When not the subject of a pending commitment action, what are
the prerequisites for an individual to receive voluntarily treatment?
There must be an application for admission to a hospital for
observation, diagnosis, and care and treatment of a mental illness. The application must
be by the proposed voluntary patient or, if a minor, by a spouse, parent, or legal
guardian. The results of a preliminary examination by an admitting psychiatrist or
qualified psychologist must reveal the need for hospitalization. Sec 21-511
Conditions necessary for emergency treatment/observation.
There must be reason to believe that the subject is mentally ill
and, because of the illness, is likely to injure himself or others if he is not
immediately detained. This determination to be made by an accredited officer or agent of
the Department of Human Services, or an officer authorized to make arrests in D.C., or a
physician or qualified psychologist of the person in question. Sec. 21-521
- Is mental illness/disorder defined?
"Mental illness" means a psychosis or other disease
which substantially impairs the mental health of a person.
"Mentally ill person" means a person who has a mental
illness, but does not include a person committed to a private or public hospital in the
District of Columbia by order of the court in a criminal proceeding.
Maximum duration of emergency treatment/observation before a
judicial hearing must be held.
This is indefinite depending upon the response of the committed
individual. The original detention can not exceed 48 hours unless there is an application
filed within the 48 hours for continued hospitalization. If such an application is filed,
it is reviewed and acted on by the Court without a hearing. The Court also receives
supporting reports of the original applicants, the examining expert, and any other
relevant information. The Court must act on the application within 24 hours of its receipt
of the application. A hearing is only conducted if requested by the subject. If requested,
it must be held within 24 hours after receipt of the request. Sec’s 21-524,
21-525
The time requirements referenced above are extended if they are to
expire on a Saturday, Sunday, or legal holiday. They are also extended to an hour no
earlier than 12:00 noon. Sec. 21-526
Therefore, assuming that there is no extension by weekend, holiday,
or early morning action, and assuming that the subject made a prompt request for a
hearing, the longest possible period of hospitalization before a required hearing would be
96 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. There is a 48 hour delayed release for voluntary patients. Sec’s
21-511, 21-512
Are there any requirements that a potential committee be
capable of deciding to voluntarily undergo treatment?
This is not addressed in the statute. There is a separate provision
of the statute for the hospitalization of nonprotesting persons. This would be a more
appropriate section for the commitment of an individual whose incapacity was obvious. Sec.
21-513
Who may petition for an individual to receive assisted
inpatient treatment?
An accredited officer or agent of the Department of Human
Services, an officer authorized to make arrests in D.C., or a physician or qualified
psychologist of the person in question may petition for emergency assisted
hospitalization. Sec. 21-521
The same individuals may commence proceedings for the judicial
hospitalization of an individual (non-emergency). The subject’s spouse, parent, or
legal guardian may also commence such an action. Sec. 21-541
Required elements of a petition.
The petition must be in writing and filed with the Commission on
Mental Health. It shall be accompanied by either:
A certificate of a physician or qualified psychologist stating that
he has examined the person and is of the opinion that the person is mentally ill, and,
because of the illness, is likely to injure himself or other persons if allowed to remain
at liberty; or
A sworn written statement by the petitioner that:
the petitioner has good reason to believe that the person is
mentally ill, and, because of the illness, is likely to injure himself or other persons if
allowed to remain at liberty; and the person has refused to submit to examination by
physician or qualified psychologist. Sec. 21-541
Is there a penalty for filing an unfounded petition?
Yes. It is a crime punishable by imprisonment up to three years
to: (1) cause or conspire or assists another to cause the apprehension, detention,
restraint, or hospitalization of another if the action is taken without probable cause to
believe the subject to be mentally ill; (2) cause, conspire, or assist another to violate
the rights of a person under the commitment law; or (3) act as a physician, psychiatrist,
or psychologist to knowingly make a false application as to the mental condition of a
person.
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 initial hearing shall be prompt and informal. It shall be
conducted in a physical setting not likely to have a harmful effect on the mental health
of the person named in the petition. There is no automatic standing for the attendance of
anybody other than the subject of the petition. The Commission, however, is charged to
hear all relevant evidence that may be offered. Therefore, if a family member had relevant
evidence, and if it were to be offered at the hearing, the Commission would be charged
with hearing the evidence. The presence of the witness would then obviously be necessary. Sec.
21-542
Length of initial term of assisted inpatient treatment.
