- When not the subject of a pending commitment action, what are the
prerequisites for an individual to receive voluntarily treatment?
§ 5122.02(A). Anyone
who is eighteen years of age or older and "…who is, appears to be, or believes
self to be mentally ill…" may file a written application for voluntary admission
to a hospital’s chief medical officer.
§ 5122.02(B). An application may be made on behalf of a
minor by a parent, guardian or person with custody. An application may be made on behalf
of an incompetent adult by the guardian, or the person with custody.
"Any person [apply for voluntary admission] may be admitted
[for treatment]…" unless the chief clinical officer finds that hospitalization
is inappropriate…" However, if the person seeks voluntary admission to a public
hospital, that person cannot be admitted without the "…authorization of the
board of the person’s county of residence."
- Conditions necessary for emergency treatment/observation.
§ 5122.10. "[R]eason to believe that the
person is a mentally ill person subject to hospitalization…and represents a
substantial risk of physical harm to self or others if allowed to remain at liberty
pending examination."
See No. 12 for definition of
"mentally ill person subject to hospitalization."
- Is mental illness/disorder defined?
§ 5122.01(A). "‘Mental
illness’ means a substantial disorder of thought, mood, perception, orientation, or
memory that grossly impairs judgment, behavior, capacity to recognize reality, or ability
to meet the ordinary demands of life."
- Maximum duration of emergency treatment/observation before a
judicial hearing must be held.
Unless a continuance is requested by
respondent’s counsel and granted by the court, the maximum duration of emergency
treatment before a hearing must be held is the initial 24 hours for emergency examination
plus the five court days, not including Saturdays, Sundays and holidays (which potentially
could be a maximum of ten days if it fell over a two week period with two holidays). Thus,
the ten added to the 24 hours makes the potential maximum 11 days. However, a typical
maximum would be seven days (the five court days plus a weekend) plus the 24 hours for an
eight day maximum.
§ 5122.10. "A person transported or transferred to a
hospital or community mental health center…[for emergency examination]…shall be
examined by the staff of the hospital or agency within 24 hours after arrival…"
"After examination, if the chief clinical officer believes that the person is a
mentally ill person subject to hospitalization by court order, [he/she]…may detain
the person for not more than three court days following the day of the examination."
During the three day period, the chief clinical officer may admit the patient as a
voluntary patient or file an affidavit that the patient is "a mentally ill patient
subject to hospitalization."
§ 5122.141(B). An initial hearing shall be conducted within
five court days from the day the respondent is detained or an affidavit is filed,
whichever occurs first. "On the motion of the respondent, his counsel, the chief
clinical officer, or on its own motion, and for good cause shown, the court may order a
continuance of the hearing. The continuance may be for no more than ten days from the day
on which the respondent is detained or on which an affidavit is filed, whichever occurs
first. Failure to conduct the hearing within this time shall effect an immediate discharge
of the respondent."
Comment: The hearing addressed above is the initial hearing.
The Ohio Code does not state the minimum amount of time a patient may be held prior to the
full hearing.
§ 5122.01(L). "‘Court day’ means Monday,
Tuesday, Wednesday, Thursday, and Friday, except when such day is a holiday."
Comment: The statutory language addressing a hearing without
a continuance uses "court days" while that addressing a hearing with a
continuance uses only the term "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?
§ 5122.15(G)(1). Yes.
Any person who has been committed, or for whom proceedings for hospitalization have been
commenced, may apply at any time for voluntary admission. The court shall notify
relevant parties of the voluntary admission, and upon receipt of such notice, the court
shall dismiss the case.
Comment: Under this statutory language potential committees
simply could enter voluntarily and then request release. Thus, it is probable that some
type of procedure exists to keep the potential committee in the system, because potential
committees simply could enter voluntarily, then request release.
No minimum amount of time is specified, however, § 5122.03
suggests that the voluntary patient may be kept for a minimum of three days.
