PRIOR PRINTER'S NO. 1460
PRINTER'S NO. 1838
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1233
Session of
2017
INTRODUCED BY MURT, BAKER, BENNINGHOFF, BLOOM, BOBACK, BRIGGS,
V. BROWN, SCHLEGEL CULVER, DeLISSIO, EVERETT, GODSHALL,
HEFFLEY, IRVIN, KINSEY, MICCARELLI, D. MILLER, MUSTIO,
NEILSON, NELSON, RADER, ROTHMAN, TAYLOR, TOEPEL, TOOHIL,
WATSON, WHITE AND HANNA, APRIL 17, 2017
AS REPORTED FROM COMMITTEE ON HUMAN SERVICES, HOUSE OF
REPRESENTATIVES, AS AMENDED, MAY 24, 2017
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," in general provisions, further providing for scope
of act, providing for definitions and further providing for
individualized treatment plan; in involuntary examination and
treatment, further providing for persons subject, for persons
for whom application may be made, and for additional periods
of court-ordered involuntary treatment; and adding provisions
relating to assisted outpatient treatment.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 103 of the act of July 9, 1976 (P.L.817,
No.143), known as the Mental Health Procedures Act, is amended
to read:
Section 103. Scope of Act.--This act establishes rights and
procedures for all involuntary treatment of mentally ill
persons, whether inpatient or outpatient, and for all voluntary
inpatient treatment of mentally ill persons. ["Inpatient
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treatment" shall include all treatment that requires full or
part-time residence in a facility. For the purpose of this act,
a "facility" means any mental health establishment, hospital,
clinic, institution, center, day care center, base service unit,
community mental health center, or part thereof, that provides
for the diagnosis, treatment, care or rehabilitation of mentally
ill persons, whether as outpatients or inpatients.]
Section 2. The act is amended by adding a section to read:
Section 103.1. Definit ions.
The following DEFINITION S.--THE FOLLOWING words and phrases
when used in this act shall have the meanings given to them in
this section unless the context clearly indicates otherwise:
"Assisted outpatient treatment." Community-based outpatient
social, medical and behavioral health treatment services ordered
by a court for a severely mentally disabled person, which
services may include, but need not be limited to:
(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 treatments when the treatment
is a co-occurring condition for a person with a primary
diagnosis of mental health illness.
(9) Any other service prescribed to treat the person's
mental illness that either assists the person in living and
functioning in the community or helps to prevent a relapse or a
deterioration of the person's condition that would be likely to
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result in a substantial risk of serious harm to the person or
others.
"Facility." A mental health establishment, hospital, clinic,
institution, center, day care center, base service unit,
community mental health center, or part thereof, that provides
for the diagnosis, treatment, care or rehabilitation of mentally
ill persons, whether as outpatients or inpatients.
"Inpatient treatment." All treatment that requires full or
part-time residence in a facility.
"Qualified professional." A physician, licensed
psychologist, prescribing psychologist, certified nurse
practitioner, clinical nurse specialist with a specialty in
mental health or a physician assistant with a specialty in
mental health, or other mental health professional who by years
of education, training and experience in mental health settings
has:
(1) achieved professional recognition and standing as
defined by their respective discipline, including, but not
limited to, medicine, social work, psychology, nursing,
occupational therapy, recreational therapy and vocational
rehabilitation; and
(2) obtained, if applicable, licensure, registration or
certification.
Section 3. Section 107 of the act is amended to read:
Section 107. Individualized Treatment Plan.--(a)
Individualized treatment plan means a plan of treatment
formulated for a particular person in a program appropriate to
his specific needs, including an assisted outpatient treatment
plan under subsection (b). To the extent possible, the plan
shall be made with the cooperation, understanding and consent of
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the person in treatment, and shall impose the least restrictive
alternative consistent with affording the person adequate
treatment for his condition.
(b) Assisted outpatient treatment plan means an
individualized treatment plan developed by the treatment team
that is ordered by a court for involuntary outpatient civil
commitment of a person. 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 subsection (a), the treatment plan shall
include:
(1) The delineation of specific assisted outpatient
treatment services to be provided based on the person's specific
needs.
(2) The delineation of the providers that agree to provide
assisted outpatient treatment services to the person.
(3) The documentation of how the person was involved in the
initial development of the treatment plan and the process for
involving the person in ongoing evaluation and, if appropriate,
modifications to the treatment plan.
