PRINTER'S NO. 4088
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2423
Session of
2015
INTRODUCED BY MURT, DAVIS, GROVE, HARHAI, KINSEY, MAHONEY,
ROZZI, SAYLOR, WHEELAND AND YOUNGBLOOD, OCTOBER 20, 2016
REFERRED TO COMMITTEE ON HEALTH, OCTOBER 20, 2016
AN ACT
Amending the act of July 9, 1976 (P.L.817, No.143), entitled "An
act relating to mental health procedures; providing for the
treatment and rights of mentally disabled persons, for
voluntary and involuntary examination and treatment and for
determinations affecting those charged with crime or under
sentence," providing for assisted outpatient treatment.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of July 9, 1976 (P.L.817, No.143), known
as the Mental Health Procedures Act, is amended by adding an
article to read:
ARTICLE III-A
ASSISTED OUTPATIENT TREATMENT
Section 301-A. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Assisted outpatient treatment." The community-based
outpatient social, medical and behavioral health treatment
services ordered by a court for a severely mentally disabled
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person which may include, but is not limited to, any of the
following services:
(1) Community psychiatric supportive treatment.
(2) Assertive community treatment.
(3) Medications.
(4) Individual or group therapy.
(5) Peer support services.
(6) Financial services.
(7) Housing or supervised living services.
(8) Alcohol or substance abuse treatment.
(9) Any other services prescribed to treat the person's
mental illness that either assist the person in living and
functioning in the community or help to prevent a relapse or
a deterioration of the person's condition.
"Court-ordered assisted outpatient treatment plan." An
individualized treatment plan developed by the treatment team
that is authorized by a court. The treatment plan shall contain
the reasonable objectives and goals for a person determined to
be in need of assisted outpatient treatment. In addition to the
requirements of section 107, the treatment plan shall include:
(1) Delineation of specific assisted outpatient
treatment services to be provided based on the person's
specific needs.
(2) Provider information for each provider that has
agreed to provide assisted outpatient treatment services to
the person.
(3) Documentation of how the person was involved in the
initial development of the treatment plan, the process for
involving the person in ongoing evaluation and any
appropriate modifications to the plan.
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"Department." The Department of Human Services of the
Commonwealth.
"Qualified professional." A physician, licensed
psychologist, prescribing psychologist, certified nurse
practitioner or clinical nurse specialist with a specialty in
mental health or a physician assistant with a specialty in
mental health.
Section 302-A. Determination of need for court-ordered assisted
outpatient treatment.
(a) Criteria.--The need for court-ordered assisted
outpatient treatment shall be shown by establishing by clear and
convincing evidence that:
(1) the person would benefit from treatment as
manifested by evidence of behavior that indicates all of the
following:
(i) The person is unlikely to survive safely in the
community without supervision, based on a clinical
determination.
(ii) The person has a history of lack of voluntary
adherence to treatment for mental illness and one of the
following applies:
(A) at least twice within the 36 months prior to
the filing of a petition seeking court-ordered
assisted outpatient treatment, the person's failure
to adhere to treatment has been a significant factor
in necessitating inpatient hospitalization or receipt
of services in a forensic or other mental health unit
of a correctional facility, provided that the 36-
month period shall be extended by the length of any
hospitalization or incarceration of the person in a
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correctional institution that occurred within the 36-
month period; or
(B) within the 48 months prior to the filing of
a petition seeking court authorized outpatient
treatment, the person's failure to adhere to
treatment resulted in one or more acts of serious
violent behavior toward self or others or threats of,
or attempts at, serious physical harm to self or
others, provided that the 48-month period shall be
extended by the length of any hospitalization or
incarceration of the person in a correctional
institution that occurred within the 48-month period.
(iii) The person, as a result of the person's mental
illness, is unlikely to voluntarily participate in
necessary treatment.
(iv) Based on the person's treatment history and
current behavior, the person is in need of treatment in
order to prevent a relapse or deterioration that would be
likely to result in substantial risk of serious harm to
the person or others.
(2) (Reserved).
(b) Determination.--An individual who meets only the
criteria under subsection (a) shall not be subject to
involuntary inpatient hospitalization unless a determination of
clear and present criteria is made in accordance with section
301(b).
