Involuntary Outpatient Commitment Legislation: State Perspectives

1. Involuntary Outpatient Commitment Legislation: State Perspectives Virginia House of Delegate'sHealth, Welfare and Institutions Committee July 30, 2007 Sarah Steverman, MSW Policy Associate National Conference of State Legislatures

2. Common Characteristics of Involuntary Treatment Statutes • Most have a “grave disability” provision. • Most states permit outpatient commitment. • The standards for inpatient and outpatient commitment differ. • Some states require outpatient treatment to be shown available before outpatient commitment is granted.

3. Common Characteristics of Involuntary Treatment Statutes continued • A person’s history of behavior and treatment can be taken into account when determining whether an individual meets commitment standards. • Medication compliance is usually addressed separate from the civil commitment hearing. • Outpatient commitment is most often used at the point of discharge from inpatient treatment.

4. Texas • Requires a court order for outpatient commitment. • Inpatient and outpatient civil commitment uses same processes. • Some overlap in inpatient and outpatient criteria. • Prior history of up to two years preceding the commitment hearing may be considered.

5. Texas • Court may order outpatient treatment if • Person has mental illness that is “severe and persistent.” • Untreated illness will lead to severe distress and the individual will be unable to live safely in the community without mental health services. • The individual is unable to participate voluntarily in treatment as evidenced by past history or current clinical condition making it impossible to make a rational decision to seek outpatient treatment.

6. Michigan • Initial detention initiated by psychiatrist or psychologist, peace officer, application of an individual to a court. • Availability of community mental health services must be assessed. • At least one deposition or testimony by a physician or psychologist must be submitted to the court. • Court provides law enforcement with involuntary treatment order.

7. Michigan continued • Types of involuntary treatment orders • Hospitalization • Alternative to hospitalization • Combination of hospitalization and alternative treatment • Length of time of treatment orders vary. • Person with combined order can be returned to the hospital without hearing if deemed clinically appropriate.

8. North Carolina • Inpatient and outpatient commitment statutes differ greatly. • Outpatient treatment is defined in the statute as a mechanism to avoid inpatient commitment. • Prior history may be used to determine civil commitment. • Anyone can petition the court to take the person into custody for assessment.

9. North Carolina continued • If outpatient commitment is recommended, the court schedules a hearing with the individual and proposed treatment center or physician. • Counsel not automatically assigned for IOC • Forced medication and treatment not allowed pending hearing. • Hearing must be held within 10 days.

10. North Carolina continued • Five criteria for outpatient commitment: • Mental illness • Capable of surviving safely in the community with available supervision • Threat of dangerousness (defined in statute) based on history • Mental illness leads to inability to voluntarily seek and participate in treatment • Outpatient treatment is available

11. North Carolina continued • Combination of inpatient and outpatient treatment can be ordered. • Medication cannot be forced unless immediate danger to self or others. • Anecdotal evidence that outpatient commitment is most often used at point of discharge from inpatient treatment.

12. Ohio • Treatment of those civilly committed lies with the local boards of alcohol, drug addiction, and mental health services, including financial responsibility. • Provides incentives for local boards to limit commitment and increase community services. • Court can order person into a variety of settings, but the treatment provider designated to provide care must consent. • Commitment is usually to the local board, who then makes decision.

13. Ohio continued • Medication compliance is separate issue from civil commitment and requires a judicial hearing. • 2000 Ohio Supreme Court Decision: Steele v. Hamilton County Community Board

14. Oregon • Court and Mental Health Division Director work closely together during civil commitment procedures. • With the approval of the court, Mental Health Division Director can commit individual to outpatient treatment only if the treatment is available. • Director establishes terms of outpatient commitment. • Outpatient commitment can be revoked or modified by Director when “it is in the best interest of the person.”

15. Oregon continued • Outpatient commitment used rarely in Oregon, trial visits from hospital used more frequently. • Anecdotal evidence that lack of community resources may place individuals at greater risk for commitment. • Inconsistencies between rural and urban application of the statute.

16. Wisconsin • Permits the use of medical records data in making commitment determination. • Specifies what does not constitute adequate proof that the individual meets commitment criteria. • If protection/treatment exists in the community and the person is likely to take advantage of those services. • Provides for a “settlement agreement” postponing commitment hearing for up to 90 days while person participates in outpatient treatment. • 5th Standard-question of capacity and prospect of deterioration in the absence of treatment.

17. Wisconsin • Enrollment in a health plan determination before assessment or treatment under civil commitment. • Court may appoint a temporary guardian for up to 30 days.

18. Policy Issues • The statute is only one element of the treatment issue. • IOC is only successful if there are adequate community resources. • Outpatient commitment relies on good communication between the court, assessing psychiatrist or psychologist, treatment provider, and often the mental health authority. • IOC is often administered inconsistently, especially between rural and urban areas. • Availability of evidence-based treatment prevents the need for IOC.

19. Sarah StevermanPhone: 202-624-3583Email: sarah.steverman@ncsl.org Resources: M. Susan Ridgely, John Borum, John Petrila “The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States”http://www.rand.org/pubs/monograph_reports/MR1340/ NCSL Mental Health Webpage http://www.ncsl.org/programs/health/mental.htm