INVOLUNTARY MENTAL HEALTH COMMITMENTS

1. INVOLUNTARY MENTAL HEALTH COMMITMENTS Lisa Granberry Corbett Angel Gray Assistant Attorneys General John Aldridge Special Deputy Attorney General

2. INVOLUNTARY COMMITMENT PROCESS Can be initiated by: An officer A third party Physician or eligible psychologist Special emergency procedures

3. REASONS TO USE INVOLUNTARY PROCESS • Criteria are mentally ill and • Dangerous to self or others • OR is a substance abuser and • Dangerous to self or others. • Can use involuntary out patient procedure for persons who do not follow up voluntarily with out patient treatment.

4. DANGER TO SELF • Within the relevant past the individual has acted to show: • (1) that he/she would be unable, without care, supervision, and the continued assistance of others not otherwise available, to exercise appropriate self-control, judgment, and discretion in the conduct of his/her daily responsibilities or to satisfy his need for Nourishment, personal or medical care, shelter or self-protection and safety; AND

5. DANGER TO SELF • (2) That there is a reasonable probability of his suffering serious physical debilitation within the near future unless adequate treatment is given. A showing of behavior that is grossly irrational, or actions that the individual is unable to control, of behavior that is grossly inappropriate to the situation, or other evidence of severely impaired insight and judgment; OR

6. DANGER TO SELF • The individual has attempted suicide or threatened suicide and that there is a reasonable probability of suicide unless adequate treatment is given; OR • The individual has mutilated himself or attempted to mutilate himself and that there is a reasonable probability of serious self-mutilation unless adequate treatment is given

7. DANGER TO OTHERS • Within the relevant past, the individual has: • Inflicted or attempted to inflict or threatened to inflict serious bodily harm on another; or • Acted in such a way as to create a substantial risk of serious bodily harm to another; or • Engaged in extreme destruction of property; • AND • There is reasonable probability that this conduct will be repeated

8. INVOLUNTARY COMMITMENTPROCEDURES • Petition is taken by any person who has knowledge that a person is mentally ill and dangerous to self or others, or • Is a substance abuser and is a danger to self or others. • Mental retardation is no longer a criteria for commitment. • Petition is usually filled out at magistrate’s office or clerk of court’s office, and is sworn to. • NOTE: Physician or eligible psychologist petitioner can have petition notarized and faxed to magistrate for issuance of custody order.

9. INVOLUNTARY COMMITMENTPROCEDURES • Magistrate issues custody order to have law enforcement transport patient to an area facility for evaluation, or to any physician locally available. It is the custody order that authorizes law enforcement to take respondent into custody and transport. • Custody order must be served within 24 hours of issuance. Times must be noted on papers. • First evaluator has 24 hours to evaluate after presentation to the facility. It is important for law enforcement officer to note time of presentation to facility for examination.

10. The law enforcement officer should stay with the respondent until he determines that a physician or eligible psychologist is available to conduct the examination. It is also recommended that the law enforcement officer ensure that the respondent is left under appropriate supervision. Factors for appropriate supervision include: Whether respondent appears violent, or has a history of violence, type of facility (secure?) and personnel available to supervise.

11. FIRST EXAMINATION • First evaluator can stop the process and release respondent. Law enforcement officer returns respondent to home. • If criteria for inpatient are met, law enforcement takes patient to 24 hour facility. Law enforcement officer does not have to stay with the client once he delivers to a responsible person at the 24 hour facility. • Evaluator has 24 hours after presentation at the 24 hour facility to evaluate in second examination. • Patient can be released at this step as well and is returned home via law enforcement.

12. Some exceptions • This first examination is not required if the affiant who obtained the custody order is a physician or eligible psychologist who recommends inpatient commitment (The affiant should fill the evaluation form out in these cases) • The first examination is also not required if the respondent is sent to the 24 hour facility on a special order as incapable to proceed and charged with a violent crime. (Also known as HB 95)

13. EMERGENCY PROCEDURE • N.C.G.S. Section 122C-262 • Anyone, including a law enforcement officer, who has knowledge of an individual who is subject to inpatient commitment and who requires immediate hospitalization to prevent harm to self or others, may transport the individual directly to an area facility or other place, including a State facility for the mentally ill, for examination by a physician or eligible psychologist

14. EMERGENCY PROCEDURE • Upon examination by the physician or eligible psychologist, if the individual meets inpatient criteria, the physician or eligible psychologist shall so certify in writing before any official authorized to administer oaths • NOTE: If the physician or eligible psychologist executes the oath, appearance before a magistrate shall be waived. The physician or eligible psychologist shall send a copy of this certificate to the clerk of superior court by the most reliable and expeditious means

15. Emergency Procedure • The emergency certificate acts as the custody order, and law enforcement transports respondent to a 24 hour facility. • DMH form 5-72-01A • The physician or eligible psychologist that signed the emergency certificate usually fills out the first evaluation, another community evaluation is not required.

