These bills are listed as follows:
Bill SB 683 (PA 496) broadens the
classification for a "person requiring treatment," for
involuntary court ordered treatment, to include persons with mental
illness who have been noncompliant with treatment recommendations,
and have been institutionalized as a result, twice or more in the
previous 48 months. This bill also includes a classification for
those with mental illness who have acted on, attempted or threatened
serious violent behavior once in the previous 48 months;
Bill SB 684 (PA 497) designates a
process for AOT petition filing for a "person requiring
treatment. This bill also states the enduring right of an individual
for an appeal under any state law or court ruling;
Bill SB 685 (PA 498) specifies the
restricted length of an AOT court order, and requires hospitalization
for those found to be noncompliant of the AOT order;
Bill SB 686 (PA 499) defines what
is and what is not involved in a court ordered AOT program. An AOT
program can be coordinated through an intensive case management
service or an assertive community treatment service. The Michigan
Department of Community Health is required to present a report on
Michigan AOT services report the legislature annually (Michigan.gov).
Every year bills concerning AOT
are presented to the House of Representatives. Just as Kevins Law
came into existence through legislation, these bills are either voted
down or passed and moved on to the Senate for approval. Some bills
regarding AOT are reviewed and passed through the Senate, some are
being reviewed or voted down. Most of these new bills seek to line
up with the Kevins Law additions to the Michigan Mental Health Code.
The beneficiaries of Kevins Law
are the patient, the family, other loved ones and the community.
Someone with severe and persistent mental illness may be in a state
of refusal to receive any form of treatment. Alternatively, they may
simply be unaware of the severity of their mental condition,
especially at times when those individuals are involved activities
which bring about violence and or hospitalization. Once the patient
is able to receive some of the services they need for recovery, they
have an opportunity to view the situation clearly and make a decision
whether or not to move forward into a healthy lifestyle.
Kevins Law is helpful to the
psychiatric patient as well as everyone else involved in that persons
well being. These people involved would otherwise have no power to
help. As naturally follows with safety of the patient, Kevins Law is
also very effective in the outcome on public safety. A similar
policy in New York called Kendras Law" decreased arrests by 83%,
diminished homelessness by 86% and has lessened medication
noncompliance for those who are sentenced with court ordered
treatment by 67% (Allen, 2008).
Kevins Law is used by our courts
in coordination with mental health treatment. Mental health
professionals can make diagnoses and treatment recommendations as to
what is needed by an individual they have worked with. The case is
brought in front of the judge, who is aware of these treatment
recommendations and in power to enforce them as a court order for the
patient to follow, in the course of a probationary track. The court
ordered patient has treatment coordinated through the local Community
Mental Health agency or other governmental mental health agency.
Perceived Problem Addressed by
Kevins Law
Problems of incarceration and
homelessness among untreated mentally ill populations have been
evident for quite some time in America (psychiatryonline.org). The
deinstitutionalization of patients from mental hospitals in the 1960s
created a public mass of people in need of treatment and services
without means to receive help. This has remained a pervasive issue
in relation to a vulnerable and sometimes dangerous population going
without treatment or even basic human needs.
Kevins Law is based on the
assumption that someone sorely in need of mental health treatment is
very often beyond the capacity to make those decisions for
themselves. This policy creates an opportunity for society to lift a
person with severe mental illness out of a diseased situation.
Previously the problem in helping those with severe and persistent
mental illness laid within Michigans strict legal criterion. In
addition to a patients noncompliance, there was a far too stringent
criteria for imminent danger to self or others
(psychiatryonline.org). In result the patient was turned loose, not
admitted to treatment or kept for only a short period, even when
served a court order. Most often mothers and other loved ones were
the only source of support which remained, if any at all.
Some of the newer problems in
implementing Kevins Law are that of witness requirements. A lay
witness is needed to testify to the facts of the case; an expert
witness is needed to determine the diagnosis and qualification for
involuntary treatment, and another expert witness to testify to
specific actions of the patient. These witnesses are often hard to
find for a patient, especially in large urban areas.
