When not the subject of a pending commitment action, what are
the prerequisites for an individual to receive voluntarily treatment?A person 14 years of age or older who substantially understands the nature of
voluntary treatment may submit himself to a treatment facility or the administrator for
examination and treatment deemed to be appropriate. There must be a written consent that
shall designate the facility. The consent shall be on a prescribed form and may give
notice of a delayed release of up to 72 hours. A parent, guardian, or individual standing
in loco parentis may submit a child under 14 years of age for examination and treatment.
Sec. 7201, 7202, &7203
Conditions necessary for emergency treatment/observation.
An individual must be "severely mentally disabled and in
need of immediate treatment" to be committed involuntarily for examination
and treatment. A person is deemed to be severely mentally disabled when, as
a result of mental illness, his capacity to exercise self-control, judgement and
discretion in the conduct of his affairs and social relations or to care for his own
personal needs is so lessened that he poses a clear and present danger of
harm to others or to himself. Sec. 7301(a).
Clear and present danger to others shall be
shown by establishing that within the past 30 days the person has inflicted or attempted
to inflict serious bodily harm on another and that there is a reasonable probability that
such conduct will be repeated. [If the person has been found either incompetent to be
tried, or not guilty due to insanity for the conduct involving infliction of or attempt to
inflict substantial bodily harm of another, the 30 day requirement shall not apply so long
as an application for examination and treatment is filed within 30 days of such
determination.] A clear and present danger of harm to others may be
demonstrated by proof that the person has made threats of harm and has committed acts in
furtherance of the threat to commit harm. Sec. 7301(b)(1).
Clear and present danger to himself shall
be shown by establishing that within the past 30 days:
- the person has acted in such a manner as to evidence that he would be
unable, without care, supervision and the continued assistance of others , to satisfy his
need for nourishment, personal or medical care, shelter, or self-protection and safety,
and that there is a reasonable probability that death, serious bodily injury or serious
physical debilitation would ensue within 30 days unless adequate treatment were provided;
or
- the person has attempted suicide and that there is the reasonable
probability of suicide unless adequate treatment is afforded . For the purposes of this
subsection, a clear and present danger may be demonstrated by the
proof that the person has made threats to commit suicide and has committed acts which are
in furtherance of the threat to commit suicide; or
- the person has substantially mutilated himself or attempted to do so
and there is a reasonable probability of mutilation unless adequate treatment is afforded.
For purposes of this subsection, a clear and present danger shall be
established by proof that the person has made threats to commit mutilation and has
committed acts which are in furtherance of the threat to commit mutilation.Sec.
7301(b)(2)
Treatment on a voluntary basis shall be preferred to involuntary
treatment; and in every case, the least restrictions consistent with adequate treatment
shall be employed. Persons who are mentally retarded, senile, alcoholic, or drug dependent
shall receive mental health treatment only if they are also diagnosed as mentally ill.
Sec. 7102
- Is mental illness/disorder defined?
See #2 for definitions. The act specifically excludes persons who are
mentally retarded, senile, alcoholic, or drug dependent unless also diagnosed as mentally
ill and these conditions shall not be regarded as mental illnesses.
- Maximum duration of emergency/observation treatment before a
judicial hearing must be held.
An emergency examination
is to be completed within two hours of a patient’s arrival at a
treatment facility. This is for a professional determination as to whether the individual
is severely mentally disabled and in need of immediate
treatment. If the individual is not found to be severely mentally
disabled and in need of immediate treatment he shall be
discharged.
A person who is in treatment pursuant to this section shall be
discharged whenever it is determined that he no longer needs treatment, and in any event
within 120 hours, unless within such period:
- he is admitted to voluntary treatment, or
- a certification for extended involuntary emergency treatment is
filed.
Sec. 7302(b)&(d)
If a petition for extended involuntary treatment is filed as per
Section 7303 there shall be an informal hearing within 24 hours after the application is
filed. This hearing shall be with a judge or a mental health review officer and, if
practicable, shall be held at the treatment facility. Sec. 7303(b)
- 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, but there is no prohibition from the filing of an
application for involuntary treatment for someone who is in voluntary treatment. A
provider of voluntary treatment can require that the individual being treated remain in
treatment for up to 72 hours after he gives notice of intent to leave treatment. This 72
hour delayed release from treatment is required for all who were previously treated
involuntarily, but who have converted their treatment to voluntary treatment. An
application for involuntary treatment may be filed during this period of delayed release. Sec.
7203 & 7206(a).
The minimum time that a voluntary committee would have to stay in
treatment varies. If there were no requirement for delayed release imposed by the
treatment provider, the potential committee could leave treatment at any time. Also, the
treatment provider may discharge a patient without a delay if the director of the facility
concludes that treatment is not medically indicated.
