Bill Text: MS SB2906 | 2010 | Regular Session | Engrossed
Bill Title: Mental commitment; revise 72-hour hold procedures and authorize Crisis Intervention Teams.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2010-03-27 - Died In Conference [SB2906 Detail]
Download: Mississippi-2010-SB2906-Engrossed.html
MISSISSIPPI LEGISLATURE
2010 Regular Session
To: Public Health and Welfare
By: Senator(s) Bryan
Senate Bill 2906
(As Passed the Senate)
AN ACT TO AMEND SECTION 41-21-63, MISSISSIPPI CODE OF 1972, TO CLARIFY THAT THE CHANCERY COURT HAS JURISDICTION IN COMMITMENT PROCEEDINGS EXCEPT IN CASES OF PENDING FELONY CHARGES; TO AMEND SECTION 41-21-67, MISSISSIPPI CODE OF 1972, TO CLARIFY USE OF THE 72-HOUR HOLD PROCEDURES AND AUTHORIZE USE OF CRISIS INTERVENTION TEAMS; TO AMEND SECTION 41-21-73, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT COMMITMENT HEARINGS MAY BE HELD AT THE LOCATION WHERE THE RESPONDENT IS BEING HELD; TO CREATE NEW SECTION 41-4-10, MISSISSIPPI CODE OF 1972, TO PROVIDE FOR IMPLEMENTATION OF CRISIS INTERVENTION TEAMS; TO PROVIDE THAT CRISIS INTERVENTION TEAMS BE OPERATED WITHIN LOCAL CATCHMENT AREAS SERVED BY CERTAIN LAW ENFORCEMENT AGENCIES; TO PROVIDE THAT ONLY ONE LICENSED MEDICAL FACILITY WILL SERVE AS A SINGLE POINT OF ENTRY FOR A CRISIS INTERVENTION TEAM CATCHMENT AREA; TO AUTHORIZE CERTAIN TRAINED LAW ENFORCEMENT OFFICERS TO TAKE INTO CUSTODY PERSONS WITH SUBSTANTIAL LIKELIHOOD OF BODILY HARM FOR THE PURPOSE OF EMERGENCY TREATMENT IN A LICENSED MEDICAL FACILITY SERVING AS A SINGLE POINT OF ENTRY; TO EXEMPT LAW ENFORCEMENT OFFICERS FROM CIVIL AND CRIMINAL LIABILITY FOR DETAINING A MENTALLY ILL PERSON IN GOOD FAITH; TO AUTHORIZE CERTAIN LICENSED PSYCHIATRIC NURSE PRACTITIONERS AND CERTAIN QUALIFIED PHYSICIAN ASSISTANTS TO HOLD A PATIENT FOR TREATMENT IN A LICENSED MEDICAL FACILITY SERVING AS A SINGLE POINT OF ENTRY; TO EXEMPT PSYCHIATRIC NURSE PRACTITIONERS AND PSYCHIATRIC PHYSICIAN ASSISTANTS FROM CIVIL AND CRIMINAL LIABILITY FOR DETAINING A MENTALLY ILL PERSON IN GOOD FAITH; TO PROVIDE FOR COMPREHENSIVE PSYCHIATRIC EMERGENCY SERVICES OPERATED BY A LICENSED MEDICAL FACILITY THAT IS SERVING AS THE SINGLE POINT OF ENTRY FOR A CRISIS INTERVENTION TEAM CATCHMENT AREA; TO REQUIRE THAT COMPREHENSIVE PSYCHIATRIC EMERGENCY SERVICES PROVIDE BEDS NEEDED FOR EXTENDED TREATMENT AND TO REQUIRE THAT THESE BEDS BE LICENSED BY THE STATE BOARD OF HEALTH; TO PROVIDE THAT A COMPREHENSIVE PSYCHIATRIC EMERGENCY SERVICE MAY PROVIDE TREATMENT OF A PERSON WITH MENTAL ILLNESS UP TO BUT NOT EXCEEDING 72 HOURS; TO AMEND SECTION 41-4-3, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE STATE BOARD OF MENTAL HEALTH SHALL HAVE QUARTERLY MEETINGS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 41-21-63, Mississippi Code of 1972, is amended as follows:
41-21-63. (1) No person, other than persons charged with crime, shall be committed to a public treatment facility except under the provisions of Sections 41-21-61 through 41-21-107 or 43-21-611 or 43-21-315. However, nothing herein shall be construed to repeal, alter or otherwise affect the provisions of Section 35-5-31 or to affect or prevent the commitment of persons to the Veterans Administration or other agency of the United States under the provisions of and in the manner specified in said sections.