Another difficulty of Kevins Law
is the complexities of sentencing treatment recommendations on the
part of the judge. Judges are put in an awkward position of
discretion as to what measures and the degree of measures to be taken
in giving a court ordered treatment. Today there are mental health
courts where a judge is educated in the process of our mental health
system and or mental health recovery. However, the judge is put into
a position of acting as a pseudo-physician/probation officer in these
mental health court situations. Judges will review a patient
regularly as a part of a court order, or in a situation of
noncompliance with the order.
Mental health court judges do have
the in-court help of mental health professionals from the local
agencies which patients are referred to for treatment. These
agencies offer various programs under the umbrella of the local
Community Mental Health agency. Some of the services include case
management, psychiatry, counseling, peer support services, substance
abuse services, Integrated Dual Diagnosis Treatment (IDDT), Assertive
Community Treatment (ACT), Wellness and Recovery Action Plan (WRAP),
and more. Many times there is a wide variety of agencies and
services that a patient can be placed in, or pursue on their own in a
pro-active approach to seeking help. The judges of mental health
court can modify a sentence to include new or different treatment
services however they see fit (as recommended to the court by
professionals or otherwise determined).
Kevins Law does have many
benefits, but it is a new policy in the process of evolution. There
are remaining problems with getting patients to court when they often
refuse, are not provided transportation or become unreachable. There
is also difficulty in proving the elusive definition of
non-compliance (Mack, 2008).
Purpose of Kevins Law
Since American
deinstitutionalization of mental hospitals, which started in 1963
with the Community Mental Health Act and grew massive in Michigan
during the 1970s, it has become obvious that our mental health system
is ineffective. Funds that were previously being used to hospitalize
patients were supposed to follow them into community care, but they
did not. A 2003 figure indicated that annually, a person with mental
illness in Michigan received services totaling around six thousand
dollars. In that year Michigan Governor Jennifer Granholms
spokesperson Liz Boyd told reporters she believes that over the last
decade, the state has turned away from caring for people who are
mentally ill and from fiscal accountability in the
system.(Newsbank.com, 2003) Former Governor Granholm appointed a 12
month commission to study this and other crisis issues in the
Michigan mental health care system. The commission focused on
continuum of care, hospital closings, sufficiency of long-term care
and appropriateness of mixed services.
New York City was faced with
similar problems in the 1990s. A homeless individual with untreated
mental illness killed a woman by pushing her into a subway trains
path in lower Manhattan. "Kendras Law" was created
named after this victim. Kendras Law allows judges to impose court
ordered AOT for those exhibiting mental illness in the state of New
York.
Senator Virgil Bernero of Lansing,
MI was the first to begin sponsorship of the Michigan AOT Law.
Kevins Law is named after the University of Michigan Social Work
student Kevin Heisinger who was beaten and killed by Brian Williams
in the Kalamazoo bus station on August 17, 2000. Williams was a 40
year old man living with untreated schizophrenia (Newsbank.com,
2003).
Williams had been arrested and
released the previous week for wandering through traffic with an
8-inch knife. He was also spotted walking naked and stopping in
front of storefront windows. Previous to the murder trial,
Heisingers family did some work with Senator Tom George of Texas
Township to look at Michigans problems in treatment of the mentally
ill. The trial formed the new AOT legislation, Kevins Law, which is
designed to reduce the possibility of this terrible situation ever
occurring again.
Today, Michigan is following the
lead of other states who have found a solution to these problems
caused by deinstitutionalization. Georgia, California, Arizona and
Connecticut have paved the way for Michigan and many other states in
the way of system transformation. It has been found most-effective
to integrate a recovery focus into services and policies, in
place of the former stabilization focus. A part of this
recovery-focused treatment is peer services. Another is
client-centered services which put the client in a motivational
position of opportunity to become a larger part of thier own
treatment planning and otherwise. Client-centered services and a
majority of emerging mental health treatment models come from the
work of Carl Rogers' 1902-1987 in his model of "Humanistic
Approach."
