- When not the subject of a pending commitment action, what are the prerequisites for an individual to receive voluntarily treatment?
§ 572.001(a). “A person 16 years of age or older or a
person younger than 16 years of age who is or has been married may request
admission to an inpatient mental health facility by filing a request with the
administrator of the facility to which admission is requested.”
§ 572.001(e). “A request for
admission as a voluntary patient must state that the person for whom admission
is requested agrees to voluntarily remain in the facility until the person's
discharge and that the person consents to the diagnosis, observation, care, and
treatment provided until the earlier of: 1. the person's discharge; or 2. the
period prescribed by Section 572.004.”
- Conditions necessary for emergency treatment.
For emergency detention by a peace officer:
§ 573.001(a). “A peace officer, without a warrant, may take a
person into custody if the officer: (1) has reason to believe and does
believe that: (A) the person is mentally ill; and (B) because of that mental
illness there is a substantial risk of serious harm to the person or to others
unless the person is immediately restrained; and (2) believes that there is not
sufficient time to obtain a warrant before taking the person into custody. (a) A substantial risk of serious harm to
the person or other sunder Subsection (a)(1)(B) may be demonstrated by: (1) the
person's behavior; or (2) evidence of severe emotional distress and
deterioration in the person's mental condition to the extent that the person
cannot remain at liberty. (b) The peace
officer may form the belief that the person meets the criteria for
apprehension: (1) from a representation of a credible person; or (2) on the
basis of the conduct of the apprehended person or the circumstances under which
the apprehended person is found.”
For emergency detention by judge’s or magistrate’s order:
§ 573.011(a). “An adult may file a written application for
the emergency detention of another person. b. The application must state: (1)
that the applicant has reason to believe and does believe that the person
evidences mental illness; (2) that the applicant has reason to believe and does
believe that the person evidences a substantial risk of serious harm to himself
or others; (3) a specific description of the risk of harm; (4) that the
applicant has reason to believe and does believe that the risk of harm is
imminent unless the person is immediately restrained; (5) that the applicant's
beliefs are derived from specific recent behavior, overt acts, attempts, or
threats; (6) a detailed description of the specific behavior, acts, attempts,
or threats; and (7) a detailed description of the applicant's relationship to
the person whose detention is sought.”
§ 573.012(a). “An applicant for emergency detention must
present the application personally to a judge or magistrate. The judge or
magistrate shall examine the application and may interview the applicant.
Except as provided by Subsection (g), the judge of a court with probate
jurisdiction by administrative order may provide that the application must be:
(1) presented personally to the court; or (2) retained by court staff and
presented to another judge or magistrate as soon as is practicable if the judge
of the court is not available at the time the application is presented. b. The
magistrate shall deny the application unless the magistrate finds that there is
reasonable cause to believe that: (1) the person evidences mental illness; (2)
the person evidences a substantial risk of serious harm to himself or others;
(3) the risk of harm is imminent unless the person is immediately restrained;
and (4) the necessary restraint cannot be accomplished without emergency
detention. c. A substantial risk of serious harm to the person or others under
Subsection (b)(2) may be demonstrated by: (1) the person's behavior; or (2)
evidence of severe emotional distress and deterioration in the person's mental
condition to the extent that the person cannot remain at liberty.”
For emergency Admission and Detention in a facility:
§ 573.022(a). “A person may be
admitted to a facility for emergency detention only if the physician who
conducted the preliminary examination of the person makes a written statement
that:
- is acceptable to the facility;
- states that after a preliminary examination it
is the physician's opinion that: (A) the person is mentally ill; (B) the person
evidences a substantial risk of serious harm to himself or others; (C) the
described risk of harm is imminent unless the person is immediately restrained;
and (D) emergency detention is the least restrictive means by which the necessary
restraint may be accomplished; and
- includes: (A) a description of the nature of
the person's mental illness; (B) a specific description of the risk of harm the
person evidences that may be demonstrated either by the person's behavior or by
evidence of severe emotional distress and deterioration in the person's mental
condition to the extent that the person cannot remain at liberty; and (C) the
specific detailed information from which the physician formed the opinion in
Subdivision (2).”
- Is mental illness/disorder defined?