(2) The chancery court, or the chancellor in vacation shall have jurisdiction under Sections 41-21-61 through 41-21-107 except over persons with unresolved felony charges pending.
(3) The circuit court shall have jurisdiction under Sections 99-13-7, 99-13-9 and 99-13-11.
SECTION 2. Section 41-21-67, Mississippi Code of 1972, is amended as follows:
41-21-67. (1) Whenever the affidavit provided for in Section 41-21-65 is filed with the chancery clerk, the clerk, upon direction of the chancellor of the court, shall issue a writ directed to the sheriff of the proper county to take into his * * * custody the person alleged to be in need of treatment and to bring the person before the clerk or chancellor, who shall order pre-evaluation screening and treatment by the appropriate community mental health center established under Section 41-19-31 and for examination as set forth in Section 41-21-69. The order may provide where the person shall be held prior to the appearance before the clerk or chancellor. However, when the affidavit fails to set forth factual allegations and witnesses sufficient to support the need for treatment, the chancellor shall refuse to direct issuance of the writ. Reapplication may be made to the chancellor. If a pauper's affidavit is filed by a guardian for commitment of the ward of the guardian, the court shall determine if the ward is a pauper and if the ward is determined to be a pauper, the county of the residence of the respondent shall bear the costs of commitment, unless funds for those purposes are made available by the state.
In any county which has established a Crisis Intervention Team pursuant to the provisions of Section 41-4-10(2), the clerk, upon the direction of the chancellor, may require that the person be referred to the Crisis Intervention Team for appropriate psychiatric or other medical services prior to the issuance of the writ.
(2) Upon issuance of the writ, the chancellor shall immediately appoint and summon two (2) reputable, licensed physicians or one (1) reputable, licensed physician and either one (1) psychologist, nurse practitioner or physician assistant to conduct a physical and mental examination of the person at a place to be designated by the clerk or chancellor and to report their findings to the clerk or chancellor. Provided, however, that any nurse practitioner or physician assistant conducting the examination shall be independent from, and not under the supervision of, the other physician conducting the examination. In all counties in which there is a county health officer, the county health officer, if available, may be one (1) of the physicians so appointed. Neither of the physicians nor the psychologist, nurse practitioner or physician assistant selected shall be related to that person in any way, nor have any direct or indirect interest in the estate of that person nor shall any full-time staff of residential treatment facilities operated directly by the State Department of Mental Health serve as examiner.
(3) The clerk shall ascertain whether the respondent is represented by an attorney, and if it is determined that the respondent does not have an attorney, the clerk shall immediately notify the chancellor of that fact. If the chancellor determines that the respondent for any reason does not have the services of an attorney, the chancellor shall immediately appoint an attorney for the respondent at the time the examiners are appointed.
(4) If the chancellor determines that there is probable cause to believe that the respondent is mentally ill and that there is no reasonable alternative to detention, the chancellor may order that the respondent be retained as an emergency patient at any available regional mental health facility or any other available suitable location as the court may so designate pending an admission hearing and may, if necessary, order a peace officer or other person to transport the respondent to that mental health facility or suitable location. Any respondent so retained may be given such treatment by a licensed physician as is indicated by standard medical practice. However, the respondent shall not be held in a hospital operated directly by the State Department of Mental Health; and shall not be held in jail unless the court finds that there is no reasonable alternative.
