- When not the subject of a pending commitment action, what are the prerequisites for an individual to receive voluntarily treatment?
§ 17a-506(a). “Any hospital for psychiatric disabilities may receive for observation and treatment any person who in writing requests to be received…”
§ 17a-506(b). “Any person
desiring admission to a hospital for psychiatric disabilities for care and
treatment of psychiatric disabilities may be admitted as a patient without
making formal or written application therefor if the superintendent deems such
person clinically suitable for such admission, care and treatment…”
- Conditions necessary for emergency treatment.
Initiated by police officer:
§ 17a-503(a). “Any police
officer who has reasonable cause to believe that a person has psychiatric
disabilities and is dangerous to himself, herself or others or gravely
disabled, and in need of immediate care and treatment, may take such person
into custody and take or cause such person to be taken to a general hospital
for emergency examination under this section.”
Initiated by physician:
§ 17a-502(a). “Any person
who a physician concludes has psychiatric disabilities and is dangerous to
himself or others or gravely disabled, and is in need of immediate care and
treatment in a hospital for psychiatric disabilities, may be confined in such a
hospital, either public or private, under an emergency certificate as
hereinafter provided…”
- Is mental illness/disorder defined?
§ 17a-458(a). “Whenever the term ‘mentally ill’ is used or referred to in the
following sections of the general statutes, the term "a person with
psychiatric disabilities" shall be substituted in lieu thereof”
§ 17a-495(a). “’mentally ill person’ means any person who
has a mental or emotional condition which has substantial adverse effects on
his or her ability to function and who requires care and treatment, and
specifically excludes a person who is an alcohol-dependent person or a
drug-dependent person.”
§ 17a-495(c). “’persons with
psychiatric disabilities’ means any person who has a mental or emotional
condition which has substantial adverse effects on his or her ability to
function and who requires care and treatment, and specifically excludes a
person who is an alcohol-dependent person or a drug-dependent person…”
- Maximum duration of emergency treatment before a judicial
hearing must be held.
After detention by police officer:
§ 17a-503(a). 72 hours.
After examination by a physician:
§ 17a-502(d). If a hearing
is requested it “shall be held within seventy-two hours of receipt of such
request, excluding Saturdays, Sundays and holidays.”
§ 17a-502(a). If a hearing is not requested, then “fifteen days.”
- Can a potential committee avoid a hearing determination by
opting to voluntarily undergo treatment and, if so, what is the minimum time he
or she must then spend in treatment?
Yes. A potential committee may elect voluntary status at any time prior to
adjudication of the application for commitment. However, if he or she requests to be released during this period,
a new application for involuntary commitment may be filed.
§ 17a498(e). “When any
patient who has elected voluntary status following the filing of an application
but prior to adjudication in any proceeding for involuntary commitment
thereafter notifies the hospital that he or she wants to be released, a new
application for involuntary commitment may be filed. If such application is
filed within forty-five days after the patient's election of voluntary status
on a prior application, the application for involuntary commitment may, at the
discretion of the judge, be heard on the merits, notwithstanding the patient's
subsequent request to remain a voluntary patient under the provisions of
section 17a-506. Notwithstanding the provisions of sections 17a-29, 17a-540,
17a-543, 17a-544, subsection (f) of section 17a-547 and section 17a-548, in the
event that a patient under section 17a-506 refuses to accept medication or
treatment in accordance with the treatment plan prescribed by the attending
physician and such patient is imminently dangerous to himself or others, an
application for involuntary commitment may be filed for such patient in
accordance with the provisions of this section.”
§ 17a-506(a).Any hospital for psychiatric disabilities may receive for
observation and treatment any person who in writing requests to be received;
but no such person shall be confined in any such hospital for psychiatric
disabilities for more than three business days, after he or she has given
notice in writing of his or her desire to leave, unless an application for
commitment has been filed in a court of competent jurisdiction.”