§ 5122.03. "A patient
admitted…[voluntarily]…who requests his release in writing, or whose release is
requested in writing by his counsel, legal guardian, parent, spouse, or adult next of kin
shall be released forthwith, except that when:
(A). The patient was admitted on his own application and the
request for release is made by a person other than the patient, release may be conditional
upon the agreement of the patient; or
(B). The chief clinical officer of the hospital, within three
court days from receipt of the release request, files…an affidavit…[for
commitment]. Release may be postponed until the …[initial hearing]…"
"The request shall serve as a request for an initial hearing if the patient is not
released within three days from receipt of the request by the chief clinical
officer."
- Are there any requirements that a potential committee be capable
of deciding to voluntarily undergo treatment?
None is listed in the Mental Health
Code, except for a provision for minors and people previously found incompetent, which is
discussed in § 5122.02(C).
- Who may petition for an individual to receive assisted inpatient
treatment?
§ 5122.11. Any person with "…reliable
information or actual knowledge…"
- Required elements of a petition.
Elements of the
petition:
§ 5122.11. The affidavit (petition) shall contain
"…a statement of alleged facts sufficient to indicate probable cause to believe
that the person is a mentally ill person subject to hospitalization by court order,"
and shall set forth the specific categories or category of the definition of a
"mentally ill person subject to hospitalization" (discussed in No. 2), which
apply to the person.
"The affidavit may be accompanied, or the court may require
that the affidavit be accompanied, by a certificate of a psychiatrist, or a certificate
signed by a licensed clinical psychologist and a certificate signed by a licensed
physician stating that the person who issued the certificate has examined the person and
is of the opinion that the person is a mentally ill person subject to hospitalization by
court order…" In the case that the person refused to submit to an examination,
the applicant shall submit a written statement, under oath, that the person has refused an
examination.
Temporary detention:
§ 5122.11. "Upon receipt of the affidavit [petition], if a
judge of the court or a referee who is an attorney at law appointed by the court has
probable cause to believe that the person…is a mentally ill person subject to
hospitalization, the judge or referee may issue a temporary order of detention ordering
any health or police officer or sheriff to [transport the person to a hospital] or place
of temporary detention, stated in § 5122.17]."
§ 5122.17. Places of temporary detention include a licensed
rest or nursing home, a licensed or unlicensed hospital, a community mental health agency,
or county home. This section states that the person shall not be held in a nonmedical
facility or a prison unless the court finds that a less restrictive alternative
"…cannot be made available."
Investigation and report:
"Upon receipt of the affidavit [petition]…the court
shall refer the affidavit [petition] to the board of alcohol, drug addiction and mental
health services or an agency the board designates to assist the court in determining
whether the respondent is subject to hospitalization and whether alternative services are
available..." "The board or agency shall review the allegations of the affidavit
and other information relating to whether or not the person named in the affidavit or
statement is a mentally ill person subject to hospitalization by court order, and the
availability of appropriate treatment."
"The person who conducts the investigation shall promptly make
a report to the court, in writing…" The report is not admissible as evidence for
the purpose of establishing whether or not the respondent is a mentally ill person subject
to hospitalization…but shall be considered by the court in its determination of and
appropriate placement for [the person]."
- Is there a penalty for filing an unfounded petition?
Not in Mental Health Law.
- Participation of other individuals in assisted treatment hearing
(i.e. notice, a right to be heard or standing for family members, legal guardians,
doctors, etc.).
For notice at hearing:
§ 5122.12. Upon receipt of the affidavit, the
court shall provide written notice of the affidavit and any temporary detention order of
any hearing (initial, full or both), by mail or otherwise, to:
(B). the subject of the
petition's legal guardian, spouse, and the parents of a minor, if these persons' addresses
"…are known to the court or can be obtained through exercise of reasonable
diligence;"
(C). the person who filed the affidavit;
(D). "…any one person designated by the subject of the
petition, but if the he/she does not make a selection, the notice shall be sent to the
adult next of kin other than the person who filed the affidavit if that person's address
is known to the court or can be obtained through exercise of reasonable diligence;"
For attendance at hearing:
§ 5122.15(A)(5). "The hearing
shall be closed to the public, unless…[subject of the petition]…requests that
the hearing be open…" (6). Even if the hearing is closed, "…the
court…may admit persons who have a legitimate interest in the proceeding…"
- Length of initial term of assisted inpatient treatment.