(5) Whenever a licensed physician or psychologist certified to complete examinations for the purpose of commitment has reason to believe that a person poses an immediate substantial likelihood of physical harm to himself or others or is gravely disabled and unable to care for himself by virtue of mental illness, as defined in Section 41-21-61(e), then the physician or psychologist may hold the person or the physician may admit the person to and treat the person in a licensed medical facility, without a civil order or warrant for a period not to exceed seventy-two (72) hours or the end of the next business day of the chancery clerk's office. Except that, if the seventy-two-hour period begins when the chancery clerk's office is closed, or within three (3) hours of closing, and the chancery clerk's office will be continuously closed for a time that exceeds seventy-two (72) hours, then the seventy-two-hour period is extended until the end of the next business day that the chancery clerk's office is open. Such person may be held and treated as an emergency patient at any licensed medical facility, available regional mental health facility, or crisis intervention center. The physician or psychologist who holds the person shall certify in writing the reasons for the need for holding.
If a person is being held and treated in a licensed medical facility, and that person decides to continue treatment by voluntarily signing consent for admission and treatment, the seventy-two-hour hold may be discontinued within filing an affidavit for commitment. Any respondent so held may be given such treatment by a licensed physician as indicated by standard medical practice. Persons acting in good faith in connection with the detention of a person believed to be mentally ill shall incur no liability, civil or criminal, for those acts.
SECTION 3. Section 41-21-73, Mississippi Code of 1972, is amended as follows:
41-21-73. (1) The hearing shall be conducted before the chancellor. However, the hearing may be held at the location where the respondent is being held. Within a reasonable period of time before the hearing, notice of same shall be provided the respondent and his attorney, which shall include: (a) notice of the date, time and place of the hearing; (b) a clear statement of the purpose of the hearing; (c) the possible consequences or outcome of the hearing; (d) the facts that have been alleged in support of the need for commitment; (e) the names, addresses and telephone numbers of the examiner(s); and (f) other witnesses expected to testify.
(2) The respondent must be present at the hearing unless the chancellor determines that the respondent is unable to attend and makes that determination and the reasons therefor part of the record. At the time of the hearing the respondent shall not be so under the influence or suffering from the effects of drugs, medication or other treatment so as to be hampered in participating in the proceedings. The court, at the time of the hearing, shall be presented a record of all drugs, medication or other treatment that the respondent has received pending the hearing, unless the court determines that such a record would be impractical and documents the reasons for that determination.
(3) The respondent shall have the right to offer evidence, to be confronted with the witnesses against him and to cross-examine them and shall have the privilege against self-incrimination. The rules of evidence applicable in other judicial proceedings in this state shall be followed.
(4) If the court finds by clear and convincing evidence that the proposed patient is a mentally ill or mentally retarded person and, if after careful consideration of reasonable alternative dispositions, including, but not limited to, dismissal of the proceedings, the court finds that there is no suitable alternative to judicial commitment, the court shall commit the patient for treatment in the least restrictive treatment facility that can meet the patient's treatment needs. Treatment prior to admission to a state-operated facility shall be located as closely as possible to the patient's county of residence and the county of residence shall be responsible for that cost. Admissions to state-operated facilities shall be in compliance with the catchment areas established by the Department of Mental Health. A nonresident of the state may be committed for treatment or confinement in the county where such person was found.
Alternatives to commitment to inpatient care may include, but shall not be limited to: voluntary or court-ordered outpatient commitment for treatment with specific reference to a treatment regimen, day treatment in a hospital, night treatment in a hospital, placement in the custody of a friend or relative or the provision of home health services.
For persons committed as mentally ill or mentally retarded, the initial commitment shall not exceed three (3) months.
(5) No person shall be committed to a treatment facility whose primary problems are the physical disabilities associated with old age or birth defects of infancy.
(6) The court shall state the findings of fact and conclusions of law that constitute the basis for the order of commitment. The findings shall include a listing of less restrictive alternatives considered by the court and the reasons that each was found not suitable.
(7) A stenographic transcription shall be recorded by a stenographer or electronic recording device and retained by the court.
(8) Notwithstanding any other provision of law to the contrary, neither the Board of Mental Health or its members, nor the Department of Mental Health or its related facilities, nor any employee of the Department of Mental Health or its related facilities, unless related to the respondent by blood or marriage, shall be assigned or adjudicated custody, guardianship, or conservatorship of the respondent.