§ 17a-506(e) “Whenever a person is confined to a hospital for psychiatric
disabilities under the provisions of this section and gives notice of the
desire to leave under subsection (a) hereof, any person, including the person in
charge of such hospital, may institute proceedings for his or her commitment in
the court of probate having jurisdiction in the town where such hospital is
located.”
- Are there any requirements that a potential committee be
capable of deciding to voluntarily undergo treatment?
Yes.
§ 17a-506(c). “The
physician shall examine the patient within ten business days of his appointment
to determine if the patient has given informed consent to his or her
hospitalization. The physician shall make a report forthwith to the court. If
the court concludes that the patient did not give informed consent
to the hospitalization, the court, on its own motion, may proceed in the manner
provided in subsections (a), (b), (c) and (f) of section 17a-498 [The court
will provide counsel for respondent and appoint at least two physicians to make
a report as to whether respondent meets the criteria for commitment and whether
respondent is capable of understanding the need to accept treatment].”
§ 17a-540(h). “’Informed
consent’ means permission given competently and voluntarily after a patient has
been informed of the reason for treatment, the nature of the proposed
treatment, the advantages or disadvantages of the treatment, medically
acceptable alternative treatment, the risks associated with receiving the
proposed treatment and the risk of no treatment…”
- Who may petition for an individual to receive assisted
inpatient care?
For court-ordered examination: §17a-503(b). “Upon application by any person…”
For assisted treatment: § 17a-497(a). “Such
application may be made by any person and, if any person with psychiatric
disabilities is at large and dangerous to the community, the first selectman or
chief executive officer of the town in which he or she resides or in which he
or she is at large shall make such application.”
- Required elements of a petition.
For court-ordered examination: §
17a-503(b). “Upon application by any person to the court of probate
having jurisdiction in accordance with section 17a-497, alleging that any
respondent has psychiatric disabilities and is dangerous to himself or others
or gravely disabled, and in need of immediate care and treatment in a hospital
for psychiatric disabilities, such court may issue a warrant for the
apprehension and bringing before it of such respondent and examine such
respondent. If the court determines that there is probable cause to believe
that such person has psychiatric disabilities and is dangerous to himself or
herself or others or gravely disabled, he shall order that such respondent be
taken to a general hospital for examination.”
For assisted treatment: § 17a-497(a). “Courts
of probate shall exercise such jurisdiction only upon written application
alleging in substance that such person has psychiatric disabilities and is
dangerous to himself or herself or others or gravely disabled.”
- Is there a penalty for filing an unfounded petition?
Yes.
§ 17a504. “Any person who wilfully
and maliciously causes, or attempts to cause, or who conspires with any other
person to cause, any person who does not have psychiatric disabilities to be
committed to any hospital for psychiatric disabilities, and any person who
wilfully certifies falsely to the psychiatric disabilities of any person in any
certificate…and any person who, under the provisions of said sections relating
to persons with psychiatric disabilities, wilfully reports falsely to any court
or judge that any person has psychiatric disabilities, shall be fined not more
than one thousand dollars or imprisoned not more than five years or both.”
- Participation of other individuals in commitment hearing (i.e.
notice, a right to be heard or standing for family members, legal guardians,
doctors, etc.).
For notice of hearing:
§ 17a-498(a) “…shall cause
reasonable notice thereof to be given to the respondent and to such relative or
relatives and friends as it deems advisable.”
For notice of admission:
§ 17a-502(g). “Any person
admitted and detained at any hospital for psychiatric disabilities under this
section shall, upon admission to such hospital, furnish the name of his or her
next of kin or close friend. The superintendent or director of such hospital
shall notify such next of kin or close friend of the admission of such patient
and the discharge of such patient, provided such patient consents in writing to
such notification of his or her discharge."
- Length of initial term of assisted inpatient care.
No maximum length is specified, but a review for a
hearing to consider patient’s release is required, at minimum, on an annual
basis.
