MISSISSIPPI LEGISLATURE
2013 Regular Session
To: Public Health and Human Services
By: Representatives Currie, Boyd, Carpenter, Monsour
AN ACT TO AMEND SECTIONS 41-21-61, 41-21-67, 41-21-131, 41-21-133, 41-21-135, 41-21-137, 41-21-139, 41-21-141 AND 41-21-143, MISSISSIPPI CODE OF 1972, TO REVISE VARIOUS PROVISIONS OF THE LAWS PROVIDING FOR CRISIS INTERVENTION TEAMS; 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) "Person with mental illness" 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. "Person with mental illness" 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. "Person with mental illness" does not include a person having only one or more of the following conditions: (1) epilepsy, (2) an intellectual disability, (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) "Person with an intellectual disability" 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 (2) 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 having an intellectual disability 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 persons with mental illness, persons with an intellectual disability or chemically dependent persons.
(j) "Substantial
likelihood of * * *
physical 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. The order may provide where the person shall be held prior to the appearance before the clerk or chancellor. 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. However, 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 State 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 the respondent does not have an attorney, the clerk shall immediately notify the chancellor of that fact. If the chancellor determines that the 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 licensed medical facility for evaluation by a physician, nurse practitioner
or physician assistant and that a peace officer transport the respondent to the
specified facility. * * * If the
person evaluating the respondent finds that the respondent is mentally ill and
in need of treatment, the chancellor may order that the respondent be retained
at the licensed medical facility or any other available suitable location as
the court may so designate pending an admission hearing. If necessary, the
chancellor may order a peace officer or other person to transport the
respondent to that facility or suitable location. Any respondent so retained
may be given such treatment as is indicated by standard medical practice.
However, the respondent shall not be held in a hospital operated directly by
the State 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 psychologist,
nurse practitioner or physician assistant who is certified to complete
examinations for the purpose of commitment or a licensed physician 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, psychologist, nurse practitioner or physician assistant may hold the
person or 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. However, if the seventy-two-hour period begins or ends 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 * * * stabilization unit.
The physician or psychologist, nurse practitioner or physician assistant 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 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. Section 41-21-131, Mississippi Code of 1972, is amended as follows:
41-21-131. As used in Sections 41-21-131 through 41-21-143, the following terms shall have the meanings as defined 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 has 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" or "CIT 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 physical 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 or a person who has an impairment caused by drugs or alcohol 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 or a person who has an impairment caused by drugs or alcohol 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 used 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 State Board of Nursing, has successfully passed either the adult or family psychiatric nurse practitioner examination and is licensed by the State Board of Nursing to work under the supervision of a physician at a single point of entry following protocols approved by the State Board of Nursing.
(l) "Psychiatric
physician assistant" means a physician assistant who has completed the
educational requirements and passed the certification examination as specified
in Section 73-26-3, is licensed by the State Board of Medical Licensure, has
had at least * * * two (2) years' expericence in the practice of psychiatry,
and is working under the supervision of a physician at a single point of entry.
SECTION 4. Section 41-21-133, Mississippi Code of 1972, is amended as follows:
41-21-133. (1) Any law
enforcement agency * * *, as a participating partner with a
community mental health center and a hospital, is authorized to establish a
Crisis Intervention * * * Team
to provide for psychiatric emergency services and triage and referral services
for persons who are with substantial likelihood of physical harm as a
more humane alternative to confinement in a jail.
(2) A Crisis Intervention
Team shall have one (1) or more designated hospitals within the specified
catchment area that has agreed to serve as a single point of entry and to
provide psychiatric emergency services, triage and referral services and other
appropriate medical services for persons in custody of a CIT officer * * *.
(3) Any hospital, as a
participating partner and serving as a single point of entry, is authorized to
establish a comprehensive psychiatric emergency service to provide psychiatric
emergency services to a person with mental illness or an impairment caused by
drugs or alcohol for a period of time greater than allowed in a hospital
emergency department when, in the opinion of the treating physician,
psychiatric nurse practitioner or psychiatric physician assistant, 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 * * *
stabilization
unit or state psychiatric hospital.
(4) Two (2) or more * * * law enforcement
agencies may jointly enter into collaborative agreements with a
community mental health center and a hospital to provide a Crisis
Intervention * * * Team.
