HS/HCS/SCS/SBs 884 & 841 - This act makes changes to Missouri's laws regarding the commitment, conditional release and the entitlement of persons who are acquitted of certain crimes based on mental disease or defect and expands the rights of victims of dangerous felonies. It makes various changes to Missouri's civil involuntary treatment laws and creates outpatient involuntary mental health treatment. It allows the Department of Social Services to create three pilot projects to stop the institutionalization of Missouri's elderly. The act changes the use of the Mental Health Earnings Fund. The act also adds an additional standard for the licensure of residential facilities and day programs for persons who are affected by a mental disorder.

MISSOURI'S CIVIL INVOLUNTARY TREATMENT LAWS

This act defines a "mental health facility" as any residential facility, public or private, or any public or private hospital which can provide evaluation, treatment and inpatient care to persons suffering from a mental disorder and a "mental health program" to mean any public or private residential facility, public or private hospital, public or private specialized service, or public or private day program that can provide care, treatment, rehabilitation or other services in an inpatient or outpatient setting to persons with mental disorders or illnesses or with a diagnosis of alcohol or drug abuse. However, no correctional facility or jail may be considered a mental health facility or mental health program.

This act also provides patients, residents or clients of a residential facility, day program, mental health facility or mental health program, the right to an impartial administrative review process on their complaints of alleged violations of their rights and also provides a method of presenting grievances on the record to a neutral decision maker who will issue findings of fact, conclusions and recommendations.

The facility shall provide a person, at the time of admission, a description of the facility, its services and its costs, information as to how to seek conditional release or discharge, a statement of rights, a description of the patient grievance procedure. The facility shall attempt to notify the family of the person being admitted within 8 hours of the time of admission.

Facilities would be allowed to disclose information and records to mental health coordinators, but only to the extent necessary to carry out their duties under Chapter 632, RSMo.

The act increases the penalty for patient, resident or client abuse or neglect from a Class A misdemeanor to a Class D felony in cases where a person mistreats or maltreats any person, patient, resident or client in a brutal or inhuman manner or if the person, patient, resident or client is treated in such a manner that a substantial probability exists that death or serious physical harm will result. All other acts of abuse or neglect would remain a Class A misdemeanor.

The Department of Mental Health must initiate an investigation within 24 hours of the receipt of an abuse or neglect case in a facility or program licensed under Chapter 197, RSMo.

A respondent accepted for treatment and rehabilitation in an alcohol or drug abuse facility shall be informed of his right to have an interpreter, at his own expense, to assist him to communicate at the facility or during the hearing or both, if he has impaired hearing.

This act changes the definition under which a person may be committed to a mental hospital involuntarily. "Likelihood of serious harm" would mean (a) A substantial risk that serious physical harm will be inflicted by a person upon his own person but does not require actual physical injury to have occurred; (b) A substantial risk that serious physical harm to a person will result or is occurring because of an impairment in his capacity to make decisions or his inability to provide for his own mental health care which may result in a substantial risk of serious physical harm; (c) A substantial risk that serious physical harm will be inflicted by one person upon another as evidenced by recent overt acts, behavior or threats.

Evidence of substantial risk may also include information about patterns of behavior that have previously resulted in serious harm being inflicted by a person upon himself.

When a mental health coordinator receives information alleging that a person, as a result of a mental disorder, presents a likelihood of serious harm to himself or others, the person considered for involuntary commitment shall be evaluated according to the likelihood of serious physical harm to himself or others. Where such a person previously has been clinically diagnosed with a mental illness, such involuntary commitment may occur if there is reasonable cause to believe that such person is mentally disordered and as a results presents likelihood of harm to himself or others.

An application for detention for evaluation and treatment may be executed by any adult person who has reason to believe that the respondent is suffering from a mental disorder and presents a likelihood of serious harm to himself or other persons. If the court finds there is probable cause, it shall direct a peace officer to take the respondent into custody and transport him to a mental health facility for detention for evaluation and treatment for a period not to exceed 96 hours unless further detention is authorized.

At the expiration of the 96 hour period, the respondent may be detained and involuntarily treated for an additional 2 judicial days if the head of the mental health facility or mental health coordinator has either filed a petition for additional inpatient detention and treatment not to exceed 21 days or has filed a petition for out-patient detention and treatment for a period not to exceed 180 days has established in this act.

If such a petition is filed it must affirm that attempts were made to provide necessary care, treatment and services in the least restrictive environment to the respondent on a voluntary basis, but that the petitioner believes that the respondent lacks the capacity to voluntarily consent to care, treatment and services or the respondent refuses to voluntarily consent to care, treatment and services. The petition must also (1) allege that there will be appropriate support from family, friends, case managers or others during the period of outpatient detention and treatment in the community if out-patient commitment is sought; (2) specify the range of care, treatment and services that shall be provided the respondent; and (3) name the entities that have agreed to fund and provide the specified interventions.

