- When not the subject of a pending commitment action, what are the prerequisites for an individual to receive voluntarily treatment?
§ 202A.021(2). “An authorized staff physician of a hospital may admit for observation, diagnosis, care and treatment any person who is
mentally ill or who has symptoms of mental illness and who applies voluntarily
therefor.”
- Conditions necessary for emergency treatment.
By court order:
§202A.028(1). “Following an examination by a
qualified mental health professional and a certification by that professional
that the person meets the criteria for involuntary hospitalization, a judge may
order the person hospitalized for a period not to exceed seventy-two (72)
hours, excluding weekends and holidays.”
By authorized staff physician at hospital:
§ 202A.031(1). “An authorized staff physician may order the
admission of any person who is present at, or is presented at, a hospital.
Within twenty-four (24) hours (excluding weekends and holidays) of the
admission under this section, the authorized staff physician ordering the admission
of the individual shall certify in the record of the individual that in his
opinion the individual should be involuntarily hospitalized.”
For evaluation initiated by peace officer:
§ 202A.041(1). “Any peace
officer who has reasonable grounds to believe that an individual is mentally
ill and presents a danger or threat of danger to self, family, or others if not
restrained shall take the individual into custody and transport the individual
without necessary delay to a hospital or psychiatric facility…for the purpose
of an evaluation to be conducted by a qualified mental health
professional.” “…the peace officer
shall provide written documentation which describes the behavior of the person
which caused the peace officer to take the person into custody.”
- Is mental illness/disorder defined?
§ 202A.011(9). "’Mentally ill person means a person
with substantially impaired capacity to use self-control, judgment or
discretion in the conduct of the person's affairs and social relations, associated
with maladaptive behavior or recognized emotional symptoms where impaired
capacity, maladaptive behavior or emotional symptoms can be related to
physiological, psychological, or social factors.”
- Maximum duration of emergency treatment before a judicial
hearing must be held.
§ 202A.028(1),
(2). “72 hours (excluding weekends and
holidays)” unless “further held under the applicable provisions of this
chapter.”
§ 202A.071(1).
“The preliminary hearing
shall be held not later than six (6) days (excluding weekends and holidays)
from the time of respondent's holding under these proceedings. If the
respondent is not held under these proceedings, the preliminary hearing shall
be held not later than six (6) days (excluding weekends and holidays) from the time
of the examination of the respondent. (2) The final hearing shall be held
within twenty-one (21) days of the date of the holding or from the date of the
examination, if not held.”
- 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?
Not clear from statute.
- Are there any requirements that a potential committee be
capable of deciding to voluntarily undergo treatment?
The statute does not specify whether one must have
capacity to voluntarily admit him/herself.
- Who may petition for an individual to receive assisted
inpatient care?
§ 202A.051(3). “ The petition shall be filed by a qualified
mental health professional, peace officer, county attorney, Commonwealth's
attorney, spouse, relative, friend, or guardian of the individual concerning
whom the petition is filed, or any other interested person.”
- Required elements of a petition.
§ 202A.051(4). “The petition shall set
forth: (a) Petitioner's relationship to the respondent; (b) Respondent's name,
residence, and current location, if known; (c) The name and residence of
respondent's parents, if living and if known, or respondent's legal guardian,
if any and if known; (d) The name and residence of respondent's husband or
wife, if any and if known; (e) The name and residence of the person having
custody of the respondent, if any, or if no such person is known, the name and
residence of a near relative or that the person is unknown; (f) Petitioner's
belief, including the factual basis therefor, that the respondent is mentally
ill and presents a danger or threat of danger to self, family or others if not
restrained; and (g) If the petition seeks a three hundred sixty (360) day
involuntary hospitalization of the respondent, the petition shall further set
forth that the respondent has been hospitalized in a hospital or a forensic
psychiatric facility for a period of thirty (30) days under the provisions of
this chapter or KRS Chapter 504 within the preceding six (6) months.
- Is there a penalty for filing an unfounded petition?
Yes.
§ 202A.99(1). “Any person who willfully causes or conspires
with or assists another in causing: (a) The unwarranted hospitalization of any
individual under the provisions of this chapter; or (b) The denial of any
individual of any of the rights accorded to him under the provisions of this
chapter; shall be guilty of a Class A misdemeanor.”