§ 17a-498(c). “If, on such hearing, the
court finds by clear and convincing evidence that the person complained of has
psychiatric disabilities and is dangerous to himself or herself or others or
gravely disabled, it shall make an order for his or her commitment, considering
whether or not a less restrictive placement is available, to a hospital for
psychiatric disabilities to be named in such order, there to be confined for
the period of the duration of such psychiatric disabilities or until he or she
is discharged or converted to voluntary status pursuant to section 17a-506 in
due course of law.”
17a-489(g). “The hospital shall notify each patient at least annually
that such patient has a right to a further hearing pursuant to this section. In
the event that the patient requests such hearing it shall be held by the court
of probate which ordered the confinement of such patient…”
- Conditions necessary for judicially ordered inpatient care
(exact wording of key portions of applicable statute desired).
§ 17a-498(c). “If, on such hearing, the court finds by clear and
convincing evidence that the person complained of has psychiatric disabilities
and is dangerous to himself or herself or others or gravely disabled, it shall
make an order for his or her commitment, considering whether or not a less
restrictive placement is available, to a hospital for psychiatric
disabilities…”
§ 17a-495(a). “‘dangerous to
himself or herself or others’ means there is a substantial risk that
physical harm will be inflicted by an individual upon his or her own person or
upon another person, and ‘gravely disabled’ means that a person, as a
result of mental or emotional impairment, is in danger of serious harm as a
result of an inability or failure to provide for his or her own basic human
needs such as essential food, clothing, shelter or safety and that hospital
treatment is necessary and available and that such person is mentally incapable
of determining whether or not to accept such treatment because his judgment is
impaired by his psychiatric disabilities.”
Hearings are held before a three-judge court and
decisions require a majority vote:
§ 17a-497(b). “…the Probate Court Administrator shall appoint a
three-judge court from among the several judges of probate to hear such application.
Such three-judge court shall consist of at least one judge who is an
attorney-at-law admitted to practice in this state…No such respondent shall be
involuntarily confined without the vote of at least two of the three judges
convened hereunder.”
- Evidentiary standard under which inpatient care criteria are
judged (two most common are “beyond a reasonable doubt” and “clear and
convincing evidence”).
§ 17a498(c).“clear and
convincing evidence.”
- Is there a least restrictive treatment requirement?
§ 17a498(c). “If, on such hearing, the court finds by clear and
convincing evidence that the person complained of has psychiatric disabilities
and is dangerous to himself or herself or others or gravely disabled, it shall
make an order for his or her commitment, considering whether or not a less
restrictive placement is available.”
- Is there a confidentiality exception for family members of
committees and/or individuals undergoing emergency evaluations?
- Are advance directives or durable powers of attorney addressed
and, if so, in what way?
There are provisions that create a
power of attorney for health care decisions. Although, there are no explicit provisions related to mental health
care, a designated agent can make any medical care decisions. In addition, the principal is allowed to
create instructions limiting treatment. The official form to create a power of attorney can be found in section
1-43 of the Connecticut General Statutes.
§ 1-54a. “In a statutory
short form power of attorney, the language conferring general authority with
respect to health care decisions shall be construed to mean that the principal,
who, in the judgment of the attending physician, is unable to receive and effectively
evaluate information pertaining to any health care decision, or to effectively
and rationally communicate such decisions, authorizes the agent to consent
to, refuse to consent to, or withdraw consent to any medical treatment
other than that designed solely for the purpose of maintaining physical
comfort, the withdrawal of life support systems or the withdrawal of nutrition
or hydration.”
- Is there a separate proceeding necessary to abrogate a
committee’s right to refuse treatment?
Yes, unless the committee has been
found incapable of giving informed consent or if there is an emergency
situation. If a guardian or conservator
has been appointed, that person’s written consent is required. If not, then the written consent of the
committee’s next of kin or a qualified physician appointed by a judge of the
Probate Court is required.