The respondent shall have the right to a hearing before a jury, if requested by the respondent or his attorney.

The mental health program or facility shall provide patients upon their release packets of educational information developed and supplied by the Department of Mental Health describing symptoms of common mental illnesses, availability of other educational, community and statewide services.

This act also provides that no biomedical or pharmacological research can be conducted in any mental health facility or program in which people may be civilly detained or in any public or private residential facility unless such research is intended to alleviate or prevent the disabling conditions or is reasonably expected to be of direct therapeutic benefit to the participants.

No biomedical or pharmacological research may be carried out on an involuntary patient without a specific court order. The application for the order shall be filed in the county where the mental health facility is located. However, the application may be transferred to the committing court if requested by the patient.

CREATION OF PILOT PROJECTS BY DEPARTMENT OF SOCIAL SERVICES

The act also allows the Department of Social Services, subject to appropriations, to develop three demonstration projects designed to prevent the premature or unnecessary institutionalization of Missouri's elderly citizens in St. Louis City, Kansas City and in region 2 of the Area Agency on Aging. The Department could expand the program within its appropriations.

The act also makes several changes to procedures involving the commitment, conditional release, and the entitlement of persons who are acquitted of certain crimes based on mental disease or defect. In addition the substitute expands the rights of victims of dangerous felonies.

MISSOURI'S INVOLUNTARY TREATMENT LAWS IN CRIMINAL CASES

The act also makes several changes to the criminal procedures involving the commitment, conditional release and the entitlement of persons who are acquitted of certain crimes based upon mental disease or defect.

When an accused is tried and acquitted on the ground of mental disease or defect "not guilty by reason of insanity", (NGRI), the court shall order the custody and care of such person to the Director of the Department of Mental Health. If the accused has not been charged with a dangerous felony or with 1st degree murder or sexual assault or attempts thereof, the accused shall be examined to determine conditions of confinement or terms for conditional release to the community. Until such time as a court enters an order granting a conditional or unconditional release such person shall be kept in a secure facility. The act prohibits a person committed to a mental institution after a trial and acquittal based on mental disease or defect from receiving treatment in an nonsecured facility.

The act also allows any party objecting to the release of the committed person to file written objections within 30 days of service of the notice to release.

The burden of persuasion for the conditional or unconditional release of a person acquitted on the grounds of mental disease or defect of a non-violent or dangerous crime shall be on the person seeking unconditional release. The committed person must prove to a clear and convincing standard that he does not have and in the reasonable future is not likely to have a mental disease or defect rending him dangerous to the safety of others.

Applications for conditional release hearings for violent or dangerous crimes are required are to be filed in the committing court.

The act would allow the court which ordered the release to issue a notice to the released person to appear on charges of violating the terms of the release. The court may also order the arrest of the released person and if necessary the return to custody of such person to the court or to a mental health facility.

The act also allows law enforcement authorities to obtain limited information concerning a NGRI committed person.

LICENSURE REQUIREMENTS

The required standards contained in the rules for licensure of residential facilities and day programs for persons who are affected by mental disorders must include by August 28, 1997 a requirement to have a criminal record review done by the Missouri State Highway Patrol for all staff in a residential facility and day program who have unsupervised contact with persons affected by a mental disorder.

VICTIMS RIGHTS

The act also makes changes to the rights of victims of dangerous or violent felonies, by making information available to victims on the release of offenders, including trial release by a court of a mental health patients and includes victims of 2nd degree burglary, 1st degree murder, voluntary manslaughter and victims of attempts of these crimes with the rights of notice and input.

MENTAL HEALTH EARNINGS FUND

The act states that the Department of Mental Health is to deposit the fees received from the substances abuse traffic offenders program shall be deposited in the Mental Health Earnings Fund. The moneys received from such fees shall be used solely for assistance in securing alcohol and drug rehabilitation services for persons who are unable to pay for the services they receive.

Revenues received for the provision of services under a managed care agreement may also be deposited into the Mental Health Earnings Fund. Subject to the appropriations process, such revenues, may be expended for the purpose of providing Mental Health services pursuant to the managed care agreement.

Money in the Mental Health Earning Fund may be used to deposit revenue received pursuant to agreements entered into by the Department of Mental Health and an Alcohol and Drug Abuse Counselor Certification Board for the purpose of providing oversight of counselor certification. However, such revenue must be accounted for separately from all other revenues deposited into the fund.

Includes language from SB 555, HB 1081, HB 1165 and HB 1430.
CHERYL GRAZIER