(9) The county where a person in need of treatment is found is authorized to charge the county of such person's residence for the costs incurred while such person is confined in the county where such person was found.
SECTION 4. The following shall be codified as Section 41-4-10, Mississippi Code of 1972:
41-4-10. (1) As used in this section:
(a) "Crisis Intervention Team" means a community partnership among a law enforcement agency, a Community Mental Health Center, a hospital, other mental health providers, consumers and family members of consumers.
(b) "Participating partner" means a law enforcement agency, a community mental health center or a hospital that have each entered into collaborative agreements needed to implement a Crisis Intervention Team.
(c) "Catchment area" means a geographical area in which a Crisis Intervention Team operates and is defined by the jurisdictional boundaries of the law enforcement agency that is the participating partner.
(d) "Crisis Intervention Team officer" means a law enforcement officer who is authorized to make arrests under Section 99-3-1 and who is trained and certified in crisis intervention and who is working for a law enforcement agency that is a participating partner in a Crisis Intervention Team.
(e) "Substantial likelihood of bodily harm" means that:
(i) The person has threatened or attempted suicide or to inflict serious bodily harm to himself; or
(ii) The person has threatened or attempted homicide or other violent behavior; or
(iii) The person has placed others in reasonable fear of violent behavior and serious physical harm to them; or
(iv) The person is unable to avoid severe impairment or injury from specific risks; and
(v) There is substantial likelihood that serious harm will occur unless the person is placed under emergency treatment.
(f) "Single point of entry" means a specific hospital that is the participating partner in a Crisis Intervention Team and that has agreed to provide psychiatric emergency services and triage and referral services.
(g) "Psychiatric emergency services" means services designed to reduce the acute psychiatric symptoms of a person who is mentally ill and, when possible, to stabilize that person so that continuing treatment can be provided in the local community.
(h) "Triage and referral services" means services designed to provide evaluation of a person with mental illness in order to direct that person to a mental health facility or other mental health provider that can provide appropriate treatment.
(i) "Comprehensive Psychiatric Emergency Service" means a specialized psychiatric service, operated by the single point of entry and located in or near the hospital emergency department that can provide psychiatric emergency services for a period of time greater than can be provided in the hospital emergency department.
(j) "Extended observation bed" means a hospital bed that is utilized by a Comprehensive Psychiatric Emergency Service and is licensed by the State Department of Health for that purpose.
(k) "Psychiatric nurse practitioner" means a registered nurse who has completed the educational requirements specified by the State Board of Nursing, has successfully passed either the adult or family psychiatric nurse practitioner examination and is licensed by the State Board of Nursing to work under the supervision of a physician at a single point of entry following protocols approved by the State Board of Nursing.
(l) "Psychiatric physician assistant" means a physician assistant who has completed the educational requirements and passed the certification examination as specified in Section 73-26-3, is licensed by the State Board of Medical Licensure, has had at least one (1) year of practice as a physician assistant employed by a regional community mental health center, and is working under the supervision of a physician at a single point of entry.
(2) Any county is authorized to establish Crisis Intervention Teams to provide for psychiatric emergency services and triage and referral services for persons who are at substantial likelihood of bodily harm as a more humane alternative to confinement in a jail.
(3) Any county is authorized to require that a Crisis Intervention Team have one or more designated hospital(s) within the specified catchment area that has agreed to provide psychiatric emergency services, triage and referral services and other appropriate medical services for persons in custody of a Crisis Intervention Team officer (CIT officer) or referred by the Community Mental Health Center within the specified catchment area.
(4) Any county is authorized to establish Comprehensive Psychiatric Emergency Services to provide psychiatric emergency services to a person with mental illness under a collaborative agreement for a period of time greater than allowed in a hospital emergency department, when, in the opinion of the treating physician, psychiatric nurse practitioner or psychiatric physician assistant, that person likely can be stabilized within seventy-two (72) hours so that continuing treatment can be provided in the local community rather than a Crisis Intervention Center or state psychiatric hospital.
