INVOLUNTARY MENTAL INVOLUNTARY MENTAL HEALTH COMMITMENTSHEALTH COMMITMENTS

Lisa Granberry CorbettLisa Granberry CorbettAssistant Attorney GeneralAssistant Attorney General

Jane Ammons GilchristJane Ammons GilchristAssistant Attorney GeneralAssistant Attorney General

INVOLUNTARY COMMITMENT PROCESSINVOLUNTARY COMMITMENT PROCESS

Can be initiated by:Can be initiated by:

An officerAn officer

A third partyA third party

Physician or eligible psychologistPhysician or eligible psychologist

Special emergency proceduresSpecial emergency procedures

REASONS TO USE INVOLUNTARY REASONS TO USE INVOLUNTARY PROCESSPROCESS

Criteria are mentally ill andCriteria are mentally ill and

Dangerous to self or othersDangerous to self or others

OR is a substance abuse andOR is a substance abuse and

Dangerous to self or others.Dangerous to self or others.

Can use involuntary out patient procedure Can use involuntary out patient procedure for persons who do not follow up for persons who do not follow up voluntarily with out patient treatment.voluntarily with out patient treatment.

DANGER TO SELFDANGER TO SELF

Within the relevant past the individual has acted Within the relevant past the individual has acted to show:to show:

(1) that he/she would be unable, without care, (1) that he/she would be unable, without care, supervision, and the continued assistance of others supervision, and the continued assistance of others not otherwise available, to exercise appropriate not otherwise available, to exercise appropriate self-control, judgment, and discretion in the conduct self-control, judgment, and discretion in the conduct of his/her daily responsibilities or to satisfy his need of his/her daily responsibilities or to satisfy his need forfor Nourishment, personal or medical care, Nourishment, personal or medical care, shelter or self-protection and safety; ANDshelter or self-protection and safety; AND

DANGER TO SELFDANGER TO SELF

(2) That there is a reasonable probability of his (2) That there is a reasonable probability of his suffering serious physical debilitation within the suffering serious physical debilitation within the near future unless adequate treatment is given. near future unless adequate treatment is given. A showing of behavior that is grossly irrational, A showing of behavior that is grossly irrational, or actions that the individual is unable to control, or actions that the individual is unable to control, of behavior that is grossly inappropriate to the of behavior that is grossly inappropriate to the situation, or other evidence of severely impaired situation, or other evidence of severely impaired insight and judgment;insight and judgment;

OROR

DANGER TO SELFDANGER TO SELF

The individual has attempted suicide or The individual has attempted suicide or threatened suicide and that there is a threatened suicide and that there is a reasonable probability of suicide unless reasonable probability of suicide unless adequate treatment is given; adequate treatment is given;

OROR

The individual has mutilated himself or The individual has mutilated himself or attempted to mutilate himself and that there is a attempted to mutilate himself and that there is a reasonable probability of serious self-mutilation reasonable probability of serious self-mutilation unless adequate treatment is givenunless adequate treatment is given

DANGER TO OTHERSDANGER TO OTHERS

Within the relevant past, the individual has:Within the relevant past, the individual has: Inflicted or attempted to inflict or threatened to Inflicted or attempted to inflict or threatened to

inflict serious bodily harm on another; orinflict serious bodily harm on another; or Acted in such a way as to create a substantial Acted in such a way as to create a substantial

risk of serious bodily harm to another; orrisk of serious bodily harm to another; or Engaged in extreme destruction of property; Engaged in extreme destruction of property;

ANDAND

There is reasonable probability that this There is reasonable probability that this conduct will be repeatedconduct will be repeated

INVOLUNTARY COMMITMENTINVOLUNTARY COMMITMENT

PROCEDURESPROCEDURES Petition is taken by any person who has Petition is taken by any person who has knowledge that a person is mentally ill and knowledge that a person is mentally ill and dangerous to self or others, ordangerous to self or others, orIs a substance abuser and is a danger to self or Is a substance abuser and is a danger to self or others.others.Mental retardation is no longer a criteria for Mental retardation is no longer a criteria for commitment.commitment.Petition is usually filled out at magistrate’s office Petition is usually filled out at magistrate’s office or clerk of court’s office, and is sworn to.or clerk of court’s office, and is sworn to.NOTE: Physician or eligible psychologist NOTE: Physician or eligible psychologist petitioner can have petition notarized and faxed petitioner can have petition notarized and faxed to magistrate for issuance of custody order.to magistrate for issuance of custody order.