Section 4. Section 301(a) of the act is amended and the
section is amended by adding a subsection to read:
Section 301. Persons Who May be Subject to Involuntary
Emergency Examination and Treatment.--(a) Persons Subject.--
Whenever a person is severely mentally disabled and in need of
immediate treatment, he may be made subject to involuntary
emergency examination and treatment. A person is severely
mentally disabled when, as a result of mental illness, his
capacity to exercise self-control, judgment and discretion in
the conduct of his affairs and social relations or to care for
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his own personal needs is so lessened that he poses a clear and
present danger of harm to others or to himself, or the person is
determined to be in need of assisted outpatient treatment as
defined in subsection (c).
* * *
(c) Determination of Need for Assisted Outpatient
Treatment.--(1) The need for assisted outpatient treatment
shall be shown by establishing by clear and convincing evidence
that the person would benefit from assisted outpatient 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 assisted outpatient treatment, the
person's failure to adhere to treatment has been a significant
factor in necessitating INVOLUNTARY 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 correctional institution that
occurred within the 36-month period.
(B) Within the 48 months prior to the filing of a petition
seeking court-ordered assisted outpatient treatment, the
person's failure to adhere to treatment resulted in one or more
acts of serious violent behavior toward others or himself or
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threats of, or attempts at, serious physical harm to others or
himself, 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 others or himself.
(2) An individual who meets only the criteria described in
clause (1) shall not be subject to involuntary inpatient
hospitalization unless a separate determination is made that the
individual poses a clear and present danger in accordance with
subsection (b).
Section 5. Section 303(c)(1) of the act is amended to read:
Section 303. Extended Involuntary Emergency Treatment
Certified by a Judge or Mental Health Review Officer - Not to
Exceed Twenty Days.--* * *
(c) Informal Conference on Extended Emergency Treatment
Application.--(1) At the commencement of the informal
conference, the judge or the mental health review officer shall
inform the person of the nature of the proceedings. Information
relevant to whether the person is severely mentally disabled and
in need of treatment shall be reviewed, including the reasons
that continued involuntary treatment is considered necessary.
Such explanation shall be made by a physician who examined the
person and shall be in terms understandable to a layman. The
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judge or mental health review officer may review any relevant
information even if it would be normally excluded under rules of
evidence if he believes that such information is reliable. The
person or his representative shall have the right to ask
questions of the physician and of any other witnesses and to
present any relevant information. At the conclusion of the
review, if the judge or the review officer finds that the person
is severely mentally disabled and in need of continued
involuntary treatment, either as an inpatient or through less
restrictive assisted outpatient treatment, he shall so certify.
Otherwise, he shall direct that the facility director or his
designee discharge the person.
* * *
Section 6. Section 304(a), (e), (f) and (g) of the act are
amended and the section is amended by adding subsections to
read:
Section 304. Court-ordered Involuntary Treatment Not to
Exceed Ninety Days.--(a) Persons for Whom Application May be
Made.--(1) A person who is severely mentally disabled and in
need of treatment, as defined in section 301(a), may be made
subject to court-ordered involuntary treatment upon a
determination of clear and present danger under section 301(b)
(1) (serious bodily harm to others), or section 301(b)(2)(i)
(inability to care for himself, creating a danger of death or
serious harm to himself), or 301(b)(2)(ii) (attempted suicide),
or 301(b)(2)(iii) (self-mutilation), or upon determination that
a person meets the requirements under section 301(c)
(determination of need for assisted outpatient treatment).
(2) Where a petition is filed for a person already subject
to involuntary treatment, it shall be sufficient to represent,
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and upon hearing to reestablish, that the conduct originally
required by section [301] 301(b) in fact occurred, and that his
condition continues to evidence a clear and present danger to
himself or others, or that the conduct originally required by
section 301(c) in fact occurred and that his condition continues
to evidence a need for assisted outpatient treatment. In such
event, it shall not be necessary to show the reoccurrence of
dangerous conduct, either harmful or debilitating, within the
past 30 days.
* * *
(c.1) Procedures for Initiating Assisted Outpatient
Treatment for Persons Already Subject to Involuntary
Treatment.--(1) Petition for assisted outpatient treatment for
persons already subject to involuntary treatment under section
301(b)(1) or (2), 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 include a statement of the facts constituting
reasonable grounds to believe that the person is:
(i) No longer determined to be in need of involuntary
inpatient treatment under section 301(b)(1) or (2), or no longer
subject to treatment in a forensic facility or correctional
institution.
(ii) Determined to be in need of assisted outpatient
treatment under section 301(c).
(3) The petition shall state the name of any examining
physician and the substance of his opinion regarding the mental
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condition of the person. It shall also state that the person has
been given the information required by subsection (b)(3).
