Mental Health Procedures Act

1. Mental Health Procedures Act

2. Mental Health Procedures Act of 1976 • Mental Health Procedures Act was established in 1976 in response to judicial decisions that indicated the commitment standards and procedures of MH/MR Act of 1966 were unconstitutional. • MHPA was passed to establish criteria and the required due process procedures for commitment. • Intent: to assure that severely mentally disabled individuals are provided the care they need for their own health and safety and the safety of others.

3. Mental Health Procedures Act • Treatment on a voluntary basis shall be preferred to involuntary treatment. • The least-restrictive setting with adequate treatment shall be employed. • MHPA applies to individuals with diagnoses of mental illness. It does not apply to individuals who have been diagnosed with mental retardation, dementia, or persons with substance abuse issues solely.

4. Voluntary Commitments 201 • Voluntary treatment is always preferred. • An individual may consent for a voluntary admission into his/her preferred facility as long as admission criteria are met. (i.e. danger to self, danger to others or inability to care for self) • There is no time limit for voluntary treatment. • Patients who voluntarily admit themselves for inpatient treatment must give the facility 72-hours notice before being discharged against physician’s recommendation. • If the treating physician believes the patient is still a danger to him/herself or others, he may petition for involuntary treatment (304C) during the 72-hour notice period. A hearing is held to determine if patient should be subject to involuntary treatment, either inpatient or outpatient.

5. What if they will not go voluntarily? • For individuals who will not seek voluntary treatment and can not be maintained safely in the community, involuntary inpatient treatment (302) is appropriate.

6. What is a 302? • A 302 petition is a civil warrant authorized by a County Delegate, Physician, or Police Officer to take an individual to the nearest emergency room for an immediate evaluation against his/her will due to concern of imminent danger. • A 302 petition guarantees that an individual will receive an emergency evaluation. It does not guarantee an admission to an inpatient unit and can be overturned by the evaluating doctor. A 302 petition does not expire, but can be voided by the County Delegate.

7. 302 Criteria • Specific criteria must be met in order for a 302 to be authorized. These include: • Clear and present danger to others shall be shown by establishing that within the last 30 days the person has inflicted or attempted to inflict serious bodily harm on another and there is reasonable probability that such conduct will be repeated. A clear and present danger of harm to others may be demonstrated by proof that the person has made threats of harm and has committed acts in furtherance of the threat to commit harm.

8. 302 Criteria continued: • The person has acted in such a manner as to evidence that he/she would be unable, without care, supervision and the continued assistance of others, to satisfy his/her need for nourishment, personal or medical care, shelter, or self-protection and safety, and that these is reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within 30 days unless adequate treatment were afforded under the act. • The person has attempted suicide and there is reasonable probability of suicide unless adequate treatment is afforded under this act. For the purpose of this subsection, a clear and present danger may be demonstrated by the proof that the person has made threats to commit suicide and has committed acts which are in furtherance of the threat to commit suicide. • The person has substantially mutilated himself/herself or attempted to mutilate himself/herself substantially and that there is the reasonable probability of mutilation unless adequate treatment is afforded under the act. A clear and present danger shall be established by proof that the person had made threats to commit mutilation and has committed acts which are in furtherance of the threat to commit mutilation.

9. How to obtain a 302 • Anyone who has witnessed the dangerous behaviors first hand or heard threats directly can petition for a 302. • Potential petitioners can contact Crisis Intervention Services at 724-775-5208 ext. 1 to inquire about petitioning a 302 with the County Delegate. • The County Delegate will review the potential petitioners concerns and discuss the intervention options. • If the County Delegate authorizes a 302 Transport Without Warrant due to immediate danger, Medic Rescue will be contacted to transport the individual to Heritage Valley Beaver ER for evaluation. The petitioner must follow the ambulance to the Emergency Room at HVB to fill out the 302 paperwork. If this is not done, the individual legally has the right to leave the ER without an evaluation.

10. How to obtain a 302 • A potential petitioner can also come directly to Crisis Intervention Services 7 days a week from 7am-10pm to inquire about petitioning a 302. They will meet with a County Delegate and fill out the 302 paperwork. From 10pm to 7am, potential petitioners will need to present to HVB ER to fill out 302 paperwork. • The Delegate will authorize the 302 if criteria are met and sign off on the 302 petition. • Once the 302 paperwork is authorized, the petitioner will then deliver the 302 paperwork directly to local police department who will serve it. Police will contact Medic Rescue for transport once the individual is located and secured.