(5) Community Mental Health Centers shall have oversight of Crisis Intervention Teams operating within their service area. Proposals for Crisis Intervention Teams shall include the necessary collaborative agreements among the Community Mental Health Center, a law enforcement agency and a hospital that will serve as the single point of entry for the Crisis Intervention Team catchment area.
(6) The collaborative agreements shall specify that the hospital acting as the single point of entry shall accept all persons who are in custody of a CIT officer operating within the catchment area, when custody has been taken because of substantial likelihood of bodily harm, and shall accept all persons with mental illness who are referred by the Community Mental Health Center serving the catchment area, when a qualified staff member of the Community Mental Health Center has evaluated the person and determined that the person needs acute psychiatric emergency services that are beyond the capability of the Community Mental Health Center.
(7) The Director of the Community Mental Health Center shall determine if all collaborative agreements address the needs of the proposed Crisis Intervention Team, including generally accepted standards of law enforcement training, as specified by the State Department of Mental Health, before authorizing operation of the plan. Said generally accepted standards for law enforcement training shall be specified by the State Department of Mental Health, and the department shall develop and issue detailed training requirements for law enforcement officers relating to handling respondents in commitment proceedings.
(8) If the Director of the Community Mental Health Center has reason to believe that an authorized Crisis Intervention Team is not operating in accordance with the collaborative agreements and within general acceptable guidelines and standards, the director has the authority to review the operation of the Crisis Intervention Team and, if necessary, suspend operation until corrective measures are taken.
(9) The Director of the Community Mental Health Center shall establish a process whereby complaints from the public regarding the operation of a Crisis Intervention Team can be evaluated and addressed and provide for the inclusion of consumer representatives in that process.
(10) The internal operation of a single point of entry shall be governed by the administration of the hospital and regulated by the State Department of Health, the Joint Commission on Accreditation of Healthcare Organizations and other state and federal agencies that have regulatory authority over hospitals. All collaborative agreements must be in compliance with these governing authorities.
(11) Notwithstanding any other provision of law, nothing in this section shall be interpreted to create an entitlement for any individual to receive psychiatric emergency services at a single point of entry.
(12) A hospital operating as a single point of entry for a Crisis Intervention Team shall appoint a medical director to oversee the operation of the hospital-based service. The medical director will assure that the services provided are within the guidelines established by collaborative agreements.
(13) If a CIT officer determines that a person has a substantial likelihood of bodily harm, that officer may take the person into custody for the purpose of transporting the person to the designated single point of entry serving the catchment area in which the officer works. The CIT officer shall certify in writing the reasons for taking the person into custody.
(14) A CIT officer shall have no further legal responsibility or other obligations once a person taken into custody has been transported and received at the single point of entry.
(15) A CIT officer acting in good faith in connection with the detention of a person believed to have a substantial likelihood of bodily harm shall incur no liability, civil or criminal, for such acts.
(16) Only CIT officers authorized to operate within a catchment area may bring persons in custody to the single point of entry for that catchment area. Law enforcement officers working outside the designated catchment area are not authorized to transport any person into the catchment area for the purpose of bringing that person to the single point of entry.
(17) Any person transported by a CIT officer to the single point of entry or any person referred by the Community Mental Health Center following guidelines of the collaborative agreements shall be examined by a physician, psychiatric nurse practitioner or psychiatric physician assistant. If the person does not consent to voluntary evaluation and treatment, and the examiner determines that the person is a mentally ill person, as defined in Section 41-21-61(e), the examiner shall then determine if that person can be held under the provisions of Section 41-21-67(5). All other provisions of Section 41-21-67(5) shall apply and be extended to include licensed psychiatric nurse practitioners and psychiatric physician assistants employed by the single point of entry, including protection from liability, as stated, when acting in good faith.
(18) To implement a Comprehensive Psychiatric Emergency Service, a single point of entry must request licensure from the State Department of Health for the number of extended observation beds that are required to adequately serve the designated catchment area. A license for the requested beds must be obtained before beginning operation.