Yes. § 571.003(14) “’mental illness’” means an illness, disease, or condition,
other than epilepsy, senility , alcoholism, or mental deficiency that (A)
substantially impairs a person’s thought, perception of reality, emotional process,
or (B) judgment or grossly impairs behavior as demonstrated by recent disturbed
behavior.”
- Maximum duration of emergency treatment before a judicial hearing must be held.
§ 573.021. 24 hours.
- 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 voluntary patient may avoid a hearing determination. However, an application for court-ordered mental health services may be filed “against” a voluntary patient if:
§ 572.005(1) “a request for release of the patient has been filed
with the facility administrator; or (2) in the opinion of the physician
responsible for the patient's treatment, the patient meets the criteria for
court-ordered mental health services and: (A) is absent from the facility
without authorization; (B) is unable to consent to appropriate and necessary
psychiatric treatment.”
- Are there any requirements that a potential committee be capable of deciding to voluntarily undergo treatment?
Not specified in mental health code.
- Are there any requirements that a potential committee be capable of deciding to voluntarily undergo treatment?
§ 574.001(a).“A county or district attorney or other adult.”
- Required elements of a petition.
§ 574.002(a). a. An application for court-ordered
mental health services must be styled using the proposed patient's initials and
not the proposed patient's full name. b. The application must state whether the
application is for temporary or extended mental health services. An application
for extended mental health services must state that the person has received
court-ordered inpatient mental health services under this subtitle or under
Section 5, Article 46.02, Code of Criminal Procedure, for at least 60 consecutive
days during the preceding12 months. c. Any application must contain the
following information according to the applicant's information and belief: (1)
the proposed patient's name and address; (2) the proposed patient's county of
residence in this state; (3) a statement that the proposed patient is mentally
ill and meets the criteria in Section 574.034 or 574.035 for court-ordered
mental health services; and (4) whether the proposed patient is charged with a
criminal offense.
- Is there a penalty for filing an unfounded petition?
§ 571.020(a) “A person commits an offense if the person intentionally causes, conspires with another to cause, or assists another to cause the unwarranted commitment of a person to a mental health facility.”
- 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:
§ 574.006(b) “A copy of the
application and the written notice shall be delivered in person or sent by
certified mail to the proposed patient's: (1) parent, if the proposed patient
is a minor; (2) appointed guardian, if the proposed patient is the subject of a
guardianship; or (3) each managing and possessory conservator that has been
appointed for the proposed patient. c. Notice may be given to the proposed
patient's next of kin if the relative is the applicant and the parent cannot be
located and a guardian or conservator has not been appointed. d. Notice of the
time and place of any hearing and of the name, telephone number, and address of
any attorneys known or believed to represent the state or the proposed patient
shall be furnished to any person stating that that person has evidence to
present upon any material issue, without regard to whether such evidence is on
behalf of the state or of the proposed patient. The notice shall not include
the application, medical records, names or addresses of other potential
witnesses, or any other information whatsoever.”
- Length of initial term of assisted inpatient care.
§ 574.034(g).“An order for
temporary mental health services shall state that treatment is authorized for
not longer than 90 days.The order may
not specify a shorter period.”
- Conditions necessary for judicially ordered inpatient care (exact wording of key portions of applicable statute desired).
For court-ordered treatment by judge:
§ 574.034(a). “The judge may
order a proposed patient to receive court-ordered temporary inpatient mental
health services only if the judge or jury finds, from clear and convincing
evidence, that: (1) the proposed patient is mentally ill; and (2) as a result
of that mental illness the proposed patient: (A) is likely to cause serious
harm to himself; (B) is likely to cause serious harm to others; or (C) is: (i)
suffering severe and abnormal mental, emotional, or physical distress; (ii)
experiencing substantial mental or physical deterioration of the proposed
patient's ability to function independently, which is exhibited by the proposed
patient's inability, except for reasons of indigence, to provide for the
proposed patient's basic needs, including food, clothing, health, or safety;
and (iii) unable to make a rational and informed decision as to whether or not
to submit to treatment. “
For court-ordered treatment by jury:
§ 574.032(f).“In a hearing before a
jury, the jury shall determine if the proposed patient is mentally ill and
meets the criteria for court-ordered mental health services. The jury may not
make a finding about the type of services to be provided to the proposed
patient.”
- Evidentiary standard under which inpatient care criteria are judged (two most common are “beyond a reasonable doubt” and “clear and convincing evidence”).