INVOLUNTARY COMMITMENTINVOLUNTARY COMMITMENTPROCEDURESPROCEDURES

Magistrate issues custody order to have law Magistrate issues custody order to have law enforcement transport patient to an area facility enforcement transport patient to an area facility for evaluation, or to any physician locally for evaluation, or to any physician locally available. It is the custody order that authorizes available. It is the custody order that authorizes law enforcement to take respondent into custody law enforcement to take respondent into custody and transport.and transport.Custody order must be served within 24 hours of Custody order must be served within 24 hours of issuance. Times must be noted on papers.issuance. Times must be noted on papers.First evaluator has 24 hours to evaluate after First evaluator has 24 hours to evaluate after presentation to the facility. It is important for law presentation to the facility. It is important for law enforcement officer to note time of presentation enforcement officer to note time of presentation to facility for examination.to facility for examination.

The law enforcement officer should stay with the The law enforcement officer should stay with the respondent until he determines that a physician respondent until he determines that a physician or eligible psychologist is available to conduct or eligible psychologist is available to conduct the examination. It is also recommended that the examination. It is also recommended that the law enforcement officer ensure that the the law enforcement officer ensure that the respondent is left under appropriate supervision. respondent is left under appropriate supervision. Factors for appropriate supervision include: Factors for appropriate supervision include: Whether respondent appears violent, or has a Whether respondent appears violent, or has a history of violence, type of facility (secure?) and history of violence, type of facility (secure?) and personnel available to supervise.personnel available to supervise.

FIRST EXAMINATIONFIRST EXAMINATION

First evaluator can stop the process and release First evaluator can stop the process and release respondent. Law enforcement officer returns respondent. Law enforcement officer returns respondent to home.respondent to home.If criteria for inpatient are met, law enforcement If criteria for inpatient are met, law enforcement takes patient to 24 hour facility. Law enforcement takes patient to 24 hour facility. Law enforcement officer does not have to stay with the client once he officer does not have to stay with the client once he delivers to a responsible person at the 24 hour delivers to a responsible person at the 24 hour facility.facility.Evaluator has 24 hours after presentation at the 24 Evaluator has 24 hours after presentation at the 24 hour facility to evaluate in second examination. hour facility to evaluate in second examination. Patient can be released at this step as well and is Patient can be released at this step as well and is returned home via law enforcement.returned home via law enforcement.

Some exceptionsSome exceptions

This first examination is not required if the affiant This first examination is not required if the affiant who obtained the custody order is a physician or who obtained the custody order is a physician or eligible psychologist who recommends inpatient eligible psychologist who recommends inpatient commitment (The affiant should fill the commitment (The affiant should fill the evaluation form out in these cases)evaluation form out in these cases)

The first examination is also not required if the The first examination is also not required if the respondent is sent to the 24 hour facility on a respondent is sent to the 24 hour facility on a special order as incapable to proceed special order as incapable to proceed and and charged with a violent crime. (Also known charged with a violent crime. (Also known as HB 95)as HB 95)

EMERGENCY PROCEDUREEMERGENCY PROCEDURE

N.C.G.S. Section 122C-262N.C.G.S. Section 122C-262

Anyone, including a law enforcement officer, who Anyone, including a law enforcement officer, who has knowledge of an individual who is subject to has knowledge of an individual who is subject to inpatient commitment and who requires inpatient commitment and who requires immediate hospitalization to prevent harm to self immediate hospitalization to prevent harm to self or others, may transport the individual directly to or others, may transport the individual directly to an area facility or other place, an area facility or other place, including a State including a State facility for the mentally illfacility for the mentally ill, for examination by a , for examination by a physician or eligible psychologistphysician or eligible psychologist

