Interstate Compact on Mental Health

1. 1 Interstate Compact onMental Health Bonnie Lee Legal Issues Coordinator State Operated Services Scottsdale, Arizona

2. 2 HISTORY Residency determined treatment and financial responsibility. Residency strictly defined by court decisions and statutory provisions.

3. 3 HISTORY Persons often ineligible for treatment if not a resident or citizen. Families often separated during treatment and aftercare.

4. 4 HISTORY Persons immediately transferred to state of residency, even if no ongoing connections to state of origin. Improved patients unable to be discharged to states where family lived.

5. 5 HISTORY 1955-The start of change. Governor’s Conference recommended further meetings to discuss treatment of persons with mental illness. Representatives from New York, New Jersey, Connecticut, Pennsylvania met in April, 1955.

6. 6 HISTORY Meeting Intent: Each state would agree to accept transfer of any residents hospitalized in another state. Legal Difficulties immediately identified.

7. 7 No common denominator of residence and settlement among the four states which governed hospital admissions. CT. delegation suggested the emphasis on residency inconsistent with modern health care of the day. HISTORY

8. 8 New Approach Focus on clinical needs of the patient. Focus on interstate cooperation. Require minimum dependency on legal definitions of residency.

9. 9 Recommendation Recommendations made to the NE State Government Conference on Mental Health held in Wilmington, Delaware. Pursue development of Interstate Compact.

10. 10 Council of State Government Several drafts and two meetings later language approved. A resolution adopted and Council of State Government asked to establish a ten state committee to draft a compact.

11. 11 Resulting Recommendation September,1955, at a meeting in Burlington, Vermont, compact language approved by NE State Government Conference on Mental Health. Strong resolution urging early consideration and action in the NE and other parts of the country.

12. 12 Ratification Alabama 1975 Alaska 1957 Arkansas 1959 Colorado 1965 Connecticut 1955 Delaware 1962 District of Columbia Florida 1971 Georgia 1973 Hawaii 1967 Idaho 1961 Illinois 1965 Indiana 1959 Iowa 1970 Kansas 1967 Kentucky 1958 Louisiana 1958 Maine 1957 Maryland 1962 Massachusetts 1956 Michigan 1974 Minnesota 1957 Missouri 1959 Montana 1971 Nebraska 1969 New Hampshire 1957

13. 13 Ratification New Jersey 1956 New Mexico 1969 New York 1956 North Carolina 1959 North Dakota 1963 Ohio 1959 Oklahoma 1959 Oregon 1957 Pennsylvania 1961 Rhode Island 1957 South Carolina 1959 South Dakota 1959 Tennessee 1971 Texas 1969 Utah 1989 Vermont 1959 Washington 1965 West Virginia 1957 Wisconsin 1966 Wyoming 1969

14. 14 Membership By 1968, 36 states were members. Today, 45 States and the District of Columbia are members.

15. 15 NON MEMBER STATES Arizona California Nevada Mississippi Virginia ..

16. 16 Provisions of the Compact Consists of 14 Articles. A person who is physically present in a party state is eligible for treatment, regardless of residency or citizenship. Treatment benefits patients, families, and society.

17. 17 COMPACT ARTICLES Controlling factors are community safety and availability of services. Defines key phrases used within the compact.

18. 18 Provisions of the Compact Criteria for transfer. Is the care and treatment of the patient facilitated or improved. Assessment of clinical needs. Location of the patient’s family. Character and duration of the illness. Other factors as deemed appropriate.

19. 19 Provisions of the Compact  Transfer requires approval of the receiving state. A member state is not obligated to accept a patient for transfer.

20. 20 Provisions of the Compact Transferred patients have the same rights in the receiving state as local patients. Order of admission Financial Social Service

21. 21 Provisions of the Compact Provides for aftercare when it is in the best interest of the patient and public safety will not be jeopardized. Referral and evaluation process is the same.

22. 22 Provisions of the Compact Provides authority for member states to transport patients across state lines when transfer occurs in accordance with compact provisions. Sending state pays cost of transfer, unless other arrangements are made.

23. 23 Provisions of the Compact A person may be considered a patient at only one facility. Current practice is to obtain a new commitment order. Provides for the return of committed patients on an unauthorized absence.

24. 24 Provisions of the Compact The compact is not intended to affect duties and responsibilities of a guardian in any way. Requires appointment of a compact administrator.

25. 25 Exemptions Does not apply to “criminally insane”. Does not apply to persons subject to a criminal charge. Does not apply to persons with chemical dependency as a primary diagnosis.

26. 26 Issues: The language of the compact was drafted in 1955. Generally agreed that to amend and update the language and have states repeal existing language and pass new language not realistic.

27. 27 ISSUES: Amending requires rewrite of original compact. Need consensus on what needs to be amended. Financial considerations.

28. 28 Where does this leave us? The compact was a voluntary effort to solve a serious problem of providing services to persons with mental illness or mental retardation at a time when there were fewer concerns and laws about patient rights. The compact established a cooperative process among states to provide care and treatment to the benefit of patients and their families.

29. 29 Why it works: Annual conference. Adoption of uniform procedures and forms by the ICC members. Regular review, training, networking, and communication. Establish best practice guidelines.

30. 30 Challenges: No appeal process. Cultural competency. Limited English proficiency. Registered Predatory Offenders.

31. 31 Challenges: Status of patients civilly committed as a sex offender. Returning committed patients on an unauthorized absence. Including committed sex offenders.

32. 32 And More ! Patients with special medical needs. Impact of shorter length of stays. Impact of decreasing state operated beds and movement to community based programs.

33. 33 And Finally What makes the compact work is the dedication of the staff who find creative ways to work cooperatively, and who share a common desire to ensure that the best interest of the client is served.