§ 574.034 “clear and convincing evidence.”
- Is there a least restrictive treatment requirement?
Yes. A least restrictive treatment requirement exists in the context
of treatment setting, emergency situations, attorney’s duties and duties of the
judge issuing a court order.
§ 571.004.“The least
restrictive appropriate setting for the treatment of a patient is the treatment
setting that: (1) is available (2) provides the patient with the greatest
probability of improvement or cure; and (3) is no more restrictive of the
patient’s physical or social liberties than is necessary to provide the patient
with the most effective treatment and to protect adequately against any danger
the patient poses to himself or others.”
§ 573.022(a). “A person may be
admitted to a facility for emergency detention only if the physician who conducted
the preliminary examination of the person makes a written statement that
emergency detention is the least restrictive means by which the necessary
restraint may be accomplished.”
§ 574.004(d).“Before a hearing, the
attorney shall explore the least restrictive treatment alternatives to
court-ordered inpatient mental health services.”
§ 574.036(d). “The judge shall order
the mental health services provided in the least restrictive appropriate
setting available.”
- Is there a confidentiality exception for family members of committees and/or individuals undergoing emergency evaluations?
§ 574.0415(b). “The facility shall also provide the
information to the patient's family on request, but only to the extent not
otherwise prohibited by state or federal confidentiality laws.”
- Are advance directives or durable powers of attorney addressed and, if so, in what way?
Yes. § 137.002 et seq. allow an
individual to create an advance directive to specify preferred treatment and to
designate a surrogate treatment decision maker in the event of future
incapacity.The official form for creating an advance directive may be found in Section 137.001 of the Texas
Code.
§ 137.002. “An adult who is not incapacitated may execute a declaration for mental health treatment.The preferences or instructions may include consent to or refusal of mental health treatment.”
§ 137.008. “A physician or other health care provider may subject the principal to mental health treatment in a manner contrary to the principal's wishes as expressed in a declaration for mental health treatment only: (1) if the principal is under an order for temporary or extended mental health services under Section 574.034 or 574.035, Health and Safety Code, and treatment is authorized in compliance with Section 574.106, Health and Safety Code; or (2) in case of an emergency when the principal's instructions have not been effective in avoiding the emergency.”
- Is there a separate proceeding necessary to abrogate a committee’s right to refuse treatment?
Yes, except in emergency situations.
§ 574.103. A person may not administer a psychoactive medication to a patient who refuses to
take the medication voluntarily unless: (1) the patient is having a
medication-related emergency; or (2) the patient is under an order issued under
Section 574.106 authorizing the administration of the medication regardless of
the patient's refusal.”
§ 574.104(a). “A physician who is treating a patient may,
on behalf of the state, file an application in a probate court or a court with
probate jurisdiction for an order to authorize the administration of a
psychoactive medication regardless of the patient's refusal if: (1) the
physician believes that the patient lacks the capacity to make a decision
regarding the administration of the psychoactive medication; (2) the physician
determines that the medication is the proper course of treatment for the
patient; (3) the patient is under an order for temporary or extended mental
health services under Section 574.034 or 574.035 or an application for
court-ordered mental health services under Section 574.034 or 574.035 has been
filed for the patient; and (4) the patient, verbally or by other indication,
refuses to take the medication voluntarily. b. An application filed under this
section must state: (1) that the physician believes that the patient lacks the
capacity to make a decision regarding administration of the psychoactive
medication and the reasons for that belief; (2) each medication the physician
wants the court to compel the patient to take; (3) whether an application for
court-ordered mental health services under Section 574.034 or 574.035 has been
filed or the current order for inpatient mental health services for the patient
was issued under Section 574.034 or under Section 574.035; and (4) the
physician's diagnosis of the patient. c. An application filed under this
section is separate from an application for court-ordered mental health
services.
§ 574.106(a). The
court may issue an order authorizing the administration of one or more classes
of psychoactive medication only if the court finds by clear and convincing
evidence after the hearing that: (1) the patient is under an order for
temporary or extended mental health services under Section 574.034 or 574.035;
(2) the patient lacks the capacity to make a decision regarding the
administration of the proposed medication; and (3) treatment with the proposed
medication is in the best interest of the patient. b. In making its findings,
the court shall consider: (1) the patient's expressed preferences regarding
treatment with psychoactive medication; (2) the patient's religious beliefs;
(3) the risks and benefits, from the perspective of the patient, of taking
psychoactive medication; (4) the consequences to the patient if the
psychoactive medication is not administered; (5) the prognosis for the patient
if the patient is treated with psychoactive medication; and (6) alternatives to
treatment with psychoactive medication.”