§ 17a-543(a). “No patient shall receive
medication for the treatment of the psychiatric disabilities of such patient
without the informed consent of such patient, except in accordance with
procedures set forth in subsections (b), (d), (e) and (f) of this section or in
accordance with section 17a-566 or 54-56d. (b) No medical or surgical
procedures may be performed without the patient's written informed consent or,
if the patient has been declared incapable of caring for himself or herself
pursuant to sections 45a-644 to 45a-662, inclusive, and a conservator of the
person has been appointed pursuant to section 45a-650, the written consent of
such conservator. If the head of the hospital, in consultation with a
physician, determines that the condition of an involuntary patient not declared
incapable of caring for himself or herself pursuant to said sections is of an
extremely critical nature and such patient is incapable of informed consent,
medical or surgical procedures may be performed with the written informed
consent of: (1) The patient's conservator or guardian, if he or she has one; or
(2) such person's next of kin; or (3) a qualified physician appointed by a
judge of the Probate Court. Notwithstanding the provisions of this section, if
obtaining the consent provided for in this section would cause a medically
harmful delay to a voluntary or involuntary patient whose condition is of an
extremely critical nature, as determined by personal observation by a physician
or the senior clinician on duty, emergency treatment may be provided without
consent. (c) No psychosurgery or shock therapy shall be administered to any
patient without such patient's written informed consent, except as provided in
this subsection. Such consent shall be for a maximum period of thirty days and
may be revoked at any time. If it is determined by the head of the hospital and
two qualified physicians that the patient has become incapable of giving informed
consent, shock therapy may be administered upon order of the Court of Probate
if, after hearing, such court finds that the patient is incapable of informed
consent and there is no other reasonable alternative procedure. (d) A facility
may establish an internal procedure governing decisions concerning involuntary
medication treatment for inpatients. This procedure shall provide (1) that any
decision concerning involuntary medication treatment shall be made by a person
who is not employed by the facility in which the patient is receiving
treatment, provided the selection of such person shall not be made until the
patient's advocate has had reasonable opportunity to discuss such selection
with the facility, (2) written and oral notification to the patient of
available advocacy services, (3) notice to the patient and his advocate, if one
has been chosen, of any proceeding for the determination of the necessity for
involuntary treatment not less than forty-eight hours prior to such proceeding,
(4) the right of the patient to representation during any such proceeding…”
§ 17a-540(h). “’Informed
consent’ means permission given competently and voluntarily after a patient has
been informed of the reason for treatment, the nature of the proposed
treatment, the advantages or disadvantages of the treatment, medically
acceptable alternative treatment, the risks associated with receiving the
proposed treatment and the risk of no treatment…”
- Does the treating hospital and/or physician have discretion to
release individuals before the end of their assisted inpatient care
periods?
Yes.
§ 17a-510. “If the
officers, directors or trustees of a state hospital for psychiatric
disabilities are notified by the superintendent of such institution or other
person in a managerial capacity that he has reason to believe that any person
committed thereto by order of a probate court does not have psychiatric
disabilities or a suitable subject to be confined in such institution, or is
appropriate for voluntary status, such officers, directors or trustees may
discharge such person or convert the status of such person to voluntary status
pursuant to section 17a-506.”
§ 17a-502(f). “The superintendent or
director of any hospital for psychiatric disabilities shall immediately discharge
any patient admitted and detained under this section who is later found not to
meet the standards for emergency detention and treatment.”
- Individual(s) who may decide to initiate new periods of
assisted treatment.
§ 17a-508. "If any person who has been confined in any state hospital
for psychiatric disabilities for a specified period of time pursuant to the
order of any court has psychiatric disabilities at the expiration of such
period, the person in charge of such hospital shall cause proceedings for
the commitment of such person to be instituted in the probate court having
jurisdiction in the town in which such hospital is located.”
- Type of forum that decides on need for extended treatment
(normally either judicial or administrative).
§ 17a-498(g). Judicial.
