Mandatory Outpatient Treatment Following Involuntary Inpatient Admission

Mandatory Outpatient Treatment Following Involuntary Inpatient Admission Allyson K. Tysinger Office of the Attorney General May 2010

SB 360(Barker)/HB 729(Albo)Purpose • Permits a judge or special justice to authorize a treating physician to discharge a person who has been involuntarily committed to mandatory outpatient treatment (MOT) without a further hearing • Targeted application to individuals who have a history of lack of compliance with treatment to prevent their deterioration and alleviate potential danger to themselves or others as a result

SB 360(Barker)/HB 729(Albo)Purpose • Will enable some individuals to be discharged earlier, freeing up hospital beds and permitting those individuals to receive services in a less restrictive setting • Will reduce re-hospitalization and arrests by helping to prevent relapse

Two Step Process • Judicial findings made at time of commitment hearing and authorization for treating physician to discharge an individual to MOT included in commitment order • Physician determination prior to discharge to MOT

Judicial Findings • In the order for involuntary admission, the judge or special justice may authorize the treating physician to discharge the person to MOT under a discharge plan if the judge or special justice finds by clear and convincing evidence that:

Judicial Findings (cont’d) • The person has a history of lack of compliance with treatment for mental illness that at least twice within the past 36 months has resulted in the person being subject to an order of involuntary inpatient admission; • In view of the person’s treatment history and current behavior, the person is in need of MOT following inpatient treatment in order to prevent relapse or deterioration that would be likely to result in the person meeting the criteria for involuntary inpatient admission;

Judicial Findings (cont’d) • As a result of mental illness, the person is unlikely to voluntarily participate in outpatient treatment unless the court enters an order; and • The person is likely to benefit from MOT.

Physician Determination • Prior to discharge to MOT, the treating physician shall determine, based upon his professional judgment, that:

Physician Determination (cont’d) • The person • No longer needs inpatient hospitalization • Requires MOT at time of discharge to prevent relapse or deterioration that would likely result in his meeting the criteria for involuntary inpatient admission • Has sufficient capacity to understand the stipulations of his treatment

Physician Determination (cont’d) • Has expressed an interest in living in the community and has agreed to abide by the discharge plan • Is deemed to have capacity to comply with the discharge plan and understand and adhere to conditions and requirements of treatment • The ordered treatment can be delivered on an outpatient basis by the CSB or designated provider; and

Physician Determination (cont’d) • At the time of discharge, services are actually available in the community and providers of services have actually agreed to deliver the services

Physician Determination (cont’d) • Physician shall not discharge a person to MOT if the person still meets the criteria for inpatient commitment

Discharge Plan • Discharge plan developed by the treating physician and facility staff in conjunction with the CSB and the person • Discharge plan shall serve as and contain all of the components of the comprehensive MOT plan • Initial MOT plan not required

Discharge PlanContents • Contents of discharge plan (§ 37.2-817(G)) • Identifies the specific type, amount, duration and frequency of each service to be provided to the person • Identifies the provider that has agreed to provide each service • Certifies that the services are the most appropriate and least restrictive treatment available for the person

Discharge PlanContents • Certifies that each provider has complied and continues to comply with applicable licensing requirements • Is developed with the fullest possible involvement and participation of the person and his family, with the person’s consent, and reflects his preferences to the greatest extent possible to support his recovery and self-determination

Discharge PlanContents • Specifies the particular conditions with which the person shall be required to comply • Describes how the CSB shall monitor compliance with the plan and report any material noncompliance with the plan.

Discharge Plan • Discharge plan shall be submitted to the court for approval • Upon approval, shall be filed and incorporated into the involuntary admission order • Discharge plan shall be provided to the person by the CSB at the time of discharge

Monitoring • CSB where person resides upon discharge shall monitor compliance and report any material noncompliance to the court in accordance with § 37.2-817.1.