Historically, the US mental health
system has pursued stabilization for patients by supporting them in
management of their lives and illnesses. Currently it has become
apparent that involving individuals in their own care through
self-determination, wellness recovery action planning (WRAP),
person-centered planning and peer support services are the most
effective treatments, saving states millions of dollars. This is
commonly called the transformation of the mental health system, which
eludes to recovery of the system itself.
Training mental health
professionals and clients alike in recovery trainings, and changing
policies to reflect a recovery focus have also proven to establish a
path for healthy community integration of persons with mental
illness.(Newsbank.com, 2003) Michigans larger cities are making
strides with implementing this system transformation, and people with
mental illness who might not have come into contact with that mental
health system previously are now diverted from jail into treatment
because of policies like Kevins Law.
Relationship of Kevins Law to
the Dominant U.S. Social Construction of Reality
Kevins Law is based on the
assumption that American society is dysfunctional in its treatment
and prevention of mental illness regarding crime and criminals. The
United States criminal justice system is a penal system rooted in
punishment of criminals. Many of whom have underlying issues such as
substance abuse disorders, trauma-induced disorders, along with
conditions of mental illness such as personality disorders,
schizophrenia, depression, anxiety and what have you.
When President John F. Kennedy
instituted the Community Mental Health Act of 1963, the federal
government started to pay for treatment of individuals suffering from
mental illness with services directed by Community Mental Health
(CMH) agencies. Over the next ten years, half of the people who were
institutionalized were released to live in society with help from CMH
agencies. This was a huge decline of involuntary hospitalization.
Mental health support for these individuals was now coming from CMH
outpatient services. This community integration and community care
of people with severe and persistent mental illness was largely due
to the American utilization of psychotropic medications invented in
1950s France (Judd, 2009). These medications, such as neuroleptics,
often made it possible for people suffering with severe and
persistent mental illness to live a healthy life outside of an
inpatient mental health institution.
This was an important time for the
American mental health system. On one hand, there was a new
awareness of the possible recovery from mental illness which had been
long regarded as a permanent condition. Yet, many problems rose from
The Community Mental Health Centers Act. Treating people in
the community became more difficult, professionals didnt want to work
with patients with chronic problems, and the communities would not
offer the resources necessary to sustain community care. Many people
ended up in jails or homeless. These problems are still showing up
in society today (Kirst-Ashman, 2007).
Previous to Kevins Law, The
Michigan Mental Health Code created in 1974, (would not) permit
involuntary treatment for mental illnesses, even if the individual
lacks the capacity to make an informed decision about treatment of
his or her illness (Mack, 2008). These mentally ill individuals would
either go without help, or be cast into a jail or prison. Recent
statistics of state prison inmates with mental illness are still
alarming: 56% of inmates suffer with a mental health condition; 61%
of them were convicted of violent crimes; 25% of them were
incarcerated three times or more; 58% of them have violated prison
rules; 20% have been injured in a prison fight; only 34% of them have
received treatment while in prison (Allen, 2008).
People with mental illness are an
especially vulnerable population that can become the victims of
traumatic abuse and maltreatment, whether they are in prison or
roaming the streets of America. Now in Michigan, under the
provisions of Kevins Law, when someone with a diagnosis is acting
violent and fits the qualifications of a recent history of violence
and or treatment non-compliance, they can be treated in place of
being lost in or out of the system. Still, the problem of
incarceration and homelessness throughout Americas mentally ill
population is very prevalent.
Our Michigan mental health system
has made great strides over the years in the transformation from a
stabilization focus of individuals with mental illness, to a recovery
model for mental health treatment. Recovery language and principles
have been finding their way into policies and services since the late
1990s (Mack, 2008). This recovery approach puts the treatment
power back into the hands of the recipient of services. Clinical
guidance is centered on what clients want or feel they need, as the
greatest authority on themselves.