- Participation of other individuals in the extension hearing
(i.e. notice, a right to be heard and/or right to counsel for family members,
legal guardians, doctors, etc.).
Not specified.
- Maximum length of subsequent mandated inpatient care (and of
any possible subsequent periods).
No maximum length is specified, but a review for a
hearing to consider patient’s release is required, at minimum, on an annual
basis.
17a-498(g). “The hospital shall notify each
patient at least annually that such patient has a right to a further hearing
pursuant to this section. In the event that the patient requests such hearing
it shall be held by the court of probate which ordered the confinement of such
patient…If the patient’s last annual review did not result in a hearing, and in
any event at least every two years, the probate court notified shall, within
fifteen business days, proceed with a hearing…”
- Alternatives(s) to assisted inpatient treatment (i.e.
conditional release, outpatient commitment, etc.) and conditions necessary for
a court to order placement in alternative(s) (if more than one form, specify
for each).
Not specified except in a criminal context.
- Maximum duration of alternative(s) to mandated inpatient care.
Not specified except in a criminal
context.
- Procedure necessary to transfer patient from outpatient to
inpatient care.
Not specified except in a criminal context.
- Procedure necessary to institute and maximum duration of
subsequent periods of alternative(s) to inpatient assisted treatment.
The
superintendent or director of any state-operated facility may place a patient
in a private boarding home or convalescent hospital, subject to any limitations
of the original order of commitment, if the patient is no longer in need of
active psychiatric treatment.
§ 17a-509. “The superintendent or director of
any state-operated facility, as defined in subsection (b) of section 17a-458,
may place any person with psychiatric disabilities committed to such
state-operated facility, if such person is no longer in need of active
psychiatric treatment in such state-operated facility, in a private boarding
home for mental patients licensed by the Department of Public Health in
accordance with sections 19a-490 to 19a-503, inclusive, or a chronic and convalescent
hospital, provided such person shall, despite such transfer, remain subject to
the medical supervision of the superintendent or director of such
state-operated facility, and such superintendent or director may, if medically
indicated, order and provide for the return of any such patient to such
state-operated facility, subject to any limitations of the term of commitment
contained in the order of commitment under which such patient was committed to
such state-operated facility. The provisions of this section shall not apply to
any person who is under a term of imprisonment or who has not met the
requirements of the condition of release set to provide the reasonable
assurance of such person's appearance in court.”
- Describe any procedures for conservatorship, guardianship,
etc., which are applicable to the mentally ill.
For a conservator to request hospitalization:
§ 17a-506(c). “Any person for
whom a conservator of the person has been appointed in accordance with sections
45a-644 to 45a-662, inclusive, may request admission to a hospital for
psychiatric disabilities and such hospital may admit such person. The hospital
shall notify the conservator and the probate court which appointed the
conservator of the admission within five business days of such admission. The
probate court shall, within ten business days after such notice, appoint a
physician who is a psychiatrist from the panel provided by the Commissioner of
Mental Health and Addiction Services as set forth in subsection (c) of section
17a-498. The physician shall examine the patient within ten business days of
his appointment to determine if the patient has given informed consent to his
or her hospitalization. The physician shall make a report forthwith to the
court. If the court concludes that the patient did not give informed consent to
the hospitalization, the court, on its own motion, may proceed in the manner
provided in subsections (a), (b), (c) and (f) of section 17a-498.”
- Other (may include insights into state’s mental health system,
judicial interpretation of mental health code, known movements for statutory
reform, or general comments).
The mental health code also provides for a
Psychiatric Security Review Board, which applies to criminal commitment:
§ 17a-580 et
seq. – The Psychiatric Security Review Board is an autonomous body within the
Department of Mental Health and Addiction Services for administrative purposes
only. When any person charged with an
offense is found not guilty by reason of mental disease the court will order
him or her (the “aquittee”) committed to the custody of the Commissioner of
Mental Health and Addiction Services.
The acquittee will be confined and examined and a commitment hearing
will be held.