Section 303-A. Procedures for initiating court-ordered assisted
outpatient treatment for persons already subject to
involuntary treatment.
The following shall apply:
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(1) Petition for court-ordered outpatient treatment for
persons already subject to involuntary treatment under
section 301(b)(1) and (2)(i) or (ii), or persons with mental
illness subject to treatment in a forensic facility or a
correctional institution who are ready for release, may be
made by the county administrator or the director of the
facility to the court of common pleas.
(2) The petition shall be in writing upon a form adopted
by the department and shall include a statement of the facts
constituting reasonable grounds to believe that the person
is:
(i) no longer determined to be subject to
involuntary inpatient treatment under section 301(b)(1)
and (2)(i) or (ii), or no longer subject to treatment in
a forensic facility or correctional institution; and
(ii) determined to be in need of court-ordered
outpatient treatment under this article.
(3) The petition shall state the name of any examining
physician and the substance of the examining physician's
opinion regarding the mental condition of the person. It
shall also state that the person has been given the
information required under section 304(b)(3).
(4) Upon the filing of the petition the county
administrator shall serve a copy on the person, the person's
attorney and those parties designated to be kept informed, as
provided in section 302(c), including an explanation of the
nature of the proceedings, the person's right to an attorney
and the services of an expert in the field of mental health,
as provided by section 304(d).
(5) A hearing on the petition shall be held in all
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cases, not more than five days after the filing of the
petition.
(6) Treatment shall be permitted to be maintained
pending the determination of the petition.
Section 304-A. Procedures for initiating court-ordered assisted
outpatient treatment for persons not in involuntary
treatment.
The following shall apply:
(1) Any responsible party may file a petition in the
court of common pleas requesting court-ordered assisted
outpatient treatment for any person determined under section
302-A to be in need of court-ordered assisted outpatient
treatment who is not already in involuntary treatment and who
is not already in court-ordered outpatient treatment for whom
application could be made under section 304(a).
(2) The petition shall be in writing upon a form adopted
by the department and shall set forth facts constituting
reasonable grounds to believe that the person is within the
criteria for a person in need of court-ordered assisted
outpatient treatment. The petition shall state the name of
any examining physician and shall be accompanied by a
statement of a psychiatrist, or a statement signed by a
clinical psychologist and a statement signed by a physician,
stating that the person who issued the petition has examined
the person and is of the opinion that the person is in need
of court-ordered outpatient treatment, or shall be
accompanied by a written statement by the applicant, under
oath, that the person has refused to submit to an examination
by a psychiatrist or by a clinical psychologist and
physician.
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(3) Upon a determination that the petition sets forth
reasonable cause, the court shall appoint an attorney to
represent the person and set a date for the hearing as soon
as practicable. The attorney shall represent the person
unless it shall appear that the person can afford, and
desires to have, private representation.
(4) The court, by summons, shall direct the person to
appear for a hearing. The court may issue a warrant directing
an individual authorized by the county administrator or a
peace officer to bring the person before the court at the
time of the hearing if there are reasonable grounds to
believe that the person will not appear voluntarily. A copy
of the petition shall be served on the person at least three
days before the hearing together with a notice advising the
person that:
(i) an attorney has been appointed who shall
represent him unless he obtains an attorney himself;
(ii) the person has a right to be assisted in the
proceedings by an expert in the field of mental health;
(iii) the person may request or be made subject to
psychiatric examination under section 304(c)(5).
(5) Upon motion of either the petitioner or the person,
or upon its own motion, the court may order the person to be
examined by a psychiatrist appointed by the court. The
examination shall be conducted on an outpatient basis and the
person shall have the right to have counsel present. A report
of the examination shall be given to the court and counsel at
least 48 hours prior to the hearing.
Section 305-A. Hearings on petition for court-ordered assisted
outpatient treatment.
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A hearing on a petition for court-ordered assisted outpatient
treatment shall be conducted in accordance with the following:
(1) No later than the date of the hearing, a qualified
professional shall provide a written proposed court-ordered
assisted outpatient treatment plan to the court. The plan
shall state all treatment services recommended for the person
and, for each service, shall specify a provider that has
agreed to provide the service.