As a matter of expressed policy, treatment on a voluntary basis
shall be preferred to involuntary treatment. Sec. 7102.
Are there any requirements that a potential committee be
capable of deciding to voluntarily undergo treatment?
Yes. The statute requires that the subject "substantially
understands the nature of voluntary treatment".
Who may petition for an individual to receive assisted
inpatient treatment?
Involuntary emergency examination may be undertaken based upon a
certificate made by a physician, by a warrant issued by the county administrator, or by a
warrantless pickup by a physician, peace officer, or anyone authorized by the county
administrator (if the justifying conduct is personally witnessed). A physician or other
responsible person may apply for a warrant for an involuntary emergency examination. The
county administrator acts on warrant applications. Sec 7302(a)
The statute is silent as to permissible applicants for an extension
of involuntary care to 20 days. The necessary treatment provider certifications suggest
that this application will be filed by the treatment provider or the county administrator.
Sec. 7303
Non-emergency involuntary treatment for up to 90 days (one year if
the underlying facts give rise to serious violent felony charges and subject either
incompetent for trial or NGRI) may also be sought by application. Only the county
administrator or the director of the facility providing treatment may apply if the subject
of the petition is already in involuntary treatment. Any responsible party may apply if
the subject is not in involuntary treatment. Sec. 7304
An application to extend a period of involuntary treatment under
Sec. 7304 for another period of treatment may be filed only by the county
administrator or the director of the facility providing the treatment. Sec. 7305
Required elements of a petition. All applications for emergency involuntary treatment must contain one of the
following:
- written certification from physician,
- written application setting forth facts supporting warrant, or
- written statement justifying the warrantless pickup.
Applications for non-emergency involuntary treatment must
contain:
- reason for need for additional treatment
- name of any examining physician
- substance of physician’s opinion as to the mental condition of
the patient
- written statement of facts constituting reasonable grounds to believe
the subject is seriously mentally disabled and in need of treatment
- recital that subject was informed of his/her rights
- Is there a penalty for filing an unfounded petition?
- 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.).
The subject of the commitment
proceedings is permitted to identify individuals that are to be informed of proceedings
under the Act. Sec. 7302(c). Unless needed as a witness or identified by
the subject of the proceedings as one to be informed, there is no notice of the
proceedings.
A hearing on a petition for non-emergency involuntary treatment
(90days) is a public hearing unless it is requested to be private by the subject or
his/her counsel. Sec. 7304(e). If the subject of the proceedings opted
for private proceedings, unnecessary individuals could be excluded from the proceedings.
- Length of initial term of assisted inpatient treatment.
The maximum length of an initial emergency involuntary treatment
order is 120 hours. This can be extended to 20 days by a petition to extend emergency
treatment.
The maximum length of a non-emergency involuntary treatment is 90
days. This period may be renewed for 180 day periods, but a person committed to
involuntary treatment as a clear and present danger to himself shall only be
extended past the original 90 day full-time inpatient commitment if he has first been
released to a less restrictive alternative. Sec. 7305(a).
The involuntary commitment of individuals deemed seriously mentally
disabled who have been either found incompetent for trial, or NGRI for certain enumerated
violent felonies, may be for 1 year with 1 year renewals.
- Conditions necessary for judicially ordered inpatient treatment
(exact wording of key portions of applicable statute desired).
The subject is severely mentally disabled and in need of treatment. Sec.
7304(f).
- Evidentiary standard under which eligibility for assisted
treatment is judged (two most common are "beyond a reasonable doubt" and
"clear and convincing evidence").
Clear and convincing evidence. Sec. 7304(f).
- Is there a least restrictive treatment requirement?
…an order shall be entered directing treatment of the person in
an approved facility as an inpatient or an outpatient, or a combination of such treatment
as the director of the facility shall from time to time determine. Inpatient treatment
shall be deemed appropriate only after full consideration has been given to less
restrictive alternatives. Investigation of treatment alternatives shall include
consideration of the person’s relationship to his community and family, his
employment possibilities, all available community resources, and guardianship services. An
order for inpatient treatment shall include findings on this issue. Sec. 7304(f).
Sec. 7102 of the Act provides: …in every case,
the least restrictions consistent with adequate treatment shall be enjoyed. This is part
of the statement of policy expressed in the Act.
- Is there a confidentiality exception for family members of
committees and/or individuals undergoing emergency evaluations?
No.
- Are advance directives or durable powers of attorney addressed
and, if so, in what way?
There is no express reference to advance directives in the Mental
Health Procedures Act.
- Is there a separate proceeding necessary to abrogate a
committee’s right to refuse treatment?
Yes, but the nature of such a procedure is not determined by the
Mental Health Procedures Act. The Office of Mental Health for the Commonwealth of
Pennsylvania has promulgated procedures for forced medication. These procedures are set
forth in Mental Health Bulletins. The prescribed procedures are administrative and do not
require a formal hearing. The procedures are not well publicized.