(4) Upon the filing of the petition, the county
administrator shall serve a copy on the person, his attorney and
those 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
subsection (d).
(5) A hearing on the petition shall be held in all 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.
(c.2) Procedures for Initiating Assisted Outpatient
Treatment for Persons not in Involuntary Treatment.--(1) Any
responsible party may file a petition in the court of common
pleas requesting assisted outpatient treatment for any person
determined under section 301(c) to be in need of assisted
outpatient treatment, and who is not already in involuntary
treatment, and who is not already in assisted outpatient
treatment for whom application could be made under subsection
(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 as
defined under section 301(c) for a person in need of 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
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who issued the petition has examined the person and is of the
opinion that the person is in need of assisted 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.
(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 he 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 such 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 such person at least three days before the hearing
together with a notice advising him that an attorney has been
appointed who shall represent him unless he obtains an attorney
himself, that he has a right to be assisted in the proceedings
by an expert in the field of mental health and that he may
request or be made subject to psychiatric examination under
clause (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. Such
examination shall be conducted on an outpatient basis and the
person shall have the right to have counsel present. A report of
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the examination shall be given to the court and counsel at least
48 hours prior to the hearing.
(6) Involuntary treatment shall not be authorized during the
pendency of a petition except in accordance with sections 302
and 303.
* * *
(e) Hearings on Petition for Court-ordered Involuntary
Treatment.--A hearing on a petition for court-ordered
involuntary treatment shall be conducted according to the
following:
(1) The person shall have the right to counsel and to the
assistance of an expert in mental health.
(2) The person shall not be called as a witness without his
consent.
(3) The person shall have the right to confront and cross-
examine all witnesses and to present evidence in his own behalf.
(4) The hearing shall be public unless it is requested to be
private by the person or his counsel.
(5) A stenographic or other sufficient record shall be made,
which shall be impounded by the court and may be obtained or
examined only upon the request of the person or his counsel or
by order of the court on good cause shown.
(6) The hearing shall be conducted by a judge or by a mental
health review officer and may be held at a location other than a
courthouse when doing so appears to be in the best interest of
the person.
(7) A decision shall be rendered within 48 hours after the
close of evidence.
(8) If the person is believed to be in need of assisted
outpatient treatment in accordance with section 301(c), a
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hearing on the petition shall be conducted in accordance with
the following:
(i) No later than the date of the hearing, a qualified
professional shall provide a written proposed 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.
(ii) In developing a written proposed 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:
(A) the person believed to be in need of court-ordered
assistant outpatient treatment;
(B) all current treating providers;
(C) upon the request of the person believed to be in need of
court-ordered assistant outpatient treatment, an individual
significant to the person, including any relative, close friend
or individual otherwise concerned with the welfare of the
person; and
(D) any authorized guardian or other surrogate decision-
maker.
(iii) The written proposed 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 such medication should be self-administered
or administered by a specified provider and shall specify type
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and dosage range of medication. In no event shall the plan
recommend the use of physical force or restraints to administer
medication to the person.
(iv) A qualified professional, who has personally examined
the person within ten days of the filing of the petition, shall
provide testimony in support of the finding that the person
meets all of the criteria for assisted outpatient treatment and
in support of a written proposed treatment plan developed
pursuant to this section including:
(A) the recommended assisted outpatient treatment, the
rationale for the recommended assisted outpatient treatment and
the facts that establish that such treatment is the least
restrictive appropriate alternative;
(B) information regarding the person's access to, and the
availability of, recommended assisted outpatient treatment in
the community or elsewhere; and
(C) 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, and the ongoing process for management of
such medications in response to changes in the person's medical
condition.
(9) A decision shall be rendered within 48 hours after the
close of evidence.
(f) Determination and Order.--(1) Upon a finding by clear
and convincing evidence that the person is severely mentally
disabled and in need of treatment and subject to subsection (a),
an order shall be entered directing treatment of the person in
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an approved facility as an inpatient or an outpatient, or a
combination of such treatment as the director of the facility
shall from time to time determine. Inpatient treatment shall be
deemed appropriate only after full consideration has been given
to less restrictive alternatives, including assisted outpatient
treatment. Investigation of treatment alternatives shall include
consideration of the person's relationship to his community and
family, his employment possibilities, all available community
resources, and guardianship services. An order for inpatient
treatment shall include findings on this issue.
(2) If the person is found to be in need of assisted
outpatient treatment in accordance with section 301(c) or as a
result of consideration of less restrictive settings under
clause (1), the court shall order the person to receive 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 assisted outpatient
treatment, provided that a jail or any other State or county
correctional institution shall not be an authorized facility.