(2) In developing a written proposed court-ordered
assisted outpatient treatment plan, the qualified
professional shall take into account, if existing, an advance
directive for mental health treatment and provide the
following persons with an opportunity to participate:
(i) the person believed to be in need of court-
ordered assistant outpatient treatment;
(ii) all current treating providers;
(iii) upon the request of the person believed to be
in need of court-ordered assisted outpatient treatment,
an individual significant to the person, including any
relative, close friend or individual otherwise concerned
with the welfare of the person; and
(iv) any authorized guardian or other surrogate
decisionmaker.
(3) The written proposed court-ordered assisted
outpatient treatment plan shall include case management
services or an assertive community treatment team to provide
care coordination and assisted outpatient treatment services
recommended by the qualified professional. If the plan
includes medication, it shall state whether the medication
should be self-administered or administered by a specified
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provider and shall specify type and dosage range of
medication. In no event shall the plan recommend the use of
physical force or restraints to administer medication to the
respondent.
(4) A qualified professional who has personally examined
the respondent within 10 days of the filing of the petition
shall provide testimony in support of the finding that the
respondent meets all of the criteria for court-ordered
assisted outpatient treatment and in support of a written
proposed treatment plan developed under this section that
includes:
(i) the recommended assisted outpatient treatment,
the rationale for the recommended assisted outpatient
treatment and the facts that establish that the treatment
is the least restrictive appropriate alternative;
(ii) information regarding the respondent's access
to, and the availability of, recommended assisted
outpatient treatment in the community or elsewhere; and
(iii) if the recommended assisted outpatient
treatment includes medication, the types or classes of
medication that should be authorized, the beneficial and
detrimental physical and mental effects of such
medication and whether such medication should be self-
administered or administered by a specified provider.
Section 306-A. Determination and order.
The following shall apply:
(1) If a person is found to be in need of court-ordered
assisted outpatient treatment in accordance with section 302-
A or as a result of consideration of less restrictive
settings, the court shall order the person to receive
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assisted outpatient treatment for a period not to exceed 90
days from any provider or facility approved by the department
or the county administrator for purposes of providing court-
ordered assisted outpatient treatment.
(2) The facility or provider shall examine and treat the
person in accordance with the court-ordered treatment plan.
If the person is receiving court-ordered outpatient
treatment, or receives treatment in an outpatient setting
during a subsequent period of continued commitment under
section 307-A(b), the facility or provider to whom the person
is ordered shall determine the appropriate court-ordered
assisted outpatient treatment plan for the person.
(3) The provider or facility responsible for the court-
ordered outpatient treatment shall inform the court if the
person fails materially to adhere to the treatment plan and
comply with the court order. If the court receives
information that a patient is not complying with the court's
order, the court may:
(i) set a modification hearing to assess the
person's failure to adhere to the assisted outpatient
treatment plan;
(ii) amend the assisted outpatient treatment plan to
foster adherence to necessary treatment by the person;
and
(iii) issue an order for temporary detention if
petition is filed under section 304(b).
(4) If the court determines under paragraph (3) that the
person has failed to adhere to the assisted outpatient
treatment plan, the court may not hold that person in
contempt or otherwise sanction the person solely based on the
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failure to comply with the assisted outpatient treatment
plan.
(5) A jail or any other county or State correctional
institution may not be considered an authorized facility
under this article.
Section 307-A. Duration of court-ordered assisted outpatient
treatment.
(a) General rule.--A person may be subject to court-ordered
assisted outpatient treatment for a period of up to 180 days if
the person continues to meet the requirements under section 302-
A or is discharged from involuntary inpatient treatment under
Article III.
(b) Continued commitment.--At the expiration of a period of
court-ordered assisted outpatient treatment under subsection
(a), the court may order treatment for an additional period upon
the application of the county administrator or the treatment
team. The order shall be entered upon hearing on findings as
required by section 304(a) and (b) and the further finding of a
need for continuing assisted outpatient treatment. The
additional period of involuntary treatment shall not exceed 180
days.
Section 2. This act shall take effect in 60 days.
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