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 Team * * *Teams and comprehensive psychiatric emergency services authorized under
Sections 41‑21‑131 through 41‑21‑143. 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 will facilitate the
development of those programs.
SECTION 5. Section 41-21-135, Mississippi Code of 1972, is amended as follows:
41-21-135. (1) Community mental health centers shall have oversight of Crisis Intervention Teams operating within their service areas. Proposals for Crisis Intervention Teams shall 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.
(2) 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 * * * physical harm.
(3) 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 of law enforcement training, before authorizing operation of the plan. Those generally accepted standards for law enforcement training shall be verified by the State Department of Mental Health.
(4) 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.
(5) 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 may be evaluated and addressed and provide for the inclusion of consumer representatives in that process.
SECTION 6. Section 41-21-137, Mississippi Code of 1972, is amended as follows:
41-21-137. (1) 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 * * * and other state and federal
agencies that have regulatory authority over hospitals. All collaborative
agreements must be in compliance with these governing authorities.
(2) 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 will assure that the services provided are within the guidelines established by the collaborative agreements.
(3) Notwithstanding any other provision of law, nothing in Sections 41-21-131 through 41-21-143 shall be interpreted to create an entitlement for any individual to receive psychiatric emergency services at a single point of entry.
SECTION 7. Section 41-21-139, Mississippi Code of 1972, is amended as follows:
41-21-139. (1) If a CIT
officer determines that a person is with substantial likelihood of * * *
physical 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.
(2) 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.
(3) A CIT officer acting in
good faith in connection with the detention of a person believed to be with
substantial likelihood of * * * physical harm shall incur no
liability, civil or criminal, for those acts.
(4) 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.
(5) Any person transported
by a CIT officer to the single point of entry * * * shall be
examined by a physician, psychiatric nurse practitioner or psychiatric
physician assistant. If the person does not consent to voluntary evaluation
and treatment, and the examiner determines that the person is a mentally ill
person, 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 and psychiatric physician assistants
employed by the single point of entry, including protection from liability, as
provided in this section, when acting in good faith. If the examiner determines
that the person is with substantial likelihood of * * * physical harm because of
impairment caused by drugs or alcohol and determines that there is no
reasonable, less-restrictive alternative, the person may be held at the single
point of entry until the impairment has resolved and the person is no longer
with substantial likelihood of * * * physical harm. Persons acting in
good faith in connection with the detention of a person with impairment caused
by drugs or alcohol shall incur no liability, civil or criminal, for those
acts.
SECTION 8. Section 41-21-141, Mississippi Code of 1972, is amended as follows:
41-21-141. (1) To be eligible to implement a comprehensive psychiatric emergency service, a hospital must either (a) have a collaborative agreement with a community mental health center to evaluate and, if necessary, admit persons who are experiencing a mental health crisis and are within the community mental health center's catchment area, or (b) have a collaborative agreement with a law enforcement agency and community mental health center to serve as a single point of entry for persons within the catchment area of the law enforcement agency, as provided for in Sections 41-21-131 through 41-21-139.
( * * *2) To implement a comprehensive
psychiatric emergency service, * * *the hospital 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.
( * * *3) If 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, the
department 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.
( * * *4) Each comprehensive psychiatric
emergency service shall provide or contract to provide qualified physicians,
psychiatric nurse practitioners, psychiatric physician assistants and ancillary
personnel necessary to provide services twenty-four (24) hours per day, seven
(7) days per week.
( * * *5) A comprehensive psychiatric
emergency service shall have at least one (1) physician, psychiatric nurse
practitioner or psychiatric physician assistant, 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, psychiatric nurse practitioner or psychiatric physician assistant on
call for the comprehensive psychiatric emergency service to evaluate the person
onsite within thirty (30) minutes of notification that the person has arrived.
( * * *6) 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.
SECTION 9. Section 41-21-143, Mississippi Code of 1972, is amended as follows:
41-21-143. (1) Community
mental health center directors shall actively encourage hospitals to develop
comprehensive psychiatric emergency services to serve the catchment area of
the community mental health center and/or to serve as a single point of entry
for a Crisis Intervention Team. * * *
(2) 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 those programs.
(3) State colleges and universities 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.
SECTION 10. This act shall take effect and be in force from and after July 1, 2013.