Any diagnosis of mental illness
can be disabling to an individual on many levels. Stigma and
self-stigma alone may feel disabling to someone who has been
experiencing challenges in mental conditions. Today, clients are
encouraged to develop a sense of identity and purpose and regain
control over his or her life (Mack, 2008). A diagnosis is just our
best guess, symptoms thrown together to assist in the treatment
process. It can be a warning sign for those who want a way back out
into health. Diagnoses do not define an individual. Human beings are
comprised of an infinite amount of qualities. In fact, everyone is
to some degree or another depressed (which we call sadness) or to
some degree or another has anxiety (stress). Some say that everyone
is to some degree or another schizophrenic. It is the degree to
which a mental condition makes a person's life unmanageable, which
qualify it as an illness.
Granted, individuals who are
placed into an involuntary outpatient treatment setting on a court
order may not have the willingness or motivation needed to make
changes. However, the hope is that once a person is put into an
environment of much needed treatment services, where they have
opportunities to make healthy decisions, they will find the clarity
to act on what has been presented to them as being in their own best
interest. Regardless of the outdated institutional terms of
"chronic" or "incurable," recovery is
possible for anyone with treatment. Especially now that we
have a systemic recovery. A system which can offer, encourage and
support strength-based treatment interventions. When a client is not
healthy, we as mental health professionals know that it is time for a
new approach. This is a new approach branching out on a grand scale.
In a way, AOT and any involuntary
treatment is diversion with an ecological perspective. Social works
systems theory applied. We know that the individual and their
environment have impact on each other. If we cant change the
individual, maybe we can change the environment. Regulation under
Kevins Law negotiates for the betterment of the individuals own
health and well-being. It also aids in the safety and security of
society at large.
Much of the professional and
recovering community have an idea of treatment being a positive
factor in someones life, but there are other ideologies. Some would
argue that freedom, liberty and the pursuit of happiness spoken of in
the U.S. Constitution does not line up with a broadened law regarding
enforcement of involuntary treatment. Still, a close examination of
the Michigan Mental Health Code reveals many laws in place to protect
the rights of patients. CMH programs protect client rights and
provide outlets for clients to express these rights. Grievances and
Appeals, Recipient Rights and Quality Management are a few of the CMH
departments that regulate such policies.
Regarding U.S. construction of
reality, the American culture of capitalism has an overwhelming every
man for himself, pick yourself up from your own bootstraps mentality.
Americans tend to have a firm sense of their own individual self, as
oppose to the sense of community found in non-western countries. For
example, Japanese culture teaches people to do for others and the
family, group, country ahead of your own desire for self-fulfillment.
US culture tells people otherwise.
Kevins Law is controversial to
those American, traditional, patriotic arguments for personal freedom
and liberty. There is a possibility of Kevins Law and similar laws
becoming an infringement on the civil, human rights of some.
However, it has been applauded by recovering individuals, families,
loved ones and policy makers as a solution to the flaws of past
policy and current social trouble. Could Kevins Law be one of the
early signs of a new communal American culture, individuals looking
out for one another? Or is it an oppressive finger from a
consistently intrusive, government hand-probing the private lives of
its citizens?
Kevins Law does have the
appearance of a big brother placement of fear mentality to control
the masses. Who really knows with our knowledge of past American
governmental conspiracy and recent unconstitutional measures such as
the Patriot Act? If the government can hear everything one talks
about and they can place a person into involuntary treatment at will,
what is to stop them from doing this to anyone? Regardless of
possible governmental misuse of legislation like Kevin's Law, it is
sorely needed currently.
Relevant Groups, Organizations
and Individuals
As previously stated, Kevins Law
was originally spurred by Michigan Senator; Dr. Tom George in
consultation with Kevin Heisingers family, then enacted as
legislation with the help of Michigan Senator Virgil Bernero. Yet,
solutions to problems with the Michigan Mental Health Code have been
long documented and pursued by Michigan officials, primarily Governor
Jennifer Granholm and her appointed commission. Sources and
procedures of funding are also major issues regarding mental health
treatment in Michigan.
Michigan mental health services
have relied on Medicaid, as well as federal reimbursement dollars
matched by the majority of Michigans general fund monies since the
1980s. Medicaid eligibility being the main qualification for an
individual to receive CMH services and any other public mental health
services leaves many people unqualified for care. Not only is this
funding system complicated, but all those who do not have private
insurance, nor qualify for Medicaid or Medicare benefits can be left
by the wayside (Mack, 2008). There are a few other public health
insurance programs offered and some emergency mental health dollars
provided through public agencies, but they are not adequate to
support the needs presented.