Monitoring and Court Review • Monitoring and court review of the order authorizing discharge to MOT following inpatient admission follows same process currently used for MOT • § 37.2-817.1(monitoring and petition for hearing) • § 37.2-817.2 (court review) • § 37.2-817.3 (rescission) • § 37.2-817.4 (continuation)

Monitoring§ 37.2-817.1(A) • Monitoring compliance includes • Contacting service providers to determine if person is complying with MOT order or order authorizing discharge to MOT following inpatient treatment • Notifying the court of the person’s material noncompliance with the MOT order or order authorizing discharge to MOT following inpatient treatment • Providers of services identified in the plan shall report material noncompliance to the CSB

Monitoring§ 37.2-817.1(B) • If CSB determines person materially failed to comply, the CSB must: • Petition court for review of MOT order or order authorizing discharge to MOT following inpatient treatment within 3 days or 24 hours if person under TDO • Recommend appropriate disposition • Send copies of petition to person and his attorney

Monitoring§ 37.2-817.1(C) • If CSB determines person not materially complying and meets commitment criteria, CSB shall immediately request an ECO or TDO

Court review of MOT Plan or Discharge Plan§ 37.2-817.2(A) • Court shall hold hearing within 5 days of receiving petition for review (or close of business on next business day) • If person is detained, within TDO timeframe • Clerk shall provide notice to person, CSB, all treatment providers, and original petitioner

Court review of MOT Plan or Discharge Plan§ 37.2-817.2(A) • Preference given to appointing attorney who represented person at initial hearing • Same judge or special justice not required to conduct review hearing • CSB shall offer to arrange transportation if person not detained and has no transportation

Court review of MOT Plan or Discharge Plan§ 37.2-817.2(B) • Independent examiner must be appointed only if requested by: • Person • CSB • Treatment provider • Original petitioner

Court review of MOT Plan or Discharge Plan§ 37.2-817.2(B) • Examination includes relevant items as is required for commitment hearing • Certification of examiner may be admitted without appearance of examiner if not objected to by person or his attorney • If not detained, CSB shall offer to arrange transportation to examination

Court review of MOT Plan or Discharge Plan§ 37.2-817.2(B) • If person fails to appear at examination, CSB must notify court, or magistrate if court not available • Court or magistrate shall issue mandatory examination order and capias • Primary law enforcement agency where person resides shall transport person to exam • Custody shall not exceed 4 hours

Court review of MOT Plan or Discharge Plan§ 37.2-817.2(C) • If person fails to appear at hearing, court shall: • Reschedule the hearing • Issue an ECO • Issue a TDO

Court review of MOT Plan or Discharge Plan§ 37.2-817.2(D) • At conclusion of evidence, the court shall: • Order involuntary inpatient admission if person meets criteria • Renew MOT order or order authorizing discharge to MOT following inpatient treatment if person meets applicable criteria, making necessary modifications acceptable to CSB or treatment providers • Rescind MOT order or order authorizing discharge to MOT following inpatient treatment • Transportation to inpatient treatment facility provided by Sheriff

Rescission of MOT Order§ 37.2-817.3(A) • If CSB determines person has complied with MOT order or order authorizing discharge to MOT following inpatient treatment and no longer meets criteria, or it is no longer necessary: • CSB may petition for rescission of order • If court agrees, it shall rescind order • Otherwise, court schedules hearing for review of MOT order

Rescission of MOT Order§ 37.2-817.3(B) • Any time after 30 days of entry of MOT order or order authorizing discharge to MOT following inpatient treatment, person may petition court to rescind order • Court shall schedule review hearing • CSB shall provide preadmission screening report • Person may petition only once in 90-day period • Court shall make one of the dispositions in § 37.2-817.2(D)

Continuation of MOT Order§ 37.2-817.4 • Within 30 days of expiration of MOT order or order authorizing discharge to MOT following inpatient treatment, CSB, any treating physician or other responsible person may petition to extend MOT order • If person and CSB, if CSB not petitioner, agree, court shall extend order without hearing

Continuation of MOT Order§ 37.2-817.4 • Court shall appoint independent examiner • CSB shall provide a preadmission screening report • Court shall make one of the dispositions in § 37.2-817.2(D) • If court continues the MOT order, it may continue it for up to 180 days • MOT order in effect at time petition for continuation filed shall remain in effect until hearing

Mandatory Outpatient Treatment Following Involuntary Inpatient Admission