- When not the subject of a pending commitment action, what are the prerequisites for an individual to receive voluntarily treatment?
AS § 47.30.670. "A person 18 years of age or older may be voluntarily admitted to a treatment facility if the person is suffering form mental illness and voluntarily signs the admission papers."
- Conditions necessary for emergency treatment.
AS § 47.30.705. "A peace officer, a psychiatrist or physician who is licensed to practice in this sate or employed by the federal government, or a clinical psychologist licensed by the state Board of Psychologists and Psychological Examiners who has probable cause to believe that a person is gravely disabled or is suffering from mental illness and is likely to cause serious harm to self or others of such immediate nature that considerations of safety do not allow initiation of involuntary commitment procedures set out in AS 47.30.700, may cause the person to be taken into custody and delivered to the nearest evaluation facility."
- Is mental illness/disorder defined? Yes.
AS § 47.30.915 (12) "’mental illness’" means an organic, mental, or emotional impairment that has substantial adverse effects on an individual’s ability to exercise conscious control of the individual’s actions or ability to perceive reality or to reason or understand; mental retardation, epilepsy, drug addiction and alcoholism do not per se constitute mental illness, although persons suffering from these conditions may also be suffering from mental illness."
- Maximum duration of emergency treatment before a judicial hearing must be held.
AS § 47.30715. 72 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?
It is unclear.
AS § 47.30.745(b). "If the respondent is admitted voluntarily following the filing of the petition, the voluntary admission constitutes a waiver of any hearing rights under AS 47.30.740 or under AS 47.30.685. If at any time during the respondent’s voluntary admission under this subsection, the respondent submits to the facility a written request to leave, the professional person in charge may file with the court a petition for a 180-day commitment of the respondent under AS 47.30.770" (the statute is unclear as to whether the patient may be detained or is free to leave the facility upon submitting a request).
- Are there any requirements that a potential committee be capable of deciding to voluntarily undergo treatment?
No requirement is specified.
- Who may petition for an individual to receive assisted inpatient care?
AS § 47.30.700. Any adult.
- Required elements of a petition.
For initiation of commitment procedures:
§ 47.30.700(b). "The petition required in (a) of this section must allege that the respondent is reasonably believed to present a likelihood of serious harm to self or others or is gravely disabled as a result of mental illness and must specify the factual information on which that belief is based including the names and addresses of all persons known to the petitioner who have knowledge of those facts through personal observation."
For petition for commitment to treatment facility:
AS § 47.30.730(a). "In the course of the 72-hour evaluation period, a petition for commitment to a treatment facility may be filed in court. The petition must be signed by two mental health professionals who have examined the respondent, one of whom is a physician. The petition must
(1)
allege that the respondent is mentally ill and as a result is likely to cause harm to self or others or is gravely disabled;
(2)
allege that the evaluation staff has considered but has not found that there are any less restrictive alternatives available that would adequately protect the respondent or others; or, if a less restrictive involuntary form of treatment is sought, specify the treatment and the basis for supporting it;
(3)
allege with respect to a gravely disabled respondent that there is reason to believe that the respondent's mental condition could be improved by the course of treatment sought;
(4)
allege that a specified treatment facility or less restrictive alternative that is appropriate to the respondent's condition has agreed to accept the respondent;
(5)
allege that the respondent has been advised of the need for, but has not accepted, voluntary treatment, and request that the court commit the respondent to the specified treatment facility or less restrictive alternative for a period not to exceed 30 days;
(6)
list the prospective witnesses who will testify in support of commitment or involuntary treatment; and
(7)
list the facts and specific behavior of the respondent supporting the allegation in (1) of this subsection."
- Is there a penalty for filing an unfounded petition?
Yes.
§ 47.30.815(c). "A person who willfully initiates an involuntary commitment procedure under AS 47.30.700 without having good cause to believe that the other person is suffering from a mental illness and as a result is gravely disabled or likely to cause serious harm to self or others, is guilty of a felony."
- Participation of other individuals in commitment hearing (i.e. notice, a right to be heard or standing for family members, legal guardians, doctors, etc.).
Only for notice of patient’s rights.
AS § 47.30.725(a). "The respondent's guardian, if any, and if the respondent requests, an adult designated by the respondent, shall also be notified of the respondent's rights."
- Length of initial term of assisted inpatient care.
AS §§ 47.30.725(b) and 47.30.735(c). Thirty days.
- Conditions necessary for judicially ordered inpatient care (exact wording of key portions of applicable statute desired).
AS § 47.30.735 "that the respondent is mentally ill and as a result is likely to cause harm to the respondent or others or is gravely disabled."