This system is difficult all
around. Moreover, those with the accompanied turmoil surrounding
mental health problems may not have the capabilities to navigate much
of the slow-moving, bureaucratic policy, process and paperwork ('red
tape'), let alone funding complications put into the hands of a
competent mental health professional. Ideally, these duties involve
individuals who are working toward recovery and have gained ample
health and clarity to take an active role. This is not always the
case. The impediments associated with funding obstacles continue to
hinder the flow of that needed recovery treatment, and consequently
the entire recovery and systemic treatment process.
Evaluation
Kevins Law is successful as
detailed amendments to Michigans Mental Health Code regarding long
standing problems of reaching those in need of treatment. Kevins Law
encompasses a population that has been abused and neglected by the
strong arm of the American criminal justice system, previous failings
of the mental health system and society in general. These
reformations represent a small portion of what is needed in the way
of treatment and prevention among Americas mentally ill citizens.
Kevins Law, and the officials who regulate it through the courts and
mental health services, are finding success in the wake of persistent
difficulties. Many people who were sick and on their own in life are
finding themselves with recovery opportunities. Those individuals
are discovering mental health and our communities are safer as a
result.
Kevins Law and the procedures
taken in its implementation are fairly new. They are far from being
inclusive of all those in need of help. However, that type of change
does not happen overnight and would be hard to achieve with a few
amendments to the Michigan Mental Health Code.
It is obvious to this researcher
there are only a few programs in America which model the treatment
for mental illness and related disorders over the penal system. Even
within these programs, there are not sufficient channels for the
mentally ill individual to move from homelessness and incarceration
to a program such as mental health court and a group home or half-way
house. America is still immature in its growth regarding systemic
recovery. After all, if the system is still ill, how can anyone
expect the individual to find recovery. The American mental health
system is making leaps and bounds in progress, which is inspiring,
and now inevitable in it's growth.
Allen,
S. (2008). Mental health treatment and the criminal justice
system. Journal of Health & Biomedical Law, 4, 1, 153-191.
Judd,
P. (2009). SWRK 6100: Social Welfare Policy (class notes and
handouts), Western Michigan University, Kalamazoo, MI
Kirst-Ashman,
K. K. (2007). Introduction to Social Work and Social Welfare
(Second Edition). Thomson Brooks/Cole, Belmont, CA.
Legislature.mi.gov
(http://legislature.mi.gov/(S(b0yuxl45djmraljiwnnkguzh))/mileg.aspx?page=home)
Michigan.gov
(http://michigan.gov/gov/0,1607,7-168-29544-107105--,00.html)
Mack, M.L, Jr. (2008). Involuntary
treatment for the twenty-first century. The Quinnipiac Probate
Law Journal, 21, 3&4, 294-320
Newsbank.com, 2003
(http://infoweb.newsbank.com/iw-search/we/InfoWeb?p_product=...)
Psychiatryonline.org
(pn.psychiatryonline.org/cgi/content/full/40/2/14)
SENATE
BILL No. 871
September
24, 2009, Introduced by Senators CHERRY, BRATER, JACOBS,
CLARK-COLEMAN, SCOTT, OLSHOVE, ANDERSON, SWITALSKI, BASHAM and THOMAS
and referred to the Committee on Health Policy. A bill to amend 1974
PA 258, entitled "Mental health code," by amending section
401 (MCL 330.1401), as amended by 2004 PA 496.