If the necessary findings of mental illness and likely-hood of
injury are established, the court may then order hospitalization for an indeterminate
period. The court may order any other course of treatment which the court believes to be
in the best interests of the person or of the public.
Conditions necessary for judicially ordered inpatient
treatment (exact wording of key portions of applicable statute desired).
The court or jury [if a jury trial is demanded] must find
"that the person is mentally ill and, because of that illness, is likely to injure
himself or other persons if allowed to remain at liberty…" Sec.
21-545
- Evidentiary standard under which eligibility for assisted
treatment is judged (two most common are "beyond a reasonable doubt" and
"clear and convincing evidence").
Though the statute is silent, case law established the standard
as "Clear and convincing evidence" In re Nelson, App. D.C., 422
A2d. 1233 (1979)
Is there a least restrictive treatment requirement?
There
is no explicit provision for "least restrictive treatment" in the statute. There
is case authority for a right to treatment by the least restrictive means. See In re
Plummer, App. D.C., 608 A.2d 741 (1992). Case authority also
identifies factors to be considered by the Court in determining "least restrictive
treatment". See In re Stokes, App. D.C., 546 A.2d 356 (1988).
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 explicit reference to advance directives or powers
of attorney in the statute.
Is there a separate proceeding necessary to abrogate a
committee’s right to refuse treatment?
The statute does not explicitly address this.
Case law in the District establishes the continuing competency of a
committee. See In re Boyd, App. D.C., 403 A.2d 744 (1979). Also
see Sec. 21-564. Notwithstanding the continued competency of the
committee, if the proofs are sufficient at a commitment trial, "…the court may
order his hospitalization for an indeterminate period, or order any other alternative
course of treatment which the court believes will be in the best interests of the
person or of the public" Sec. 21-545.
It therefore appears that the court has the power to make an order
as to treatment as part of the commitment.
Does the treating hospital and/or physician have discretion
to release individuals before the end of their assisted inpatient care periods?
The Chief of Service at the treating hospital has a duty to
release an individual who is no longer mentally ill to the extent that he is likely to
injure himself or others if not hospitalized.
Individual(s) who may decide to initiate new periods of
assisted treatment.
Since the original commitment period is for an indefinite
duration, there are no provisions for renewed or extended commitments.
Type of forum that decides on need for extended assisted
treatment (normally either judicial or administrative).
See above at 15. The committee, though, does have a right to
seek a review of his commitment and a release. This process is commenced with a request by
the patient, or his attorney, legal guardian, spouse, parent, or other nearest adult
relative to the Chief of service of the treatment facility. The request may be filed after
the expiration of 90 days of hospitalization, and not more frequently than every 6 months
thereafter. The request is first reviewed, and may be granted, by the Chief of service.
The patient does have a right to a court hearing if one of the examining doctors or
psychologists supports the release of the patient.
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.).
As noted above, a representative of, or related
party to, the patient may commence the request for release. The patient is entitled to the
assistance of his own doctor or psychologist, and one shall be provided for him at
government expense if he is indigent.
If the patient appeals to the court for his release,
he would be entitled to a counsel.
Sec’s. 21-543, 21-546, &
21-547
Maximum length of subsequent assisted inpatient treatment
(and of any possible subsequent periods).
Undetermined.
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).
The terms "conditional release" and "outpatient
commitment" do not appear in the statute. The setting and the nature of the treatment
are a subject for the court at the time of the initial commitment. See #’s 7 &13
above. The Chief of service has the power to use conditional release and outpatient
treatment. Case law has recognized the value of these options, and the ability of a
commitment order to permit the summary return of a patient to inpatient status with prompt
notice to the court. See In re Richardson 481 A.2d 473 (1984).
Maximum duration of alternative(s) to assisted inpatient
treatment.
There is no time limitation.
Procedure necessary to transfer patient from outpatient to
inpatient care.
A patient may be summarily returned to the hospital from
outpatient status for an observation period of 5 days. There must be prompt notice to the
court, the patient, and the patient’s counsel. To hold the patient after the 5 day
observation period there must be a new proceeding for involuntary hospitalization. See In
re Richardson 481 A.2d 473 (1984), and Matter of Plummer 608
A.2d 741 (1992).
Describe any procedures for conservatorship, guardianship,
etc., which are applicable to the mentally ill.
There are no such provisions in the Law governing commitments in
D.C.