§ 5122.15(15)(C). Not to
exceed 90 days.
- Conditions necessary for judicially ordered inpatient treatment
(exact wording of key portions of applicable statute desired).
§ 5122.15(C). The court must
find that that the person is a "mentally ill person subject to hospitalization by
court order."
§ 5122.01.(B). "‘Mentally
ill person subject to hospitalization by court order’ means a mentally ill person
who, because of the person's illness:
(1) represents substantial risk of physical harm to
self as manifested by evidence of threats of, or attempts at, suicide or serious
self-inflicted bodily harm;
(2) represents a substantial risk of physical harm to others
as manifested by evidence of recent homicidal or other violent behavior, evidence of
recent threats that place another in reasonable fear of violent behavior and serious
physical harm, or other evidence of present dangerousness;
(3) represents a substantial and immediate risk of
serious physical impairment or injury to self as manifested by evidence that the person is
unable to provide for and is not providing for the person's basic physical needs because
of the person's mental illness and that appropriate provision for those needs cannot be
made immediately available in the community; or
(4) would benefit from treatment in a hospital for his
mental illness and is in need of such treatment as manifested by evidence of behavior that
creates a grave and imminent risk to substantial rights of others or himself."
- Evidentiary standard under which eligibility for assisted
treatment is judged (two most common are "beyond a reasonable doubt" and
"clear and convincing evidence").
§ 5122.15(15)(B). Clear and convincing
evidence.
- Is there a least restrictive treatment requirement?
Least restrictive treatment
required for commitment order:
§ 5122.15(15)(E). The court shall order
"…the least restrictive alternative available and consistent with treatment
goals."
Least restrictive treatment required while
hospitalized:
§ 5122.27(F)(1). The chief clinical officer
of the hospital shall assure that all patients committed shall "…[r]eceive
humane care and treatment, including without limitation, the least restrictive environment
consistent with the treatment plan…"
- Is there a confidentiality exception for family members of
committees and/or individuals undergoing emergency evaluations?
§ 5122.31. No. Records cannot
be revealed without patient consent, except:
(A). "If the [person or person's
legal guardian, minor's parent or legal guardian], consents, and if the disclosure is in
the best interests of the person, as may be determined by the court for judicial records
and by the chief clinical officer for medical records;"
(G). "That a patient’s family member who is involved in
the provision, planning, and monitoring of services to the patient may receive medication
information, a summary of the patient’s diagnosis and prognosis, and a list of the
services and personnel available to assist the patient and the patient’s family, if
the patient’s treating physician determines that the disclosure would be in the best
interests of the patient. No such disclosure shall be made unless the patient is notified
first and receives the information and does not object to the disclosure."
However, under § 5122.18 "[w]henever a
person has been involuntarily detained at or admitted to a hospital, community mental
health agency, or other facility…" including a temporary detention facility,
"…at the request of anyone other than the person’s legal guardian, spouse ,
or next of kin…" "…the chief clinical officer of [the
facility]…shall immediately notify the person’s legal guardian, spouse or next
of kin, and counsel, if these persons can be ascertained through exercise of reasonable
diligence." If the patient is voluntarily admitted, the patient must provide consent
for this notice to be provided.
- Are advance directives or durable powers of attorney addressed
and, if so, in what way?
Not in Mental Health Law.
- Is there a separate proceeding necessary to abrogate a
committee’s right to refuse treatment?
It appears that separate proceedings
are necessary for a committee to refuse certain types of treatments. These are discussed
in the subsections directly below.
§ 5122.271(A). The patient shall have
the right to refuse consent for any type of surgery, convulsive therapy, major aversive
interventions, sterilizations, and any unusually hazardous treatment.
Subsequent subsections discuss these respective treatments in more
detail: (B) discusses unusually hazardous treatment, sterilization and psycho-surgery, (D)
discusses surgery, and (E) discusses "major aversive interventions."