THE
PEOPLE OF THE STATE OF MICHIGAN ENACT: Sec. 401. (1) As used in this
chapter, "person requiring treatment" means (a), (b), (c),
or (d): (a) An individual who has mental illness, and who as a result
of that mental illness can reasonably be expected within the near
future to intentionally or unintentionally seriously physically
injure himself, herself, or another individual, and who has engaged
in an act or acts or made significant threats that are substantially
supportive of the expectation. AN INDIVIDUAL WHO HAS MENTAL ILLNESS,
WHOSE JUDGMENT IS SO IMPAIRED THAT HE OR SHE IS UNABLE TO UNDERSTAND
HIS OR HER NEED FOR TREATMENT, AND WHOSE CONTINUED BEHAVIOR AS THE
RESULT OF THIS MENTAL ILLNESS CAN REASONABLY BE EXPECTED, ON THE
BASIS OF COMPETENT CLINICAL OPINION, TO RESULT IN SIGNIFICANT
PHYSICAL HARM TO HIMSELF, HERSELF, OR OTHERS. THIS INDIVIDUAL SHALL
RECEIVE INVOLUNTARY MENTAL HEALTH TREATMENT INITIALLY ONLY UNDER THE
PROVISIONS OF SECTIONS 434 THROUGH 438. (b) An individual who has
mental illness, and who as a result of that mental illness is unable
to attend to those of his or her basic physical needs such as food,
clothing, or shelter that must be attended to in order for the
individual to avoid serious harm in the near future, and who has
demonstrated that inability by failing to attend to those basic
physical needs. (c) An individual who has mental illness, whose
judgment is so impaired that he or she is unable to understand his or
her need for treatment and whose continued behavior as the result of
this mental illness can reasonably be expected, on the basis of
competent clinical opinion, to result in significant physical harm to
himself, herself, or others. This individual shall receive
involuntary mental health treatment initially only under the
provisions of sections 434 through 438. AN INDIVIDUAL WHO HAS MENTAL
ILLNESS, AND WHO AS A RESULT OF THAT MENTAL ILLNESS CAN REASONABLY BE
EXPECTED WITHIN THE NEAR FUTURE TO INTENTIONALLY OR UNINTENTIONALLY
SERIOUSLY PHYSICALLY INJURE HIMSELF, HERSELF, OR ANOTHER INDIVIDUAL,
AND WHO HAS ENGAGED IN AN ACT OR ACTS OR MADE SIGNIFICANT THREATS
THAT ARE SUBSTANTIALLY SUPPORTIVE OF THE EXPECTATION. (d) An
individual who has mental illness, whose understanding of the need
for treatment is impaired to the point that he or she is unlikely to
participate in treatment voluntarily, who is currently noncompliant
with treatment that has been recommended by a mental health,
professional and that has been determined to be necessary to prevent
a relapse or harmful deterioration of his or her condition and whose
noncompliance with treatment has been a factor in the individual's
placement in a psychiatric hospital, prison, or jail at least 2 times
within the last 48 months or whose noncompliance with treatment has
been a factor in the individual's committing 1 or more acts,
attempts, or threats of serious violent behavior within the last 48
months. An individual under this subdivision is only eligible to
receive assisted outpatient treatment under section 433 or 469a. THE
COURT SHALL APPLY AND CONSIDER EACH OF THE CRITERIA IN SUBSECTION
BEFORE DETERMINING AN INDIVIDUAL IS NOT A PERSON REQUIRING TREATMENT.
An individual whose mental processes have been weakened or impaired
by a dementia, an individual with a primary diagnosis of epilepsy, or
an individual with alcoholism or other drug dependence is not a
person requiring treatment under this chapter unless the individual
also meets the criteria specified in subsection. An individual
described in this subsection may be hospitalized under the informal
or formal voluntary hospitalization provisions of this chapter if he
or she is considered clinically suitable for hospitalization by the
hospital director.
HOUSE BILL No. 4809
MENTAL HEALTH CIVIL ADMISSIONS:
REVISE DEF. OF "PERSON REQUIRING TREATMENT"
House Bill 4809
Sponsor:
Rep. Rick Jones
Committee:
Health Policy
Complete to 6-15-09
A SUMMARY OF HOUSE BILL 4809 AS INTRODUCED 4-21-09
The bill would revise the definition of "person
requiring treatment" contained in Chapter 4 of the Mental Health
Code, entitled Civil Admission and Discharge Procedures:
Mental Illness.