EMERGENCY PROCEDUREEMERGENCY PROCEDURE

Upon examination by the physician or eligible Upon examination by the physician or eligible psychologist, if the individual meets inpatient psychologist, if the individual meets inpatient criteria, the physician or eligible psychologist shall criteria, the physician or eligible psychologist shall so certify in writing before any official authorized to so certify in writing before any official authorized to administer oathsadminister oaths

NOTENOTE: If the physician or eligible psychologist : If the physician or eligible psychologist executes the oath, appearance before a magistrate executes the oath, appearance before a magistrate shall be waived. The physician or eligible shall be waived. The physician or eligible psychologist shall send a copy of this certificate to psychologist shall send a copy of this certificate to the clerk of superior court by the most reliable and the clerk of superior court by the most reliable and expeditious meansexpeditious means

Emergency ProcedureEmergency Procedure

The emergency certificate acts as the The emergency certificate acts as the custody order, and law enforcement custody order, and law enforcement transports respondent to a 24 hour facility.transports respondent to a 24 hour facility.

DMH form 5-72-01ADMH form 5-72-01A

The physician or eligible psychologist that The physician or eligible psychologist that signed the emergency certificate usually signed the emergency certificate usually fills out the first evaluation, another fills out the first evaluation, another community evaluation is not required.community evaluation is not required.

EMERGENCY PROCEDUREEMERGENCY PROCEDURE

Respondents received at a 24-hour facility under Respondents received at a 24-hour facility under this statute shall be examined by a second this statute shall be examined by a second physicianphysician

After receipt of notification that the district court After receipt of notification that the district court has determined reasonable grounds for this has determined reasonable grounds for this commitment, further proceedings shall be commitment, further proceedings shall be carried out in the same way as for all other carried out in the same way as for all other respondentsrespondents

Special emergency procedureSpecial emergency procedureSubstance AbusersSubstance Abusers

NCGS 122C-282 Special emergency NCGS 122C-282 Special emergency procedure for violent individualsprocedure for violent individuals Individual must meet commitment criteria of Individual must meet commitment criteria of

substance abuser and dangerous to self or substance abuser and dangerous to self or othersothers

Must also be violent and require restraintMust also be violent and require restraint Delaying taking individual to a physician or Delaying taking individual to a physician or

eligible psychologist would likely endanger life eligible psychologist would likely endanger life or propertyor property

Emergency substance abuseEmergency substance abuse

Law enforcement officer can take individual into Law enforcement officer can take individual into custody and take him before a magistrate or custody and take him before a magistrate or clerk, and swear that the person meets above clerk, and swear that the person meets above criteria.criteria. AOC form AOC –SP-909MAOC form AOC –SP-909M

The Clerk or Magistrate must find by clear, The Clerk or Magistrate must find by clear, cogent and convincing evidence respondent cogent and convincing evidence respondent meets criteria.meets criteria.Orders respondent directly to a designated 24 Orders respondent directly to a designated 24 hour facilityhour facility

ENTERING PRIVATE PREMISESENTERING PRIVATE PREMISES

A law enforcement officer may enter A law enforcement officer may enter private premises in any of the following private premises in any of the following three situations to take a respondent into three situations to take a respondent into custody pursuant to a custody order.custody pursuant to a custody order.

First—Same Circumstances as an First—Same Circumstances as an Arrest WarrantArrest Warrant

Probable cause to believe person to be Probable cause to believe person to be taken into custody is on premisestaken into custody is on premises

Have given or made reasonable effort to Have given or made reasonable effort to give occupant notice of the officer’s give occupant notice of the officer’s presencepresence

Have signed custody order in officer’s Have signed custody order in officer’s possessionpossession

Second—NCGS § 15A-285Second—NCGS § 15A-285

An officer may enter buildings, vehicles, An officer may enter buildings, vehicles, and other premises if he reasonably and other premises if he reasonably believes that doing so is believes that doing so is urgently urgently necessarynecessary to save a life, prevent serious to save a life, prevent serious bodily harm, or avert or control a public bodily harm, or avert or control a public catastrophe.catastrophe.

