LAW ENFORCEMENT TRAINING

1. LAW ENFORCEMENT TRAINING Highlights and Points of Emphasis for Chapter 51 and 55 Issues December 7, 2010

2. GOING TO ED! -This presentation focuses on situations where the decision to initiate an Emergency Detention has been made -Assumes that LEO has already determined to commence the Chapter 51 or Chapter 55 detention -We will discuss when to detain and not detain later in the week!

3. THE BASICS -Subject has to be Mentally Ill, Developmentally Disabled or Drug Dependent -Subject has to be Dangerous -Subject has to be Treatable

4. DANGEROUSNESS • Danger to Self or Others due to threats, acts attempts to harm self or others -Ask “others” if they were in fear for safety • Dangerous because Judgment is impaired and causing Subject to unintentionally do dangerous things • Unable to care for self and provide for basic needs

5. SUBJECT AS WITNESS -Ask the Subject LOTS and LOTS and LOTS of questions! -Admissions regarding threats, attempts to harm self or others -Previous or current Mental Health treatment and medications -Anything the Subject tells you can come into evidence by LEO testimony

6. ADDITION TO 51.20(2) Current state of law requires that approval be obtained from the WCDHHS before the ED can move forward 51.15(2) reads that Detention can only occur if the County Department in the County in which the individual was taken into custody approves the need for Detention

8. APPROVAL PROCEDURE -Call made to Charge Nurse at MHC -Briefly explain the facts and circumstances -Charge Nurse will likely approve Detention -Then ask: 1) Whether medical clearance is required 2) Whether the MHC has a bed available

9. IF NO INITIAL APPROVAL If the Charge Nurse will not initially approve the Detention, then: • Ask Charge Nurse to reconsider • Ask Charge Nurse to consult with Psychiatrist on call—Charge Nurse will be trained to do this before denying the request. • Ask Charge Nurse to consult with Corporation Counsel Attorney on call

10. IF NO ULTIMATE APPROVAL If Charge Nurse will not ultimately approve the Detention, consult with your Shift Supervisor, who may recommend one of the following: • Arranging for voluntary treatment • Release to a responsible family member • Arrest, if applicable • Return to point of origin in community • Refer family to Corp. Counsel for possible 3-party Petition

11. MEDICAL CLEARANCE Three Possibilities: • No Medical Clearance needed • Need Clearance, but no ADMISSION to medical clearance facility • Subject must be ADMITTED to medical facility for clearance/treatment

12. NO CLEARANCE NECESSARY If No Medical Clearance Necessary: • Transport to MHC or other facility as directed by the MHC • Deliver Subject to that facility • That facility is the facility that should be indicated on the Emergency Detention Paperwork

13. CLEARANCE, NO ADMISSION If Medical Clearance Needed, But Subject Not Admitted to Medical Clearance Facility: • Remain with Subject at medical clearance facility • When medical clearance is complete, transport Subject to MHC or other facility as directed by MHC • The MHC or other ED facility is the facility indicated on the Emergency Detention Paperwork

14. ADMISSION FOR MEDICAL TX If Subject Must Be ADMITTED For Medical Clearance or Treatment: • Fill out Medical Police Hold form and Hospital’s form • Complete 51 paperwork with medical facility as receiving facility • When notified that Subject is cleared, call MHC Charge Nurse to determine receiving facility for 51Detention

15. MEDICAL HOLD FORM

16. “CRIMINAL” HOLDS Subject may have police hold arising out of the 51 ED or a previous matter: • Determine if there are any holds for Probation, other charges, warrants, etc. • If any holds exist, fill out the “Criminal Hold” form in the packet • Indicate any holds clearly in paperwork • Failure to follow may cause release!

17. CRIMINAL HOLD FORM

18. DETAINING FACILITY—A REVIEW Remember: Key is ADMISSION!!! -If Subject is ADMITTED for medical treatment/clearance, that date/time/place of that Admission goes on the 51 ED -If Subject is treated at but not Admitted to the medical treatment facility, the date/time/place of Admission to the Mental Health Facility goes on the ED

19. 51.45 ALCOHOL DETENTIONS Procedure Is Much The Same: -Medical Clearance issue is the same -Criminal Hold issue is the same Two Main Differences: • No approval for Detention • No prospect of PC Hearing

20. CH. 55 LAW AND DETENTION -55.12(2) reads that Protective Placement may not be made to units for the acutely Mentally Ill -We used to be able, for a limited period of time, to admit Subjects under Chapter 55 to psychiatric units or facilities…not any more!

21. 55 PROCEDURE Again, Much Is The Same as a 51: -Medical Clearance issue is the same -Criminal Hold issue is the same

22. NO 55 “APPROVAL” Like 51.45s, there is no requirement in the 55 law that the WCDHHS “approve” Detentions…but, there is a catch—which we will talk about in a second.

23. RECEIVING FACILITY FOR 55’S -It will almost always be WMH, I have never known of a 55 EPP to go elsewhere because they are going to a medical floor -Call WMH, if they will not admit— -Subject can then be admitted to the nearest medical hospital that will accept them -WMH has not turned down a Chapter 55 admission in at least 15 years!!!

24. DIRECTION FROM FACILITYDo a 51 or a 55? -Key to give facility all information when calling to check availability of bed -Facility will give you direction on whether to initiate a 51 or a 55 -If Subject is combative or otherwise needs care on psychiatric unit, YOU CANNOT DO A 55! -If ED began as a 55 but Subject now needs a 51, you must do the 51

25. KEEP IN MIND -No approval for Detention necessary in a 55—but if the matter ultimately must go forward as a 51, you must follow that procedure…including getting approval from the MHC Charge Nurse for Detention

26. THANK YOU!!! Thank you all for coming and listening. Please feel free to call me at 262-548-7432 with questions or concerns. Want copies of the outlines that were handed out today, you can get them at: www.waukeshacounty.gov