When a person who has mental illness is assessed by a
Community Mental Health Service Program as being a person in need of
treatment, the person can voluntarily agree to treatment.
If, however, the person who has mental illness is unlikely
to participate in treatment voluntarily, a court can order the person
into treatment, including outpatient treatment and/or
hospitalization.
Generally speaking, individuals are in need of treatment if they
present a danger to others or themselves, or due to the mental
illness, are unable to care for their personal needs such as food,
clothing, and shelter.
House Bill 4809 would revise the definition of "person
in need of treatment" contained in Chapter 4 of the Mental
Health Code (MCL 330.1401 and 330.1433) to mean a person who is
either of the following:
ｷ
An individual who has mental
illness and as a result of that mental illness represents a danger to
self or others, or an individual who has mental illness and without
treatment of the mental illness can reasonably be expected, based on
competent clinical opinion, to represent a threat to self or others
in the near future because of inability to understand the need for
treatment or attend to basic physical needs, including, but not
limited to, food, clothing, or shelter.
(This provision replaces Section 401(a), (b), and (c) of
the code.)
ｷ
An individual who has mental
illness, whose understanding of the need for treatment is impaired to
the point that he or she is unlikely to participate in treatment
voluntarily, who is currently noncompliant with treatment that has
been recommended by a mental health professional and that has been
determined to be necessary to prevent a relapse or harmful
deterioration of his or her condition and whose noncompliance with
treatment has been a factor in the individuals placement in a
psychiatric hospital, prison, or jail at least two times within the
last 48 months or whose noncompliance with treatment has been a
factor in the individuals committing one or more acts, attempts, or
threats of serious violent behavior within the last 48 months.
An individual under this provision is only eligible to
receive assisted outpatient treatment under Section 433 or 469a.
(This provision is contained currently in the definition
of "person requiring treatment" and has not been amended by
the bill.)
(Note:
Section 401(a), which would be revised, currently pertains to
those who, as a result of the mental illness, can reasonably be
expected within the near future to seriously physically injure
themselves or others, and who have engaged in an act or acts or made
significant threats that support the expectation of harm.
Section 401(b), which would be deleted, currently
pertains to those who have demonstrated that they are unable to
attend to basic physical needs such as food, clothing, or shelter.
Section 401(c), which also would be deleted, pertains to
those whose judgment is so impaired that they are unable to
understand the need for treatment and whose continued behavior as a
result of the mental illness can be reasonably expected to result in
significant physical harm to themselves or others.
Currently, the provision specifies that the individual
must receive involuntary mental health treatment initially only under
the provisions of Sections 434-438, which provide the petition
process for involuntary treatment; a court is then authorized to
order treatment, including hospitalization.)
FISCAL IMPACT:
This bill will have fiscal implications for the state to
the extent that the revised definition of persons requiring treatment
results in more persons being involuntary committed to state-operated
mental health facilities.