11. What happens to the individual? • The individual is transported to Heritage Valley Beaver ER where he/she will be evaluated by a Psychiatric Nurse and a ER Physician. The ER Physician will determine whether or not the individual is in need of inpatient treatment. If the individual is intoxicated or under the influence of substances, the evaluation cannot be given until the individual is below legal limit or no longer intoxicated. • The individual will be given his/her rights by the ER staff and will have the opportunity to sign a 201(voluntary admission), if clinically appropriate. If the individual refuses a 201 and inpatient treatment is needed, then the individual will be admitted be against his/her will for up to 120 hours. • The ER Physician will evaluate the individual and consult with the attending Psychiatrist on the Psych Unit as needed. If it is determined that the individual is in need of inpatient treatment, he/she will be transferred to the psych unit at HVB or a inpatient unit of his/her choice. If the psych unit is at capacity the individual will be transported to another psych unit at the nearest available hospital.

12. What happens to the Patient? • The individual can be admitted to the Psychiatric Unit for up to 120 hours on the 302 commitment. • 303 commitment hearings are held Tuesday and Thursday mornings in which the individual, the 302 petitioner and the attending psychiatrist will testify in front of the Mental Health Review Officer to determine if extended treatment is needed. The individual has the right to legal representation. A public defender is available if he/she does not have their own legal representation. • After hearing the individual’s, the petitioner’s and attending psychiatrist’s testimony, the Mental Health Review Officer will make the final determination if extended treatment is necessary. He can extend the individual inpatient treatment for up to an additional 20 days.

13. PA Mental Health Procedures ACT 147Inpatient Treatment Process for a Non-consenting Minor (14-17) • Previously, if a minor (14-17) was unwilling to consent to voluntary inpatient treatment, an involuntary commitment (302) was needed. With the law change, however, if a minor does not consent to inpatient treatment but a parent or legal guardian does consent, you may proceed with treatment against the minor’s wishes without resorting to the involuntary commitment process. This parental consent includes transporting the minor by police or ambulance to the ER for a psychiatric evaluation. • If the minor is in need of inpatient psychiatric treatment, but refuses voluntary admission, an ER Physician must complete an ACT 147. • ACT 147 does not need to completed for a minor under the age of 14. A parent can consent for inpatient treatment without their consent. • Minor’s (14-17) can still consent to voluntary outpatient or inpatient treatment without parental consent.

14. What to consider before seeking a 302? • What are the criteria for a 302? • Evidence of Mental Illness • Current treatment or past history • Dangerous Behavior • A Probability of Continuance or Recurrence • Immediacy of Danger • What Interventions have you tried? • De-escalation • Offering voluntary assessment at Crisis Intervention or ER • Remove triggers • Environmental • Others involved in conflict • PRNs

15. Crisis Intervention Services • Crisis Intervention Services are available 24 hours a day, seven days a week in Beaver County and can be accessed by dialing (724)775-5208, option 1, or the toll free number 1-800-400-6180

16. Crisis Intervention Services are available through the following: • 24 hour Telephone Hotline • Walk-in Clinic • Available 7 days a week from 7am to 10pm • After 10pm, individuals can be assessed at local ER • Mobile Crisis Services • Available Monday through Friday 10am to 6pm (excluding holidays) • Crisis Therapy • Short Term Crisis Therapy available by appointment • Provides up to 8 individual or family sessions • Funded by the Heritage Foundation

17. What to consider before seeking a 302? • Is the individual willing to go voluntarily? • Is there a petitioner available that witnessed the behavior first hand or heard the threats first hand? • Is the petitioner able to petition at the ER or able to go to Crisis Intervention? • Is the petitioner able to attend the 303 hearing?

18. What should you do to petition a 302? • Verify that you have tried all available options (i.e. PRNs, Verbal De-escalation, remove triggers, considered 201 ect.) • Report behaviors or threats to your immediate supervisor or on-call person. • Contact Crisis Intervention at 724-775-5208 and describe behaviors or threats in detail. Crisis delegate will decide if 302 criteria are met and will authorize 302 transport without warrant or recommend you come to Crisis to fill out paperwork.

19. How to Contact • Contact Crisis Intervention Services 24 hours a day at 724-775-5208 option 1 or 1-800-400-6180 for any questions or assistance.