(3) The facility or provider shall examine and treat the
person in accordance with the assisted outpatient treatment
plan. If the person is receiving assisted outpatient treatment,
or receives treatment in an outpatient setting during a
subsequent period of continued commitment under section 305, the
facility or provider to whom the person is ordered shall
determine the appropriate assisted outpatient treatment plan for
the person.
(4) If the approved court-ordered assisted outpatient
treatment plan includes medications, the court order shall
authorize the treatment team, in accordance with their
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professional judgment, to perform routine medication management,
including adjustment of specific medications and doses, in
consultation with the person and as warranted by changes in the
person's medical condition.
(5) The provider or facility responsible for the assisted
outpatient treatment plan 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
take any of the following actions:
(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; or
(iii) issue an order for temporary detention if a petition
is filed under subsection (b), provided that a State or county
correctional institution may not be considered an authorized
treatment facility.
(6) If the court determines under clause (5) 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 failure to comply with
the assisted outpatient treatment plan.
(7) THE PERSON SUBJECT TO ASSISTED OUTPATIENT TREATMENT MAY
PETITION THE COURT FOR ENFORCEMENT OF A SERVICE SPECIFICALLY
CONTAINED IN THAT PERSON'S INDIVIDUALIZED TREATMENT PLAN,
PROVIDED THAT THE PETITION MUST INCLUDE CLEAR AND CONVINCING
EVIDENCE DEMONSTRATING THAT THE SERVICE IS NOT BEING PROVIDED IN
ACCORDANCE WITH THAT PLAN.
(g) Duration of Court-ordered Involuntary Treatment.--(1) A
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person may be made subject to court-ordered involuntary
treatment under this section for a period not to exceed 90 days,
excepting only that: Persons may be made subject to court-
ordered involuntary treatment under this section for a period
not to exceed one year if:
(i) the person meets the criteria established by clause (2)
[.]; and
(ii) the person may be subject to assisted outpatient
treatment for a period not to exceed 180 days if the person
meets the criteria established by clause (5).
(2) A person may be subject to court-ordered involuntary
treatment for a period not to exceed one year if:
(i) severe mental disability is based on acts giving rise to
the following charges under the Pennsylvania Crimes Code: murder
(§ 2502); voluntary manslaughter (§ 2503); aggravated assault (§
2702); kidnapping (§ 2901); rape (§ 3121(1) and (2));
involuntary deviate sexual intercourse (§ 3123(1) and (2));
arson (§ 3301); and
(ii) a finding of incompetency to be tried or a verdict of
acquittal because of lack of criminal responsibility has been
entered.
(3) If at any time the director of a facility concludes that
the person is not severely mentally disabled or in need of
treatment pursuant to subsection (a), he shall discharge the
person provided that no person subjected to involuntary
treatment pursuant to clause (2) may be discharged without a
hearing conducted pursuant to clause (4).
(4) In cases involving involuntary treatment pursuant to
clause (2), whenever the period of court-ordered involuntary
treatment is about to expire and neither the director nor the
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county administrator intends to apply for an additional period
of court-ordered involuntary treatment pursuant to section 305
or at any time the director concludes that the person is not
severely mentally disabled or in need of treatment, the director
shall petition the court which ordered the involuntary treatment
for the unconditional or conditional release of the person.
Notice of such petition shall be given to the person, the county
administrator and the district attorney. Within 15 days after
the petition has been filed, the court shall hold a hearing to
determine if the person is severely mentally disabled and in
need of treatment. Petitions which must be filed simply because
the period of involuntary treatment will expire shall be filed
at least ten days prior to the expiration of the court-ordered
period of involuntary treatment. If the court determines after
hearing that the person is severely mentally disabled and in
need of treatment, it may order additional involuntary treatment
not to exceed one year; if the court does not so determine, it
shall order the discharge of the person.
(5) A person may be subject to assisted outpatient treatment
for a period of up to 180 days if the person continues to meet
the requirements of section 301(c) or is being discharged from
involuntary inpatient treatment under this article.
Section 7. Section 305 of the act is amended by adding a
subsection to read:
Section 305. Additional Periods of Court-ordered Involuntary
Treatment.--* * *
(c) At the expiration of a period of assisted outpatient
treatment under section 304(g) or this section, the court may
order treatment for an additional period upon the application of
the county administrator or the treatment team. Such order shall
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be entered upon hearing on findings as required by sections
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 8. This act shall take effect in 90 days.
20170HB1233PN1838 - 18 -
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