April 21, 2009, Introduced by Rep. Rick Jones and
referred to the Committee on Health Policy. A bill to amend 1974 PA
258, entitled "Mental health code," by amending sections
401 and 433 (MCL 330.1401 and 330.1433), section 401 as amended by
2004 PA 496 and section 433 as added by 2004 PA 497.
THE
PEOPLE OF THE STATE OF MICHIGAN ENACT: Sec. 401. (1) As used in this
chapter, "person requiring treatment" means a person who is
either of the following: An individual who has mental illness ,
and as a result of that mental illness represents a danger
to self or others, or an individual who has mental illness and
without treatment of the mental illness can reasonably be expected,
based on competent clinical opinion, to represent a threat to self or
others in the near future because of inability to understand the need
for treatment or attend to basic physical needs, including, but not
limited to, food, clothing, or shelter. An individual who has mental
illness, whose understanding of the need for treatment is impaired to
the point that he or she is unlikely to participate in treatment
voluntarily, who is currently noncompliant with treatment that has
been recommended by a mental health , professional
and that has been determined to be necessary to prevent a relapse or
harmful deterioration of his or her condition and whose noncompliance
with treatment has been a factor in the individual's placement in a
psychiatric hospital, prison, or jail at least 2 times within the
last 48 months or whose noncompliance with treatment has been a
factor in the individual's committing 1 or more acts, attempts, or
threats of serious violent behavior within the last 48 months. An
individual under this subdivision is only eligible to receive
assisted outpatient treatment under section 433 or 469a. An
individual whose mental processes have been weakened or impaired by a
dementia, an individual with a primary diagnosis of epilepsy, or an
individual with alcoholism or other drug dependence is not a person
requiring treatment under this chapter unless the individual also
meets the criteria specified in subsection. An individual described
in this subsection may be hospitalized under the informal or formal
voluntary hospitalization provisions of this chapter if he or she is
considered clinically suitable for hospitalization by the hospital
director. Sec. 433. Any individual 18 years of age or over may file
a petition with the court that asserts that an individual meets the
criteria for assisted outpatient treatment specified in section
401(b). The petition shall contain the facts that are the basis for
the assertion, the names and addresses, if known, of any witnesses to
the facts, the name and address of the mental health professional
currently providing care to the individual who is the subject of the
petition, if known, and the name and address of the nearest relative
or guardian, if known, or, if none, a friend, if known, of the
individual who is the subject of the petition. Upon receipt of a
petition, the court shall inform the subject of the petition and the
community mental health services program serving the community in
which the subject of the petition resides that the court shall hold a
hearing to determine whether the subject of the petition meets the
criteria for assisted outpatient treatment. Notice shall be provided
as set forth in section 453. The hearing shall be governed by
sections 454 and 458 to 465. If in the hearing, the court verifies
that the subject of the petition meets the criteria for assisted
outpatient treatment and he or she is not scheduled to begin a course
of outpatient mental health treatment that includes case management
services or assertive community treatment team services, the court
shall order the subject of the petition to receive assisted
outpatient treatment through his or her local community mental health
services program. The order shall include case management services.
The order may include 1 or more of the following: Medication. Blood
or urinalysis tests to determine compliance with or effectiveness of
prescribed medications. Individual or group therapy. Day or partial
day programs. Educational and vocational training. Supervised
living. Assertive community treatment team services. Alcohol or
substance abuse treatment, or both. Alcohol or substance abuse
testing, or both, for individuals with a history of alcohol or
substance abuse and for whom that testing is necessary to prevent a
deterioration of their condition. A court order for alcohol or
substance abuse testing shall be subject to review every 6 months.
Any other services prescribed to treat the individual's mental
illness and to either assist the individual in living and functioning
in the community or to help prevent a relapse or deterioration that
may reasonably be predicted to result in suicide or the need for
hospitalization. To fulfill the requirements of an assisted
outpatient treatment plan, the court's order may specify the service
role that a publicly-funded entity other than the community mental
health services program shall take. In developing an order under
this section, the court shall consider any preferences and medication
experiences reported by the subject of the petition or his or her
designated representative, whether or not the subject of the petition
has an existing individual plan of services under section 712, and
any directions included in a durable power of attorney or advance
directive that exists. If the subject of the petition has not
previously designated a patient advocate or executed an advance
directive, the responsible community mental health services program
shall, before the expiration of the assisted outpatient treatment
order, ascertain whether the subject of the petition desires to
establish an advance directive. If so, the community mental health
services program shall direct the subject of the petition to the
appropriate community resources for assistance in developing an
advance directive. If an assisted outpatient treatment order
conflicts with the provisions of an existing advance directive,
durable power of attorney, or individual plan of services developed
under section 712, the assisted outpatient treatment order shall be
reviewed for possible adjustment by a psychiatrist not previously
involved with developing the assisted outpatient treatment order. If
an assisted outpatient treatment order conflicts with the provisions
of an existing advance directive, durable power of attorney, or
individual plan of services developed under section 712, the court
shall state the court's findings on the record or in writing if the
court takes the matter under advisement, including the reason for the
conflict. Nothing in this section negates or interferes with an
individual's rights to appeal under any other state law or Michigan
court rule.
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