- Does the treating hospital and/or physician have discretion to release individuals before the end of their assisted inpatient care periods?
Yes. Additionally, the facility administrator may
request the court to modify the order.
§ 573.023(b) “A person admitted to a facility under
Section 573.022 shall be released if the facility administrator determines at
any time during the emergency detention period that one of the criteria
prescribed by Section 573.022(2) no longer applies.” See also § 574.086(a).
§ 574.061(a) The facility administrator of a facility to which a patient is
committed for inpatient mental health services may request the court that
entered the commitment order to modify the order to require the patient to
participate in outpatient mental health services… d. On request of the patient
or any other interested person, the court shall hold a hearing on the request…”
- Individual(s) who may decide to initiate new periods of assisted treatment.
The judge may initially order
extended inpatient treatment, which may be renewed upon court approved
application by a county, district attorney or other adult.
To initiate subsequent periods:
§ 574.035(a). “The judge may order a proposed patient to receive
court-ordered extended inpatient mental health services only if the jury, or
the judge if the right to a jury is waived, finds, from clear and convincing
evidence, that: (1) the proposed patient is mentally ill; (2) as a result of
that mental illness the proposed patient: (A) is likely to cause serious harm
to himself; (B) is likely to cause serious harm to others; or (C) is: (i)
suffering severe and abnormal mental, emotional, or physical distress; (ii)
experiencing substantial mental or physical deterioration of the proposed
patient's ability to function independently, which is exhibited by the proposed
patient's inability, except for reasons of indigence, to provide for the
proposed patient's basic needs, including food, clothing, health, or safety;
and (iii) unable to make a rational and informed decision as to whether or not
to submit to treatment; (3) the proposed patient's condition is expected to
continue for more than 90 days; and (4) the proposed patient has received
court-ordered inpatient mental health services under this subtitle or under
Article 46.02, Code of Criminal Procedure, for at least 60 consecutive days
during the preceding 12 months.”
To renew extended order:
§ 574.066(a).“A county or
district attorney or other adult may file an application to renew an order for
extended mental health services.”
- Type of forum that decides on need for extended treatment (normally either judicial or administrative).
§ 574.061. 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.).
For notice:
§ 574.006(a). b. A copy of the application and the written
notice shall be delivered in person or sent by certified mail to the proposed
patient's: (1) parent, if the proposed patient is a minor; (2) appointed
guardian, if the proposed patient is the subject of a guardianship; or (3) each
managing and possessory conservator that has been appointed for the proposed
patient. c. Notice may be given to the proposed patient's next of kin if the
relative is the applicant and the parent cannot be located and a guardian or
conservator has not been appointed.”
- Maximum length of subsequent mandated inpatient care (and of any possible subsequent periods).
§ 574.035(h). “An order for extended
inpatient or outpatient mental health services shall state that treatment is
authorized for not longer than 12 months. The order may not specify a
shorter period.”
- 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:
§ 574.034(b). “The judge may order a proposed patient to receive
court-ordered temporary outpatient mental health services only if: (1) the
judge finds that appropriate mental health services are available to the
patient; and (2) the judge or jury finds, from clear and convincing evidence,
that: (A) the proposed patient is mentally ill; (B) the nature of the mental illness
is severe and persistent; (C) as a result of the mental illness, the proposed
patient will, if not treated, continue to: (i) suffer severe and abnormal
mental, emotional, or physical distress; and (ii) experience deterioration of
the ability to function independently to the extent that the proposed patient
will be unable to live safely in the community without court-ordered outpatient
mental health services; and (D) the proposed patient has an inability to
participate in outpatient treatment services effectively and voluntarily,
demonstrated by: (i) any of the proposed patient's actions occurring within the
two-year period which immediately precedes the hearing; or (ii) specific
characteristics of the proposed patient's clinical condition that make impossible
a rational and informed decision whether to submit to voluntary outpatient
treatment.”