AS § 47.30.915(7) "’gravely disabled’" means a condition in which a person as a result of mental illness is in danger of physical harm arising from such complete neglect of basic needs for food, clothing, shelter, or personal safety as to render serious accident, illness, or death highly probable if care by another is not taken; or will, if not treated, suffer or continue to suffer severe and abnormal mental, emotional, or physical distress, and this distress is associated with significant impairment of judgment, reason, or behavior causing a substantial deterioration of the person’s previous ability to function independently."
AS § 47.30.915(10) "’likely to cause serious harm’" means a person who poses a substantial risk of bodily harm to that person’s self, as manifested by recent behavior causing, attempting, or threatening that harm; poses a substantial risk or harm to others as manifested by recent behavior causing, attempting, or threatening harm, and is likely in the near future to cause physical injury, physical abuse, or substantial property damage to another person; or manifests current intent to carry out plans of serious harm to that person’s self or another."
- Evidentiary standard under which inpatient care criteria are judged (two most common are "beyond a reasonable doubt" and "clear and convincing evidence").
AS § 47.30.735(c). "clear and convincing evidence"
- Is there a least restrictive treatment requirement?
No. However, under § 47.30.735(d) "If the court finds that there is a viable less restrictive alternative available and that the respondent has been advised of and refused voluntary treatment through the alternative, the court may order the less restrictive alternative treatment for not more than 30 days if the program accepts the respondent."
- Is there a confidentiality exception for family members of committees and/or individuals undergoing emergency evaluations?
No. However, AS § 47.30.845(2)-(3) states that "information and records may be copied and disclosed under regulations established by the department to the patient or an individual to whom the patient has given written consent to have information disclosed, or to a person authorized by a court order."
- Are advance directives or durable powers of attorney addressed and, if so, in what way?
Yes. AS § 47.30.950 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.
AS § 47.30.950. An adult of sound mind may make a declaration of preferences or instructions regarding mental health treatment, including consent to or refusal of mental health treatment. A declaration for mental health treatment continues in effect for three years or until revoked, whichever is sooner. The authority of a named attorney-in-fact and an attorney-in-fact continues as long as the declaration is in effect or until they have withdrawn. If a declaration for mental health treatment has been invoked and is in effect at the expiration of three years after its execution, the declaration remains effective until the principal is no longer incapable.
AS § 47.30.952. A declaration may designate a competent adult to act as attorney-in-fact to make decisions about mental health treatment.
AS § 47.30.958. Except to the extent the right is limited by the declaration or any federal law, an attorney-in-fact has the same right as the principal to receive information regarding the proposed mental health treatment and to receive, review, and consent to disclosure of medical records relating to that treatment. The attorney-in-fact has a duty to act consistently with the desires of the principal as expressed in the declaration and, if the principal’s intentions are unknown, to act in good faith to serve the best interests of the principal.
AS § 47.30.962. The physician or 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 if the principal is committed to a treatment facility under this chapter and treatment is authorized in compliance with AS 47.30.825 – 47.30.865 or in cases of emergency endangering life or health.
AS § 47.30.966. A declaration may be revoked in whole or in part at any time by the principal if the principal is not incapable. A revocation is effective when a capable principal communicates the revocation to the attending physician or other provider.
- Is there a separate proceeding necessary to abrogate a committee’s right to refuse treatment?
In pre-hearing and emergency situations, no separate proceeding is required, as long as certain conditions have been met. In non-emergency situations, a separate proceeding is required.
For pre-hearing treatment:
AS § 47.30.725(e). "The respondent has the right to be free of the effects of medication and other forms of treatment to the maximum extent possible before the 30-day commitment hearing; however, the facility or evaluation personnel may treat the respondent with medication under prescription by a licensed physician or by a less restrictive alternative of the respondent's preference if, in the opinion of a licensed physician in the case of medication, or of a mental health professional in the case of alternative treatment, the treatment is necessary to
(1)
prevent bodily harm to the respondent or others;
(2)
prevent such deterioration of the respondent's mental condition that subsequent treatment might not enable the respondent to recover; or
(3)
allow the respondent to prepare for and participate in the proceedings."
For Emergencies:
AS § 47.30.838. "An evaluation facility or designated treatment facility may administer psychotropic medication to a patient without the patient’s informed consent regardless of whether the patient is capable of giving informed consent, only if (1) there is a crisis situation, or an impending crisis situation, that requires immediate use of the medication to preserve the life of, or prevent significant physical harm to, the patient or another person, as determined by a licensed physician or a registered nurse; the behavior or condition of the patient giving rise to a crisis under this paragraph and the staff’s response to the behavior or condition must be documented in the patients’ medical record; the documentation must include an explanation of alternative responses to the crisis that were considered or attempted by the staff and why those responses were not sufficient and (2) the medication is ordered by a licensed physician."