Third--ConsentThird--Consent

An officer may enter private premises An officer may enter private premises when consent is given by an appropriate when consent is given by an appropriate resident.resident.

TRANSPORTATIONTRANSPORTATION

Obtaining the initial examObtaining the initial exam

Transporting the respondent from the Transporting the respondent from the initial examinitial exam

Transporting the respondent to and from a Transporting the respondent to and from a 24-hour facility24-hour facility

Initial ExamInitial Exam

NCGS § 122C-263—after taking NCGS § 122C-263—after taking respondent into custody, the officer must respondent into custody, the officer must transport the respondent to an area facility transport the respondent to an area facility “without unnecessary delay.”“without unnecessary delay.”

If physician or eligible psychologist not If physician or eligible psychologist not available at area facility, take respondent available at area facility, take respondent to “any physician or eligible psychologist to “any physician or eligible psychologist locally available.”locally available.”

Remaining with RespondentRemaining with Respondent

Law enforcement officer must stay with Law enforcement officer must stay with respondent until it is determined that a respondent until it is determined that a physician or psychologist is available to physician or psychologist is available to conduct the examconduct the exam

Before leaving a respondent officer should Before leaving a respondent officer should ensure that respondent is left under ensure that respondent is left under appropriate supervision.appropriate supervision.

Appropriate Supervision—Factors Appropriate Supervision—Factors to Considerto Consider

Whether respondent appears violentWhether respondent appears violent

Whether respondent has a history of Whether respondent has a history of violenceviolence

The type of facility where respondent is The type of facility where respondent is being examinedbeing examined

Personnel available to supervise Personnel available to supervise respondentrespondent

Use your best judgmentUse your best judgment

Transportation after initial examTransportation after initial exam

Inpatient commitment recommendedInpatient commitment recommended Law enforcement agency designated in the Law enforcement agency designated in the

custody order is responsible for transporting custody order is responsible for transporting the respondent to a 24-hour facility.the respondent to a 24-hour facility.

Outpatient recommendedOutpatient recommended Law enforcement agency designated in the Law enforcement agency designated in the

custody order is responsible for returning custody order is responsible for returning respondent to either his residence or the respondent to either his residence or the home of a consenting third party.home of a consenting third party.

No commitment recommendedNo commitment recommended NCGS § 122C-263 mandates that NCGS § 122C-263 mandates that

proceedings be terminatedproceedings be terminated Law enforcement agency designated in the Law enforcement agency designated in the

custody order is responsible for returning custody order is responsible for returning respondent to either his residence or the respondent to either his residence or the home of a consenting third party.home of a consenting third party.

Respondent shall be released from custody.Respondent shall be released from custody.

Transporting to and from 24 hour Transporting to and from 24 hour facilityfacility

Transporting within the countyTransporting within the county

Transporting outside the countyTransporting outside the county

Inside the County Inside the County

Law enforcement agency designated in Law enforcement agency designated in the original custody order is responsible the original custody order is responsible for transporting from the initial examination for transporting from the initial examination to the 24-hour facility if the facility is in the to the 24-hour facility if the facility is in the county.county. If respondent lives in the city or is taken into If respondent lives in the city or is taken into

custody in the city, the city is responsible.custody in the city, the city is responsible. If respondent lives in the county or is taken If respondent lives in the county or is taken

into custody in the county, the county is into custody in the county, the county is responsible.responsible.