(19) If the Executive Director of the State Department of Mental Health determines that a Comprehensive Psychiatric Emergency Service can provide for the privacy and safety of all patients receiving services in the hospital, he or she may approve the location of one or more of the extended observation beds within another area of the hospital rather than in proximity to the emergency department.
(20) Each Comprehensive Psychiatric Emergency Service shall provide or contract to provide qualified physicians, psychiatric nurse practitioners, psychiatric physician assistants and ancillary personnel necessary to provide services twenty-four (24) hours per day, seven (7) days per week.
(21) A Comprehensive Psychiatric Emergency Service shall have at least one (1) physician, psychiatric nurse practitioner or psychiatric physician assistant, who is a member of the staff of the hospital, on duty and available at all times. Except that, the medical director of the service, may waive this requirement if provisions are made for a physician in the emergency department to assume responsibility and provide initial evaluation and treatment of a person in custody of a CIT officer or referred by the Community Mental Health Center and provisions are made for the physician, psychiatric nurse practitioner or psychiatric physician assistant on call for the Comprehensive Psychiatric Emergency Service to evaluate the person onsite within thirty (30) minutes of notification that the person has arrived.
(22) Any person admitted to a Comprehensive Psychiatric Emergency Service must have a final disposition within a maximum of seventy-two (72) hours. If a person cannot be stabilized within seventy-two (72) hours, that person shall be transferred from an extended observation bed to a more appropriate inpatient unit.
(23) Community Mental Health Center directors shall actively encourage hospitals to develop Comprehensive Psychiatric Emergency Services. If a collaborative agreement can be negotiated with a hospital that can provide a Comprehensive Psychiatric Emergency Service, that hospital shall be given priority when designating the single point of entry.
(24) The State Department of Mental Health shall encourage Community Mental Health Center directors to actively work with hospitals and law enforcement agencies to develop Crisis Intervention Teams and Comprehensive Psychiatric Emergency Services and shall facilitate the development of these programs.
(25) State universities and colleges that provide classes in criminal justice are encouraged to collaborate with law enforcement agencies to develop training guidelines and standards for CIT officers and to provide educational classes and continuing education programs by which CIT officers can earn continuing education credits.
(26) Two or more counties may jointly provide Crisis Intervention Teams and Comprehensive Psychiatric Services authorized under this Section 41-4-10. For the purpose of addressing unique rural service delivery needs and conditions, the State Department of Mental Health may authorize two (2) or more Community Mental Health Centers to collaborate in the development of Crisis Intervention Teams and Comprehensive Psychiatric Emergency Services and will facilitate the development of these programs.
SECTION 5. Section 41-4-3, Mississippi Code of 1972, is amended as follows:
41-4-3. (1) There is hereby created a State Board of Mental Health, herein referred to as "board," consisting of nine (9) members, to be appointed by the Governor, with the advice and consent of the Senate, each of whom shall be a qualified elector. One (1) member shall be appointed from each congressional district as presently constituted; and four (4) members shall be appointed from the state at large, one (1) of whom shall be a licensed medical doctor who is a psychiatrist, one (1) of whom shall hold a Ph.D. degree and be a licensed clinical psychologist, one (1) of whom shall be a licensed medical doctor, and one (1) whom shall be a social worker with experience in the mental health field.
No more than two (2) members of the board shall be appointed from any one (1) congressional district as presently constituted.
Each member of the initial board shall serve for a term of years represented by the number of his congressional district; two (2) state-at-large members shall serve for a term of six (6) years; two (2) state-at-large members shall serve for a term of seven (7) years; subsequent appointments shall be for seven-year terms and the Governor shall fill any vacancy for the unexpired term.
The board shall elect a chairman whose term of office shall be one (1) year and until his successor shall be elected.
(2) Each board member shall be entitled to a per diem as is authorized by law and all actual and necessary expenses, including mileage as provided by law, incurred in the discharge of official duties.
(3) The board shall hold regular meetings quarterly and such special meetings deemed necessary, except that no action shall be taken unless there is present a quorum of at least five (5) members.
SECTION 6. This act shall take effect and be in force from and after its passage.