§ 574.037(a).“The court, in an order
that directs a patient to participate in outpatient mental health services,
shall identify a person who is responsible for those services. The person
identified must be the facility administrator or an individual involved in
providing court-ordered outpatient services. A person may not be designated as
responsible for the ordered services without the person's consent unless the
person is the facility administrator of a department facility or the facility
administrator of a community center that provides mental health services in the
region in which the committing court is located. b. The person responsible for
the services shall submit to the court within two weeks after the court enters
the order a general program of the treatment to be provided. The program must
be incorporated into the court order.”
For furlough (aka conditional release):
§ 574.082(a). “The facility administrator
may permit a patient admitted to the facility under an order for temporary or
extended inpatient mental health services to leave the facility under a pass or
furlough. b. A pass authorizes the patient to leave the facility for not more
than 72 hours. A furlough authorizes the patient to leave for a longer period.
c. The pass or furlough may be subject to specified conditions.”
- Maximum duration of alternative(s) to mandated inpatient care.
For outpatient commitment: 90 days § 574.034(g)
For furlough: Presumably until the inpatient order expires.
- Procedure necessary to transfer patient from outpatient to inpatient care.
For outpatient commitment:
Sec. 574.065(a). “The court may modify an order for outpatient
services at the modification hearing if the court determines that the patient
meets the applicable criteria for court-ordered mental health services
prescribed by Section 574.034(a) or 574.035(a). (b) The court may refuse to
modify the order and may direct the patient to continue to participate in
outpatient mental health services in accordance with the original order even if
the criteria prescribed by Subsection (a) have been met. (c) The court's
decision to modify an order must be supported by at least one certificate of
medical examination for mental illness signed by a physician who examined the
patient not earlier than the seventh day before the date on which the hearing
is held. (d) A modification may include: (1) incorporating in the order a
revised treatment program and providing for continued outpatient mental health
services under the modified order, if a revised general program of treatment
was submitted to and accepted by the court; or (2) providing for commitment
to an inpatient mental health facility. (e) A court may not extend the provision
of mental health services beyond the period prescribed in the original order.”
For furlough:
§ 574.084(a). “A furlough may be
revoked only after an administrative hearing held in accordance with department
rules. The hearing must be held within 72 hours after the patient is returned
to the facility. b. A hearing officer shall conduct the hearing. The hearing
officer may be a mental health professional if the person is not directly
involved in treating the patient. c. The hearing is informal and the patient is
entitled to present information and argument. d. The hearing officer may revoke
the furlough if the officer determines that the revocation is justified under
Section574.083(c).”
- Procedure necessary to institute and maximum duration of subsequent periods of alternative(s) to inpatient assisted treatment.
For outpatient commitment:
§ 574.035(h). “An order for extended
inpatient or outpatient mental health services shall state that treatment is
authorized for not longer than 12 months. The order may not specify a
shorter period.”
§ 574.066(a). “A county or district
attorney or other adult may file an application to renew an order for extended
mental health services. b. The application must explain in detail why the
person requests renewal.”
- Describe any procedures for conservatorship, guardianship, etc., which are applicable to the mentally ill.
For protective custody/guardianship:
The judge, county or district attorney may file a motion for an order of protective
custody if the patient meets the criteria for guardianship.
Sec. 574.021(a). “A motion for an order of protective custody
may be filed only in the court in which an application for court-ordered mental
health services is pending. b. The motion may be filed by the county or
district attorney or on the court's own motion. c. The motion must state that:
(1) the judge or county or district attorney has reason to believe and does
believe that the proposed patient meets the criteria authorizing the court to
order protective custody; and (2) the belief is derived from: (A) the
representations of a credible person; (B) the proposed patient's conduct; or
(C) the circumstances under which the proposed patient is found. d. The motion
must be accompanied by a certificate of medical examination for mental illness
prepared by a physician who has examined the proposed patient not earlier than
the fifth day before the day the motion is filed.”
Sec. 574.025. Probable Cause Hearing(a). “A hearing must be held to determine if: (1)
there is probable cause to believe that a proposed patient under a protective
custody order presents a substantial risk of serious harm to himself or others
to the extent that he cannot be at liberty pending the hearing on court-ordered
mental health services; and (2) a physician has stated his opinion and the
detailed reasons for his opinion that the proposed patient is mentally ill.”