Sec. 7109(c) provides: Notwithstanding any other
provision of this act, no judge or mental health review officer shall specify to the
treatment team the adoption of any treatment technique, modality, or drug therapy.
Sec. 7113 explicitly provides that an individual in
treatment retains all rights now or hereafter provided. This would include the right to
make medication decisions.
- Does the treating hospital and/or physician have discretion to
release individuals before the end of their assisted inpatient treatment periods.
The treatment providers are under a duty to release
an individual who is no longer in need of treatment. See Sec.’s 7108(b),
7206(c), 7302(b), 7303(c) & (g), 7304(g)(3). If the committee was charged
with a specified violent felony and either found incompetent or NGRI, then the treatment
providers cannot discharge the committee without a Court hearing. Sec. 7304(g)(4).
- Individual(s) who may decide to initiate new periods of assisted
treatment.
The statute is silent as to permissible applicants for an extension
of involuntary care to 20 days. The necessary treatment provider certifications suggest
that this application will be filed by the treatment provider or the county administrator.
Sec. 7303
Non-emergency involuntary treatment for up to 90 days (one year if
the underlying facts give rise to serious violent felony charges and subject either
incompetent for trial or NGRI) may also be sought by application. Only the county
administrator or the director of the facility providing treatment may apply if the subject
of the petition is already in involuntary treatment. Any responsible party may apply if
the subject is not in involuntary treatment. Sec. 7304
An application to extend a period of involuntary treatment under
Sec. 7304 for another period of treatment may be filed only by the county
administrator or the director of the facility providing the treatment. Sec. 7305
- Type of forum that decides on need for extended assisted
treatment (normally either judicial or administrative).
This may vary from county to county. There may be a Court hearing
with a judge presiding, or, the Court may appoint a Mental Health Review Officer to
conduct the hearings. If a Review Officer is used, the person subject to treatment may
file an appeal and receive a Court hearing within 72 hours. The initial hearing shall be
informal and shall be at the treatment facility if possible. Relaxed rules of evidence
shall operate.
- 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 subject of a petition under Sec. 7303
for a 20 day extension has the right to an attorney and the right to question the doctor
and any other witnesses that testify in support of the petition.
The subject of a petition under Sec.
7304 for a 90 day extension has many enumerated rights. They include (1) written
notice including the opinion of the doctor recommending treatment, (2) right to counsel,
(3) right to assistance of a mental health expert (Dr., psychologist, or other MH expert),
(4) right to remain silent, (5) right of confrontation, (6) right to present evidence.
Notice of a hearing under Sec. 7304 is to be
provided to whoever the subject of the proceedings identified. No other individuals have
any right to notice or to participate in the proceedings. Proceedings under Sec.
7304 are public unless the subject of the proceedings requests that they be
private.
- Maximum length of subsequent assisted inpatient treatment (and of
any possible subsequent periods).
The maximum length of an initial emergency involuntary treatment
order is 120 hours. This can be extended to 20 days by a petition to extend emergency
treatment.
The maximum length of a non-emergency involuntary treatment is 90
days [excepting circumstances noted in #3 above]. This period may be renewed for 180 day
periods, but a person committed to involuntary treatment as a clear and present danger to
himself shall only be extended past the original 90 day full-time inpatient
commitment if he has first been released to a less restrictive alternative. Sec.
7305(a).
The involuntary commitment of individuals deemed seriously
mentally disabled who have been either found incompetent for trial, or NGRI for certain
enumerated violent felonies, may be for 1 year with 1 year renewals.
- Alternative(s) to 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).
Treatment is defined to include inpatient treatment, partial
hospitalization, or outpatient treatment. Sec. 7104. Inpatient treatment
is defined as all treatment that requires full or part-time residence in a facility.
A commitment order shall specify the treatment that is to be
provided. See Sec.’s 7303(d)(2) & 7304(f).
- Maximum duration of alternative(s) to assisted inpatient
treatment.
There is no distinction between inpatient or outpatient care in the
duration of Court commitments.
- Procedure necessary to transfer patient from outpatient to
inpatient care.
Whenever a proposed transfer of a person in involuntary treatment
will constitute a greater restraint, the transfer shall not take place unless, upon
hearing, a judge or mental health review officer finds it to be necessary and appropriate.
Sec. 7306(c).
- Describe any procedures for conservatorship, guardianship,
etc., which are applicable to the mentally ill.
This is not addressed in the Pennsylvania Mental Health Procedures
Act that controls mental health commitments. Rather, the Pennsylvania law regarding
incapacitated individuals appears in the Probate, Estate, and Fiduciary Code (Title 50).
- Other (may include insights into state’s mental health
system, judicial interpretation of mental health code, or known movements for statutory
reform).