For Non-Emergencies:
§ 47.30.772. "An evaluation facility or designated treatment facility may administer medication or other treatment to an involuntarily committed patient only in a manner consistent with the provisions of AS 47.30.825 – 47.30.865."
§ 47.30.825(c). "A patient who is capable of giving informed consent has the right to give and withhold consent to mediation and treatment in all situations that do not involve a crisis or impending crises as described in AS 47.30.838(a)(1). A facility shall follow the procedures required under AS 47.30836 – 47.30.839 before administering psychotropic medication."
§ 47.30.836. "An evaluation facility or designated treatment facility may not administer psychotropic mediation to a patient in a situation that does not involve a crisis unless the patient (1) has the capacity to give informed consent to the medication, as described in AS 47.30.837, and gives that consent; (2) authorized the use of psychotropic medication in a declaration properly executed under AS 47.30950 – 47.30980 or authorized an attorney-in-fact to consent to the use of psychotropic medication for the patient and the attorney-in-fact does consent or (3) is determined by a court to lack the capacity to give informed consent to the medication and the court approves use of the medication under AS 47.30.839."
§ 47.30.837. "A patient has the capacity to give informed consent for purposes of AS 47.30.836 if the patient is competent to make mental health or medial treatment decisions and the consent is voluntary and informed."
§ 47.30.839. "An evaluation facility or designated treatment facility may use the procedures described in this section to obtain court approval of administration of psychotropic medication."
- Does the treating hospital and/or physician have discretion to release individuals before the end of their assisted inpatient care periods.
Yes.
AS § 47.30.780. "The professional person in charge shall at any time discharge a respondent on the ground that the respondent is no longer gravely disabled or likely to cause serious harm as a result of mental illness. A certificate to this effect shall be sent to the court which shall enter an order officially terminating the involuntary commitment."
- Individual(s) who may decide to initiate new periods of assisted treatment.
For subsequent 90-day commitment:
AS § 47.30.740(a). "At any time during the respondent's 30-day commitment, the professional person in charge, or that person's professional designee, may file with the court a petition for a 90-day commitment of that respondent."
For additional 180-day commitment:
AS § 47.30.770(a). "The respondent shall be released from involuntary treatment at the expiration of 90 days unless the professional person in charge files a petition for a 180-day commitment conforming to the requirements of AS 47.30.740(a)."
AS § 47.30.770(c). "Successive 180-day commitments are permissible on the same ground and under the same procedures as the original 180-day commitment."
- Type of forum that decides on need for extended treatment (normally either judicial or administrative).
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.).
Same as the original hearing. AS § 47.30.725 (a) "The
respondent's guardian, if any, and if the respondent requests, an adult designated by the
respondent, shall also be notified of the respondent's rights."
- Maximum length of subsequent mandated inpatient care (and of any possible subsequent
periods).
The initial subsequent commitment period is for 90 days. Each additional period
thereafter can be for up to 180 days.
AS § 47.30.740. Procedure for 90-day commitment following 30-day commitment.
(a)
"At any time during the respondent's 30-day commitment, the
professional person in charge, or that person's professional designee, may file with the court
a petition for a 90-day commitment of that respondent. The petition must include all material
required under AS 47.30.730(a) except that references to "30 days" shall be read as "90 days";
and
(1)
allege that the respondent has attempted to inflict or has inflicted
serious bodily harm upon the respondent or another since the respondent's acceptance for
evaluation, or that the respondent was committed initially as a result of conduct in which
the respondent attempted or inflicted serious bodily harm upon the respondent or another, or
that the respondent continues to be gravely disabled, or that the respondent demonstrates a
current intent to carry out plans of serious harm to the respondent or another;
(2)
allege that the respondent has received appropriate and adequate care
and treatment during the respondent's 30-day commitment;
(3)
be verified by the professional person in charge, or that person's
professional designee, during the 30-day commitment."
AS § 47.30.770. Additional 180-Day Commitment.
(a) "
The respondent shall be released from involuntary treatment
at the expiration of 90 days unless the professional person in charge files a petition for a
180-day commitment conforming to the requirements of AS 47.30.740(a) except that all references
to "30-day commitment" shall be read as "the previous 90-day commitment" and all references to
"90-day commitment" shall be read as "180-day commitment".