Upon respondent’s release from a 24-hour Upon respondent’s release from a 24-hour facility:facility: The city has the duty to transport the respondent The city has the duty to transport the respondent

home if respondent lives inside the city limits.home if respondent lives inside the city limits. Otherwise, the county is responsible for transporting Otherwise, the county is responsible for transporting

the respondent home.the respondent home. Cities and counties may contract with each other to Cities and counties may contract with each other to

provide these services.provide these services. Discharged respondent may use own transportation.Discharged respondent may use own transportation.

Outside the CountyOutside the County

If respondent is transported to 24-hour If respondent is transported to 24-hour facility in another county, the county where facility in another county, the county where respondent was taken into custody is respondent was taken into custody is responsible for transportation.responsible for transportation.

When respondent is discharged from a 24-When respondent is discharged from a 24-hour facility, transportation is provided by hour facility, transportation is provided by the county of residence of the respondent.the county of residence of the respondent.

If respondent is denied admission at a 24-If respondent is denied admission at a 24-hour facility, transportation is by the hour facility, transportation is by the agency designated in the custody order.agency designated in the custody order.

Respondent is returned to original county.Respondent is returned to original county.

When is the sheriff responsible for When is the sheriff responsible for transportation?transportation?

When designated in the original custody order.When designated in the original custody order.When the respondent is a county resident or is When the respondent is a county resident or is taken into custody in the county. Sheriff taken into custody in the county. Sheriff responsible for transportation to and from the responsible for transportation to and from the 24-hour facility.24-hour facility.When respondent must be taken to another When respondent must be taken to another county regardless of residence.county regardless of residence.When a county resident is admitted to a 24-hour When a county resident is admitted to a 24-hour facility in another county, the sheriff is facility in another county, the sheriff is responsible for transportation upon discharge.responsible for transportation upon discharge.

Legal ParametersLegal Parameters

Individuals taken into custody under these Individuals taken into custody under these laws have not committed a criminal laws have not committed a criminal offense. Law enforcement officers should offense. Law enforcement officers should advise respondents when taking them into advise respondents when taking them into custody that they are not under arrest, but custody that they are not under arrest, but are being transported to receive treatment are being transported to receive treatment for their own safety and the safety of for their own safety and the safety of others.others.

Legal ParametersLegal Parameters

Amount of forceAmount of force

Gender of transport officersGender of transport officers

Transportation costsTransportation costs

Amount of ForceAmount of Force

In transporting a respondent pursuant to a In transporting a respondent pursuant to a commitment order, a law enforcement commitment order, a law enforcement officer may use officer may use reasonable forcereasonable force to to restrain the respondent if it appears restrain the respondent if it appears necessary to protect the officer, necessary to protect the officer, respondent or others.respondent or others.

GenderGender

The transporting officer should be of the The transporting officer should be of the same sex as the respondent. same sex as the respondent.

If not of the same sex, an attendant of the If not of the same sex, an attendant of the same sex should accompany the same sex should accompany the transporting officer. Not required to be a transporting officer. Not required to be a sworn officer.sworn officer.

It may be appropriate to allow a family It may be appropriate to allow a family member to accompany respondent.member to accompany respondent.

Transportation CostsTransportation Costs

Costs and expenses of transporting a Costs and expenses of transporting a respondent to or from a 24-hour facility is respondent to or from a 24-hour facility is the responsibility of the county of the responsibility of the county of residence of the respondent.residence of the respondent.

State, city, or county that incurs State, city, or county that incurs transportation costs may recover the transportation costs may recover the reasonable costs of transportation from reasonable costs of transportation from the county of residence.the county of residence.

County of residence may recover reasonable County of residence may recover reasonable costs that it pays to the state, city or county. The costs that it pays to the state, city or county. The costs may be recovered from:costs may be recovered from: Respondent, if not indigent.Respondent, if not indigent. Person or entity legally responsible for respondent’s Person or entity legally responsible for respondent’s

support.support. Any person contractually responsible for the cost.Any person contractually responsible for the cost. Any person or entity otherwise liable under federal, Any person or entity otherwise liable under federal,

state or local law.state or local law.

Questions?Questions?