16. EMERGENCY PROCEDURE • Respondents received at a 24-hour facility under this statute shall be examined by a second physician • After receipt of notification that the district court has determined reasonable grounds for this commitment, further proceedings shall be carried out in the same way as for all other respondents

17. Special emergency procedureSubstance Abusers • NCGS 122C-282 Special emergency procedure for violent individuals • Individual must meet commitment criteria of substance abuser and dangerous to self or others • Must also be violent and require restraint • Delaying taking individual to a physician or eligible psychologist would likely endanger life or property

18. Emergency substance abuse • Law enforcement officer can take individual into custody and take him before a magistrate or clerk, and swear that the person meets above criteria. • AOC form AOC –SP-909M • The Clerk or Magistrate must find by clear, cogent and convincing evidence respondent meets criteria. • Orders respondent directly to a designated 24 hour facility

19. ENTERING PRIVATE PREMISES • A law enforcement officer may enter private premises in any of the following three situations to take a respondent into custody pursuant to a custody order.

20. First—Same Circumstances as an Arrest Warrant • Probable cause to believe person to be taken into custody is on premises • Have given or made reasonable effort to give occupant notice of the officer’s presence • Have signed custody order in officer’s possession

21. Second—NCGS § 15A-285 • An officer may enter buildings, vehicles, and other premises if he reasonably believes that doing so is urgently necessary to save a life, prevent serious bodily harm, or avert or control a public catastrophe.

22. Third--Consent • An officer may enter private premises when consent is given by an appropriate resident.

23. TRANSPORTATION • Obtaining the initial exam • Transporting the respondent from the initial exam • Transporting the respondent to and from a 24-hour facility

24. Initial Exam • NCGS § 122C-263—after taking respondent into custody, the officer must transport the respondent to an area facility “without unnecessary delay.” • If physician or eligible psychologist not available at area facility, take respondent to “any physician or eligible psychologist locally available.”

25. Remaining with Respondent • Law enforcement officer must stay with respondent until it is determined that a physician or psychologist is available to conduct the exam • Before leaving a respondent officer should ensure that respondent is left under appropriate supervision.

26. Appropriate Supervision—Factors to Consider • Whether respondent appears violent • Whether respondent has a history of violence • The type of facility where respondent is being examined • Personnel available to supervise respondent • Use your best judgment

27. Transportation after initial exam • Inpatient commitment recommended • Law enforcement agency designated in the custody order is responsible for transporting the respondent to a 24-hour facility. Outpatient recommended • Law enforcement agency designated in the custody order is responsible for returning respondent to either his residence or the home of a consenting third party.

28. No commitment recommended • NCGS § 122C-263 mandates that proceedings be terminated • Law enforcement agency designated in the custody order is responsible for returning respondent to either his residence or the home of a consenting third party. • Respondent shall be released from custody.

29. Transporting to and from 24 hour facility • Transporting within the county • Transporting outside the county

30. Inside the County • Law enforcement agency designated in the original custody order is responsible for transporting from the initial examination to the 24-hour facility if the facility is in the county. • If respondent lives in the city or is taken into custody in the city, the city is responsible. • If respondent lives in the county or is taken into custody in the county, the county is responsible.

31. Upon respondent’s release from a 24-hour facility: • The city has the duty to transport the respondent home if respondent lives inside the city limits, or was taken into custody inside the city limits. • Otherwise, the county is responsible for transporting the respondent home. • Cities and counties may contract with each other to provide these services. • Discharged respondent may use own transportation.

32. Outside the County • If respondent is transported to 24-hour facility in another county, the county where respondent was taken into custody is responsible for transportation. • When respondent is discharged from a 24-hour facility, transportation is provided by the county of residence of the respondent.

33. If respondent is denied admission at a 24-hour facility, transportation is by the agency designated in the custody order. • Respondent is returned to original county.

34. When is the sheriff responsible for transportation? • When designated in the original custody order. • When the respondent is a county resident or is taken into custody in the county. Sheriff responsible for transportation to and from the 24-hour facility. • When respondent must be taken to another county regardless of residence. • When a county resident is admitted to a 24-hour facility in another county, the sheriff is responsible for transportation upon discharge.

35. Legal Parameters • Individuals taken into custody under these laws have not committed a criminal offense. Law enforcement officers should advise respondents when taking them into custody that they are not under arrest, but are being transported to receive treatment for their own safety and the safety of others.

36. Legal Parameters • Amount of force • Gender of transport officers • Transportation costs

37. Amount of Force • In transporting a respondent pursuant to a commitment order, a law enforcement officer may use reasonable force to restrain the respondent if it appears necessary to protect the officer, respondent or others.

38. Gender • The transporting officer “shall”* be of the same sex as the respondent. • If not of the same sex, an attendant of the same sex should accompany the transporting officer. Not required to be a sworn officer. • It may be appropriate to allow a family member to accompany respondent. (*replaces “should”, per correction made by Angel Gray during presentation 08/24/09)

39. Transportation Costs • Costs and expenses of transporting a respondent to or from a 24-hour facility is the responsibility of the county of residence of the respondent. • State, city, or county that incurs transportation costs may recover the reasonable costs of transportation from the county of residence.

40. County of residence may recover reasonable costs that it pays to the state, city or county. The costs may be recovered from: • Respondent, if not indigent. • Person or entity legally responsible for respondent’s support. • Any person contractually responsible for the cost. • Any person or entity otherwise liable under federal, state or local law.

41. Questions?