PROPOSED CHANGES IN COLORADO’S CIVIL COMMITMENT LAWS Catherine Strode, MPA Health Care Advocacy Program

PROPOSED CHANGES IN COLORADO’S CIVIL COMMITMENT LAWS Catherine Strode, MPA Health Care Advocacy Program

PRESENTERS Moe Keller VP of Public Policy & Strategic Initiatives Mental Health America Amanda Kearney-Smith, MS Executive Director Colorado Mental Wellness Network 2

BILL DRAFT • February 18, 2013

INTRODUCTION • Three Colorado Statutes • Civil Commitment Holds • Consolidation • Extends Length of Mental Health Holds 4

PUBLIC AND PERSONAL SAFETY Adds “Substantial Probability” to Hold Criteria Problems for Law Enforcement Problems for Parents and Families 5

COLORADO’S SUBSTANCE USE RATES* Abuse Rates Higher Than National Average All Age Ranges *The Substance Abuse and Mental Health Services Administrationhttp://www.samhsa.gov/ 6

]COLORADO’S MENTAL HEALTH INDICATORS* Serious Psychological Distress at National Average Major Depressive Episodes Above National Average *The Substance Abuse and Mental Health Services Administrationhttp://www.samhsa.gov/ 7

ACCESS CHALLENGES Lack of Coverage Lack of Resources Lack of Short Term Care Beds Lack of Community Supports Lack of Providers 8

CRISIS CARE NEEDS “Danger to Himself or Herself” Increased Victimization* Continuum of Care Increase Speed of Medicaid Approval *www.ncbi.nlm.nih.gov 9

GOVERNOR’S INITIATIVES ‘Right Services at the Right Time’: Streamline Statutes Statewide Hotline Expand Bed Capacity Housing Vouchers Community Supports/ACT Teams Medicaid Expanded For Substance Use Disorder Services 10

GOALS OF STATUTE CHANGE • Quick Intervention and Stabilization • Integration of Mental Health, Alcohol and Substance Use Disorders • “Substantial Probability” Added As Third Criterion for Hold 11

INTERVENTION CHANGES • 72-Hour Hold Increased to 5 Days • Evaluation Required Within 24 Hours • “Substantial Probability” Initiates Hold • “Substantial Probability” in regards to harm to self • “Probability” in regards to harm to others* *February 18 Draft 12

“SUBSTANTIAL PROBABILITY” VS “SUBSTANTIAL RISK” • Bill Redrafted • Language Changed

EVALUATION CHANGES • Broadens Standard of Involuntary Commitment • Creates New Definitions: ‘Professional Persons’ ‘Designated Facility’ ‘Gravely Disabled’ 14

REVISED DEFINITIONS Danger to Self or Others Family Member Gravely Disabled

CRISIS CARE SCENARIO • Client Profile • Client Condition • Inclusion of an Advanced Directive (crisis plan) • Maximum 5 Day Hold Period

CLIENT RIGHTS • Opportunity for individuals to request an evaluation • Ability to be advised of individual rights while under an involuntary hold

EXTENDED HOLD SCENARIO • Short-term Civil Commitment • Evaluation within 24 hours • Legal procedures for reporting • Least restrictive standards • Advanced directives

STAKEHOLDER PERSPECTIVES • Individual • Family • Provider

STATUTE CHALLENGES • Communication barriers • Translation into practice • Client payment

PROVIDER CHANGES Who can initiate? Who can certify?

BILL PROPOSAL • Sponsors/Timeline • Involvement of State Departments • Implementation

RESOURCES • Colorado General Assembly Website http://www.leg.state.co.us/clics/clics2013A/cslFrontPages.nsf/HomeSplah?OpenForm • Treatment Advocacy Center http://www.treatmentadvocacycenter.org/index.php?option=com_content&view=article&id=201&Itemid=136 • Colorado Department of Human Services http://www.colorado.gov/cs/Satellite/CDHS-Main/CBON/1251575083520 • Office of Behavioral Health http://www.colorado.gov/cs/Satellite/CDHS- BehavioralHealth/CBON/1251578892077 • National Resource Center on Psychiatric Advance Directives http://www.nrc-pad.org/ • WEBINAR RECORDING www.advocacydenver.org 23

YOUR QUESTIONS AND INPUT 24

PROPOSED CHANGES IN COLORADO’S CIVIL COMMITMENT LAWS Catherine Strode, MPA Health Care Advocacy Program