(b)
The procedures for service of the petition, notification of rights,
and judicial hearing shall be as set out in AS 47.30.740 - 47.30.750. If the court or jury
finds by clear and convincing evidence that the grounds for 90-day commitment as set out in
AS 47.30.755 are present, the court may order the respondent committed for an additional
treatment period not to exceed 180 days from the date on which the first 90-day treatment
period would have expired.
(c)
Successive 180-day commitments are permissible on the same ground and
under the same procedures as the original 180-day commitment. An order of commitment may not
exceed 180 days."
- Alternative(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 conditional release (called "involuntary outpatient care" in Alaska),
where outpatient care occurs after commitment to inpatient care:
AS § 47.30.795(a) "A respondent who was originally committed to involuntary
inpatient care under AS 47.30.700 - 47.30.915 may be released before the expiration of the
commitment period if a provider of outpatient care accepts the respondent for specified
outpatient treatment for a period of time not to exceed the duration of the commitment, and
if the professional person in charge, or that person's professional designee, finds that
(1)
it is not necessary to treat the respondent as an inpatient to prevent
the respondent from harming self or others; and
(2)
there is reason to believe that the respondent's mental condition
would improve as a result of the outpatient treatment.
(b)
A copy of the conditions for early release shall be given to the
respondent and the respondent's attorney and guardian, if any, the provider of outpatient
care, and the court…"
For outpatient commitment, where the court initially orders care on an outpatient rather
than inpatient basis:
AS § 47.30.735(c) "At the conclusion of the hearing the court may commit the
respondent to a treatment facility if it finds, by clear and convincing evidence, that
the respondent is mentally ill and as a result is likely to cause harm to the respondent
or others or is gravely disabled." Per AS § 47.30.915(4) a treatment facility "means
a hospital, clinic, institution, center, or other health care facility that has been
designated by the department for the treatment or rehabilitation of mentally ill
persons…"
- Maximum duration of alternative(s) to mandated inpatient care.
For conditional release:
AS § 47.30.795. For a period of time not to exceed the duration of the inpatient commitment.
For outpatient commitment:
AS § 47.30.735(c) Thirty days.
- Procedure necessary to transfer patient from outpatient to inpatient care.
For conditional release:
AS § 47.30.795(c) "If during the commitment period the
provider of outpatient care determines that the respondent can no longer be treated on an
outpatient basis because the respondent is likely to cause harm to self or others or is
gravely disabled, the provider shall give the respondent oral and written notice that the
respondent must return to the treatment facility within 24 hours, with copies to the
respondent's attorney and guardian, if any, the court, and the inpatient treatment facility.
If the respondent fails to arrive at the treatment facility within 24 hours after receiving
the notice, the professional person in charge may contact the appropriate peace officers who
shall take the respondent into custody and transport the respondent to the facility. If it is
determined by the professional person in charge to be necessary, a member of the treatment
facility staff shall accompany the peace officers when they take the respondent into
custody."
For outpatient commitment:
AS § 47.30.800(a) "A respondent ordered by the court under the provisions of
AS 47.30.700-47.30.915 to receive involuntary outpatient treatment may be required to undergo
inpatient treatment when the provider of outpatient care finds that (1) the respondent is
mentally ill and is likely to cause serious harm to self or others or is still gravely
disabled; (2) the respondent’s behavior since the hearing resulting in court-ordered treatment
indicates that the respondent now needs inpatient treatment to protect self or others; (3)
there is reason to believe that the respondent’s mental condition will improve as a result
of inpatient treatment; and (4) there is an inpatient facility appropriate to the respondent’s
need which will accept the respondent as patient. Treatment for these respondents shall be
available at state-operated hospitals at all times."
- Procedure necessary to institute and maximum duration of subsequent periods of
alternative(s) to inpatient assisted treatment.
For conditional release:
AS § 47.30.795(d). "If the provider of outpatient care
determines that the respondent will require continued outpatient care after the expiration
of the commitment period, the provider may initiate further commitment proceedings as if the
provider were the professional person in charge, and the provisions of AS 47.30.660 - 47.30.915
apply, except that provisions relating to inpatient treatment shall be read as applicable to
outpatient treatment."
For outpatient commitment:
Same as for mandated inpatient care, see Answer No. 19.
- 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).
§ 47.30.803. Conversion from involuntary to voluntary status. "A patient
subject to involuntary hospitalization under AS 47.30.705, 47.30.735, or AS 47.30.755 may
at any time convert to voluntary status if the responsible physician agrees that (1) the
patient is an appropriate patient for voluntary hospitalization; and (2) the conversion is
made in good faith."