- 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:
§ 202A.051(6)(b). “Notify
the respondent, the legal guardian, if any, and if known, and the spouse,
parents, or nearest relative or friend of the respondent concerning the
allegations and contents of the petition and the date and purpose of the
preliminary hearing; and the name, address, and telephone number of the
attorney appointed to represent the respondent…”
To participate in hearing:
The statute does not
specify who must or may participate in the hearing, however, the language hints
that others might be allowed to take part.
§202A.076(1). “The respondent [patient] shall be
afforded an opportunity to testify, to present, and cross-examine witnesses who
appear and testify against him. The court may exclude all persons not necessary
for the conduct of the hearing.”
- Length of initial term of assisted inpatient care.
§ 202A.051(11). “If upon completion of the final hearing, the
court finds the respondent should be involuntarily hospitalized, the court
shall order the respondent hospitalized in a hospital for a period not to
exceed sixty (60) consecutive days from the date of the court order or a period
not to exceed three hundred sixty (360) consecutive days from the date of the
court order, whatever was the period of time that was requested in the
petition.”
- Conditions necessary for judicially ordered inpatient care
(exact wording of key portions of applicable statute desired).
§ 202A.026.“No person shall be involuntarily hospitalized unless such person is a mentally ill person:(1) Who presents a danger or threat of danger
to self, family or others as a result of the mental illness;(2) Who can
reasonably benefit from treatment; and (3) For whom hospitalization is the
least restrictive alternative mode of treatment presently available.”
§202A.011(2).“Danger” or “threat of
danger to self, family, or others” means a substantial physical harm or threat
of substantial physical harm upon self, family, or others, including actions
which deprive self, family, or others of the basic means of survival including
provisions for reasonable shelter, food, or clothing…”
- Evidentiary standard under which inpatient care criteria are
judged (two most common are “beyond a reasonable doubt” and “clear and
convincing evidence”).
For preliminary hearing: § 202A.051(6). “probable cause”
For final hearing: §202A.076(2). “beyond a reasonable doubt”
- Is there a least restrictive treatment requirement?
§ 202A.026. “No person shall be involuntarily hospitalized unless such
person is a mentally ill person:…(3) For whom hospitalization is the least
restrictive alternative mode of treatment presently available.”
§ 202A.011(8). "Least restrictive alternative mode of
treatment" means that treatment which will give a mentally ill individual
a realistic opportunity to improve the individual's level of functioning,
consistent with accepted professional practice in the least confining setting
available.”
- Is there a confidentiality exception for family members of
committees and/or individuals undergoing emergency evaluations?
No. However, see § 202A.091(3). “Any person seeking information contained in
the court files or the court records of proceedings involving persons under
this chapter may file a written motion in the cause setting out why the
information is needed. A District Judge may issue an order to disclose the
information sought if he finds such order is appropriate under the
circumstances and if he finds it is in the best interest of the person or of
the public to have such information disclosed.”
- Are advance directives or durable powers of attorney addressed
and, if so, in what way?
KRS §§311.621-643 provide for the “Living Will Directive Act.” The Act allows individuals to appoint an agent and/or provide specific instructions for all health care decisions, which presumably includes mental health care.
- Is there a separate proceeding necessary to abrogate a
committee’s right to refuse treatment?
Yes. §202A.191(1). “Each and every patient hospitalized under this chapter shall
have the following rights… (c) The right to refuse treatment subject to the
provisions of KRS 202A.196…(g) The right to refuse intrusive treatment subject
to the provisions of KRS 202A.196”
§ 202A.196(2). “Upon the refusal of an
involuntary patient to participate in any or all aspects of his treatment plan,
the review committee shall examine the appropriateness of the patient’s individual
treatment plan. Within three (3) days
of the refusal, the review committee shall meet with the patient and his
counsel or other representative to discuss it recommendations.”
§ 202A.196(3). “If the
patient still refuses to participate in any or all aspects of his individual
treatment plan, the hospital may petition the District Court for a de novo
determination of the appropriateness of the proposed treatment. Within seven
(7) days, the court shall conduct a hearing, consistent with the patient's rights
to due process of law…”
- Does the treating hospital and/or physician have discretion to
release individuals before the end of their assisted inpatient care
periods?
Yes.
Before completion of the final hearing: §202A.081(2). “A hospital shall discharge a patient
there held and notify the court and attorneys of record if any authorized staff
physician determines that the patient no longer meets the criteria for
involuntary hospitalization.”