§ 5122.271(C). If the chief clinical officer or attending
physician determines that the patient is mentally unable to receive the information
concerning treatment, or if the patient has been adjudicated incompetent, the
person’s natural or court-appointed guardian may provide consent. If a patient is
unable to receive the information required for surgery and has no guardian, the
information, the recommendation of the chief clinical officer, and the concurring judgment
of a licensed physician (who is not a full-time employee of the state) may be provided to
the court, which may approve the surgery. Before approving the surgery, the court shall
notify the legal rights service and shall notify the patient of the right to contest the
surgery and the right to counsel.
- Does the treating hospital and/or physician have discretion to
release individuals before the end of their assisted inpatient care periods?
Release into least
restrictive environment:
§ 5122.15(F). "During such ninety-day
period the hospital; facility; board of alcohol, drug addiction, and mental health
services; agency the board designates; or person shall examine and treat the individual.
If, at any time prior to the expiration of the ninety-day period, it is determined by the
hospital, facility, board, agency, or person that the respondent's treatment needs could
be equally well met in an available and appropriate less restrictive environment, both of
the following apply:
(1) The respondent shall be released
from the care of the hospital, agency, facility, or person immediately and shall be
referred to the court together with a report of the findings and recommendations of the
hospital, agency, facility, or person; and
(2) The hospital, agency, facility, or person shall notify the
respondent's counsel or the attorney designated by a board of alcohol, drug addiction, and
mental health services or, if the respondent was committed to a board or an agency
designated by the board, it shall place the respondent in the least restrictive
environment available consistent with treatment goals and notify the court and the
respondent's counsel of the placement.
The court shall dismiss the case or order placement in the least
restrictive environment."
Discretion to release patient, immediately
upon arrival, after court order for hospitalization:
§ 5122.19. Every person received at a hospital or community
mental health agency, under the commitment proceedings, shall be examined by the staff of
the hospital or agency within 24 hours after arrival. "[I]f the chief clinical
officer fails after such an examination to certify that in his opinion the person is a
mentally ill person subject to hospitalization by court order, the person shall be
immediately released."
Discretion to release patient upon
periodic examinations:
§ 5122.21(A). At least once every 30 days, the
patient shall be examined and whenever the chief clinical officer determines that the
conditions justifying involuntary commitment "…no longer obtain…" the
patient must be discharged. If the patient is under indictment for a crime, notice of
release shall be given to the court with criminal jurisdiction; ten days after notice is
given, the indicted patient may be released. (B). The chief clinical officer of the
hospital or agency may grant discharge without the consent or authorization of any court.
The chief clinical officer shall notify the court, which ordered judicial commitment, of
the discharge.
§ 5122.27. If the chief clinical officer of the
hospital is unable to provide appropriate treatment for any committed patient, he shall
immediately notify the patient, the court, the legal rights service, the director of
mental health, and the patient’s counsel and legal guardian. If, within 10 days, he
is unable to effect a transfer of the patient to another facility, where appropriate
treatment is available, or he has not received a court order to the contrary, the patient
must be released.
- Individual(s) who may decide to initiate new periods of assisted
treatment.
§ 5122.15(H). "…the
attorney the board designates or the prosecutor files with the court an application for
continued commitment."
- Type of forum that decides on need for extended assisted
treatment (normally either judicial or administrative).
§ 5122.15(H). The court shall hold a full
hearing, exactly the same as first full hearing, on applications for continued commitment,
when requested, at the expiration of the first 90 period.
§ 5122.15(A). "Full hearings
shall be conducted in a manner consistent with this chapter and with due process of law.
The hearings shall be conducted by a judge of the probate court or a referee designated by
a judge of the probate court and may be conducted in or out of the county in which the
respondent is held. Any referee designated under this division shall be an attorney."
§ 5122.15(J). "A referee appointed by the court may
make all orders that a judge may make under this section and [under the section regarding
detention orders and the initial hearing] except an order of contempt of court."
