designated catchment area are not authorized to transport any person into the catchment area for the purpose of bringing that person to the single point of entry.
     (17) Any person transported by a CIT officer to the single point of entry or any person referred by the community mental health center following guidelines of the collaborative agreements shall be examined by a physician or psychiatric nurse practitioner. If the person does not consent to voluntary evaluation and treatment, and the examiner determines that the person has a mental illness, as defined in Section 41-21—61(e), the examiner shall then determine if that person can be held under the provisions of Section 41—21—67(5). All other provisions of Section 41-21-67(5) shall apply and be extended to include licensed psychiatric nurse practitioners employed by the single point of entry.
     (18) To implement a comprehensive psychiatric emergency service, a single point of entry must request licensure from the State Department of Health for the number of extended observation beds that are required to adequately serve the designated catchment area. A license for the requested beds must be obtained before beginning operation.
     (19) If the Executive Director of the State Department of Health determines that a comprehensive psychiatric emergency service can provide for the privacy and safety of all patients receiving services in the hospital, he or she may approve the location of one or more of the extended observation beds within another area of the hospital rather than in proximity to the emergency department.
     (20) Each comprehensive psychiatric emergency service shall provide or contract to provide qualified physicians, psychiatric nurse practitioners and ancillary personnel necessary to provide services twenty-four (24) hours per day, seven (7) days per week.      (21) A comprehensive psychiatric emergency service shall have at least one (1) physician or psychiatric nurse practitioner, who is a member of the staff of the hospital, on duty and available at all times. However, the medical director of the service may waive this requirement if provisions are made for a physician in the emergency department to assume responsibility and provide initial evaluation and treatment of a person in custody of a CIT officer or referred by the community mental health center and provisions are made for the physician or licensed psychiatric nurse practitioner on call for the comprehensive psychiatric emergency service to evaluate the person onsite within thirty (30) minutes of notification that the person has arrived.
     (22) Any person admitted to a comprehensive psychiatric emergency service must have a final disposition within a maximum of seventy—two (72) hours. If a person cannot be stabilized within seventy—two (72) hours, that person shall be transferred from an extended observation bed to a more appropriate inpatient unit.
     (23) Community mental health center directors shall actively encourage hospitals to develop comprehensive psychiatric emergency services. If a collaborative agreement can be negotiated with a hospital that can provide a comprehensive psychiatric emergency service, that hospital shall be given priority when designating the single point of entry.
     (24) The State Department of Mental Health shall encourage community mental health center directors to actively work with hospitals and law enforcement agencies to develop crisis intervention teams and comprehensive psychiatric emergency services and shall facilitate the development of these programs.
     (25) State universities and colleges that provide classes in criminal justice are encouraged to collaborate with law enforcement agencies to develop training guidelines and standards for CIT officers and to provide educational classes and continuing education programs by which CIT officers can earn continuing education credits.
     (26) For the purpose of addressing unique rural service delivery needs and conditions, the State Department of Mental Health may authorize two (2) or more community mental health centers to collaborate in the development of crisis intervention teams and comprehensive psychiatric emergency services and shall facilitate the development of these programs.

SECTION 4. This act shall take effect and be in force from and after July 1, 2010.