Mental Health Commitments
Under the Pennsylvania Mental Health Procedures Act ("MHPA"), a person must be severely mentally disabled and in need of immediate treatment before he or she can be required to undergo an involuntary emergency examination and subsequent treatment. A person is considered to be severely mentally disabled when, as a result of a mental illness, his or her capacity to exercise self-control, judgment, and discretion in the conduct of his or her affairs and social relations, or to care for his or her own personal needs is so diminished that he or she poses "a clear and present danger of harm" to others or to himself or herself. According to Pennsylvania Superior Court decisions, a person can be a clear and present danger of harm not only by committing some dangerous act, such as attempting to injure someone or attempting suicide or self-mutilation, but also by showing he or she would be unable to satisfy his or her need for nourishment, personal or medical care, self-protection, and safety without the assistance of others so that death, serious bodily injury or serious physical debilitation is likely within 30 days.
In Erie County, Pennsylvania an emergency examination of a person believed to be severely mentally disabled may take place at the emergency rooms of Millcreek Community Hospital, Saint Vincent Health Center, or Corry Memorial Hospital. Each of these hospitals has a mental health treatment facility and has been approved for emergency examinations by the Erie County Mental Health Mental Retardation ("MHMR") Administrator. An emergency examination can be requested for a person in three ways: on the basis of a warrant issued by an MHMR delegate, under a warrantless procedure implemented by a physician or a peace officer or voluntarily.
1. A Warrant to Compel Involuntary Emergency Examination
Crisis Services of Erie County can be called at (814) 456-2014 if there is an emergency regarding someone who has a serious mental illness. A crisis worker who answers the call will ask the caller for information about events occurring around the time of the call that indicate that a crisis is occurring. The crisis worker may also ask questions to determine if the crisis involves a person who may be severely mentally disabled. The crisis worker answering the call may dispatch a crisis team to the location in Erie County where the crisis is occurring. The crisis worker may also put the caller in touch with a delegate of the Erie County MHMR Administrator who is on duty at that time if the information received during the call indicates that the crisis may involve a person who may be severely mentally disabled. Or the crisis worker may wait until he or she gets a report from the crisis team regarding the crisis to contact the MHMR delegate.
If and when the MHMR delegate makes an inquiry, the delegate will ask questions required by the standards of the MHPA, concerning what happened at that time of the crisis and what has happened within the last 30 days to indicate that the person in question is severely mentally disabled and in need of immediate treatment. The MHMR delegate will also cover reasons why, without adequate mental health treatment, the caller believes that there is a reasonable probability that death, serious bodily injury, or serious physical debilitation would occur during the next 30 days.
If the MHMR delegate determines, based on the information received, that the person in question may be severely mentally disabled, under the MHPA the delegate can issue a warrant requiring a person authorized by the delegate, or any police officer, to take the person in question to an approved emergency room identified in the warrant. Within two hours of arrival, a physician at the emergency room is required to examine the person to determine whether the person in question is severely mentally disabled and in need of treatment.
2. Warrantless Involuntary Emergency Examination by a Physician or Peace Officer
Under the MHPA, a physician or a peach officer, such as a police officer, sheriff's deputy, prison guard or worker, who has reasonable grounds in believing that a person the physician or officer is observing is severely mentally disabled and is in need of immediate treatment has the authority, without a warrant, to take that person to an emergency room approved for an emergency examination. The physician or peace officer must make a written statement setting forth grounds occurring during the previous 30 days for believing the person to be in need of such examination and why, without adequate mental health treatment, the physician or peace officer believes there is a reasonable probability that death, serious bodily injury or serious physical debilitation would occur within the next 30 days. As indicated above, within two hours of arrival, a physician at the emergency room is required to examine the person to determine whether the person is severely mentally disabled and in need of treatment.
3. Inpatient Treatment Available and Outpatient Treatment Possible in the Future
Currently, in the summer of 2011, if a physician at the emergency room determines that a person is severely mentally disabled and in need of treatment, inpatient treatment is ordered. While the MHPA allows either inpatient or outpatient treatment for persons severely disabled and in need of treatment, only inpatient treatment has been used since the MHPA was passed in 1976. One reason may be that by the time a person poses "a clear and present danger of harm" to himself or herself, he or she may be in such a condition that inpatient treatment is the only realistic option.
The Pennsylvania Department of Public Welfare's Office of Mental Health and Substance Abuse Services ("OMHSAS") has announced that in the Summer of 2011 it will begin training county MHMR administrators and others involved with mental health commitments with respect to the possible use of outpatient treatment as an option under the MHPA. However, the standard for implementing such treatment is statutory and cannot be changed without a change in the MHPA. Nor can the MHPA's relatively short treatment periods. An attempt to make such a change to enable persons with severe mental illness is to be treated on an outpatient basis before they deteriorate to the extent required under the current law is pending before the Pennsylvania Legislature, House Bill 58 and Senate Bill 115. These identified bills that would make a slight change in the criteria for outpatient treatment to "likely to pose a clear and present danger of harm" to others or to himself or herself and extend the outpatient treatment period to up to six months. The criteria, time periods and other requirements for inpatient treatment would remain the same.
4. Treatment Period Extensions and Discharge
A person who is found to be in need of treatment due to a severe mental disability must be discharged whenever it is determined that he or she is no longer in need of treatment. Discharge must occur within 120 hours of commitment unless the person (1) agrees to voluntary treatment, or (2) an application for extended involuntary emergency treatment is filed by any treating or examining physician within 72 hours to continue the treatment for another 20 days. A hearing must be held before a mental health review officer within 24 hours after the application for extended treatment is filed to determine if the person remains severely mentally disabled and in need of treatment. The person has a right to have counsel appointed for him or her for the hearing unless he or she can afford and desires to have private counsel.
5. Voluntary Emergency Evaluation and Treatment
An emergency evaluation and inpatient treatment may be sought for a person who is willing to go or to be taken voluntarily to an approved emergency room. That person will be evaluated to determine if he or she has a severe mental illness in the same manner as someone who is brought to the emergency room on an involuntary basis. If treatment is found to be necessary, he or she must agree to remain in treatment for up to 72 hours after having given a notice of intent to withdraw from treatment.
If a person undergoing voluntary treatment wishes to withdraw from treatment, a treating or examining physician can apply to extend that person's treatment for 20 days, and a hearing will be held in the same manner indicated above for involuntary treatment. 5/11
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