"Within fourteen days of the making of an order by a referee, a
party may file written objections to the order with the court. Within ten days of the
filing of the objections, a judge of the court shall hold a hearing on the objections and
may hear and consider any testimony or other evidence relating to the respondents mental
condition. At the conclusion of the hearing, the judge may ratify, rescind, or modify the
referee’s order."
§ 5122.15(A)(5). "The hearing shall be closed to the
public, unless…[subject of the petition]…requests that the hearing be
open…" (6). Even if the hearing is closed, "…the court…may
admit persons who have a legitimate interest in the proceeding…"
- 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.).
See answer to No. 10.
- Maximum length of subsequent assisted inpatient treatment (and of
any possible subsequent periods).
§ 5122.15(H). "The
court shall hold a full hearing on applications for continued commitment at the expiration
of the first ninety-day period and at least every two years after the expiration of the
first ninety-day period."
However, the court shall hold full hearings on a person’s
continued commitment, when request of an involuntarily committee, or the committee’s
counsel, is more than 180 days after the person's last full hearing. The court may hold a
hearing prior to the 180 days, when good cause is shown, upon the application of a person
involuntarily committed, which is supported by an affidavit of a psychiatrist or licensed
clinical psychologist, alleging that the person no longer requires involuntary
hospitalization.
- Alternative(s) to assisted inpatient treatment (i.e. conditional
release, trial release, assisted outpatient treatment, etc.) and conditions necessary for
a court to order placement in alternative(s) (if more than one form, specify for each).
Outpatient commitment: §
5122.15(15)(C)(6). "If, upon completion of the [initial commitment] hearing, the
court finds…that the respondent is a mentally ill person subject to hospitalization
by court order…" as one option for commitment, the court may order the person to
"…any other facility or person able to provide treatment consistent with the
diagnosis, prognosis, and treatment needs of the person."
Trial visits: § 5122.22. "When
the chief clinical officer of a hospital considers it in the best interests of a patient,
the officer may permit the patient to leave the hospital on a trial visit. The trial visit
shall be for the period of time the chief clinical officer determines, but shall not
exceed ninety days, unless extended for subsequent periods not to exceed ninety days after
evaluation of the patient’s condition." "The chief clinical
officer…may impose requirements and conditions…while the patient is absent from
the hospital…"
"The chief clinical officer…[may revoke] the trial visit
if there is reason to believe that it is in the best interests of the patient to be
returned to the hospital." If the patient does not comply with the revocation within
five days, the chief clinical officer may authorize a police officer to transport the
patient to the hospital.
"At the completion of the trial visit, the chief clinical
officer shall take whatever measures are necessary to enable the patient to return to the
hospital."
"If an involuntarily committed patient has successfully
completed one year of continuous trial visit, the chief clinical officer shall discharge
the patient…[and notify the court which ordered hospitalization, of the
discharge]."
Conditional release: § 5122.15(F). "During such
ninety-day period the hospital; facility; board of alcohol, drug addiction, and mental
health services; agency the board designates; or person shall examine and treat the
individual. If, at any time prior to the expiration of the ninety-day period, it is
determined by the hospital, facility, board, agency, or person that the respondent's
treatment needs could be equally well met in an available and appropriate less restrictive
environment, both of the following apply:
(1) The respondent shall be released from the care of the
hospital, agency, facility, or person immediately and shall be referred to the court
together with a report of the findings and recommendations of the hospital, agency,
facility, or person; and
(2) The hospital, agency, facility, or person shall notify
the respondent's counsel or the attorney designated by a board of alcohol, drug addiction,
and mental health services or, if the respondent was committed to a board or an agency
designated by the board, it shall place the respondent in the least restrictive
environment available consistent with treatment goals and notify the court and the
respondent's counsel of the placement.
The court shall dismiss the case or order placement in the least
restrictive environment."
- Maximum duration of alternative(s) to assisted inpatient
treatment.
§ 5122.15(15)(C). A period
not to exceed 90.
- Procedure necessary to transfer patient from outpatient to
inpatient care.