After
hospitalization is ordered: §202A.171. “An authorized staff physician of a
hospital shall discharge an involuntary patient when he no longer meets the
criteria for involuntary hospitalization.”
- Individual(s) who may decide to initiate new periods of
assisted treatment.
The
statute does not specify who initiates new periods of assisted treatment. Presumably the process mirrors that for
initial hospitalization. See Answer No.
7.
- Type of forum that decides on need for extended treatment
(normally either judicial or administrative).
The
statute does not specify who decides the need for new periods of assisted
treatment. Presumably the process
mirrors that for initial hospitalization and is thus a judicial determination.
- 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.).
The
statute does not specify who may participate in a hearing for extended
treatment. Presumably the process
mirrors that for initial hospitalization. See Answer No. 10.
- Maximum length of subsequent mandated inpatient care (and of
any possible subsequent periods).
The
statute does not specify length of subsequent mandated inpatient care. Presumably the process mirrors that for
initial hospitalization. See Answer No.
11.
- 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).
For
outpatient commitment: § 202A.081(1). “Following the preliminary hearing but prior
to the completion of the final hearing, the court may order the person [to
be]…released, upon application and agreement of the parties, for the purpose of
community- based outpatient treatment…(4) The release of the person pursuant to
subsection (1) of this section for the purpose of community-based outpatient
treatment does not terminate the proceedings against the person, and the court
ordering such release may order the immediate holding of the person at any time
with or without notice if the court believes from an affidavit filed with the
court that it is to the best interest of the person or others that the person
be held pending the final hearing, which shall be held within twenty-one (21)
days of the person's further holding.”
For
convalescent leave status: §202A.181(1). “An authorized staff physician may release an involuntary
patient on convalescent leave status when the physician concludes that the
patient would not present a danger or a threat of danger to self or others if
provided with continued medical supervision in a less restrictive
alternative…Release on convalescent leave status does not terminate the
involuntary hospitalization order and shall include provisions for the
development of a treatment plan jointly by the hospital and by a provider of
outpatient care…”
- Maximum duration of alternative(s) to mandated inpatient care.
For outpatient commitment: § 202A.081(5). “the final hearing may be continued for a
period not to exceed sixty (60) days if a provider of outpatient care accepts
the respondent…”
For convalescent leave status: not specified in code, presumably until the
hospitalization order expires.
- Procedure necessary to transfer patient from outpatient to
inpatient care.
For
outpatient commitment: § 202A.081(4). “The release of the person pursuant to
subsection (1) of this section for the purpose of community-based outpatient
treatment does not terminate the proceedings against the person, and the court
ordering such release may order the immediate holding of the person at any time
with or without notice if the court believes from an affidavit filed with the
court that it is to the best interest of the person or others that the person be
held pending the final hearing, which shall be held within twenty-one (21) days
of the person's further holding.”
For convalescent leave status: §202A.181(2). “The hospital from which such patient is given convalescent leave status
may at any time readmit the patient without additional court proceedings. If there is reason to believe that it is to
the best interest of the patient to be rehospitalized, the secretary or an
authorized staff physician of the hospital may issue an order for the immediate
rehospitalization of the patient…”
- Procedure necessary to institute and maximum duration of
subsequent periods of alternative(s) to inpatient assisted treatment.
For outpatient commitment: § 202A.081(5). "Community-based outpatient treatment may be
ordered for an additional period not to exceed sixty (60) days upon application
and agreement of the parties.”
For
convalescent leave status: not specified in the code.
- Describe any procedures for conservatorship, guardianship,
etc., which are applicable to the mentally ill.
Not specified in mental health code.
- Other (may include insights into state’s mental health system,
judicial interpretation of mental health code, known movements for statutory
reform, or general comments).
Two noteworthy aspects of the Kentucky
law: outpatient treatment provisions and hospital review committees. As outlined in Answer No. 23, Kentucky has
unique provisions for outpatient treatment. Here, the petitioner and the patient can agree and apply for
community-based treatment following the preliminary hearing but prior to
completion of the final hearing. The
court may then order the patient to community-based treatment and suspends, but
does not terminate, the commitment proceedings for twenty-one days.
§202A.196 establishes “hospital review committees” that have
authority to review the appropriateness of individual treatment plans. If an involuntary patient refuses to
participate in his treatment plan, the committee reviews the plan and then
meets with the patient and representative to discuss recommendations. If refusal persists, the committee may
petition the District Court to determine the appropriateness of the treatment
plan.
