Download Chapter 51 Civil Commitment Process: What Families Can Expect

Chapter 51
Civil Commitment Process:
What Families Can Expect
Galen Strebe, Dane County
Assistant Corporation Counsel
Sarah Henrickson, LCSW, Mental
Health Center of Dane County
November 17, 2009
Mental Health Act
Chapter 51, Wisconsin Statutes
Provides legal procedures for voluntary and
involuntary admission, treatment and
rehabilitation of individuals (adults and minor
children) afflicted with mental illness,
developmental disability, drug dependency,
or alcoholism.
Criteria for Involuntary
Civil Commitment
1)
2)
3)
The individual has a mental illness,
developmental disability, or drug/alcohol
dependence.
The individual’s illness/disability/
dependence is treatable.
The individual is dangerous to him/herself
or others, due to the illness/disability/
dependence.
Definition of Mental Illness for
Involuntary Civil Commitment
A substantial disorder of thought, mood,
perception, orientation, or memory, which
grossly impairs judgment, behavior, capacity
to recognize reality, or ability to meet the
demands of life, but does not include
alcoholism.
Definition of Developmental Disability
for Involuntary Civil Commitment
A disability attributable to brain injury,
cerebral palsy, epilepsy, autism, Prader-Willi
syndrome, or mental retardation, which is
expected to continue indefinitely, and which
constitutes a substantial handicap to the
afflicted individual.
Definition of Drug Dependence for
Involuntary Civil Commitment
A disease which is characterized by the
dependency of an individual who uses one or
more drugs to the extent that the individual’s
health is substantially impaired, or his/her
social or economic functioning is
substantially disrupted.
Definition of Alcoholism for
Involuntary Civil Commitment
A disease which is characterized by the
dependency of an individual on alcohol, to
the extent that his/her health is substantially
impaired or endangered, and his/her social
or economic functioning is substantially
disrupted.
Alcohol and Drug Commitments


Rarely done for minor children because very
difficult to prove legal standards.
Requires established pattern of use, which
causes substantial impairment of health and
functioning, and which causes dangerousness to self or others.
Standards of Dangerousness Required
for Involuntary Civil Commitment
1)
2)
3)
Recent acts, attempts or threats of suicide or
serious bodily harm to self.
Recent acts, attempts, or threats of serious
bodily harm to others, or violent behavior
which places others in reasonable fear of
serious physical harm.
A pattern of recent acts or omissions which
evidences impaired judgment causing the
individual to be an inadvertent danger to self.
Standards of Dangerousness Required
for Involuntary Commitment (cont.)
4) Mental illness causes the individual to be so
gravely disabled that he/she is unable to
satisfy life’s basic needs for nourishment,
medical care, shelter, or safety.
5) Individual’s psychiatric treatment history,
coupled with his/her present mental
deterioration due to incompetent decision to
refuse psychotropic medication, causes
likelihood that the individual will lose ability
to function independently in the community.
Definitions of Treatment for
Involuntary Civil Commitment
Statutory: Those psychological, educational,
social, chemical, medical, or somatic techniques
designed to bring about the rehabilitation of an
individual who has mental illness, developmental
disability, drug dependency, or alcoholism.
Jury Instruction: An individual is a proper subject
for treatment if the administration of treatment
techniques may control, improve, or cure his/her
mental illness, developmental disability, drug
dependency, or alcoholism.
Methods of Initiating an Involuntary
Civil Commitment Proceeding



Law Enforcement Emergency Detention
Treatment Director Emergency Detention
Three Party - Petition for Examination
Law Enforcement
Emergency Detention (ED)
Law enforcement officers may take individual
into custody, file a statement of emergency
detention (ED), and detain that individual at
an approved mental health facility based
upon the officers’ belief, from either personal
observation or reliable reports of others, that
the individual is mentally ill, developmentally
disabled, or drug dependent, and dangerous
to self or others, and needs treatment.
Law Enforcement
Emergency Detention (cont.)



Law enforcement officers must consult with crisis
staff/mental health workers of the county
department of community programs.
County department must approve the need for
detention of the individual before law
enforcement officers can do an ED.
The receiving mental health facility/unit usually
requires medical clearance of the individual prior
to detention, to check for medical problems, drug
or alcohol use, and to evaluate the individual’s
mental status.
Treatment Director
Emergency Detention (ED)
●
●
●
The Treatment Director of a mental health
facility/unit may file statement of Emergency
Detention (ED) and detain patient who is admitted to
the facility/unit.
ED must allege that the patient is mentally ill,
developmentally disabled, or drug dependent, and
dangerous to self or others, and needs treatment.
Treatment Director ED usually occurs when an
individual is voluntarily admitted to a facility/unit, and
later refuses treatment and/or requests discharge.
Three Party - Petition for Examination



Three adults sign a sworn petition drafted by
the County Corporation Counsel.
At least one of the petitioners (signers) must
have personal knowledge of the individual’s
dangerous behavior.
Petition must allege that the individual is
mentally ill, developmentally disabled, or
drug dependent, and dangerous to self or
others, and a proper subject for treatment.
Three Party - Petition for Examination
(cont.)



Petitioners who have not directly observed the
individual’s dangerous behavior must provide a
basis for their belief that the allegations are true.
The County Corporation Counsel files the
petition with the court. After review, the judge
may order detention of the individual by law
enforcement to a mental health facility, or may
just set the case for a probable cause hearing
without detention.
This process may take several days or more,
and should not be used in emergency situations.
Probable Cause Hearing



Court hearing must be held within 72 hours of
individual’s detention at a mental health facility
(excluding weekends and holidays).
Witnesses testify from personal observations
about the allegations of dangerousness in the
petition or ED, and doctor testifies about mental
illness, disability, or dependence, and treatment.
After the hearing, the judge determines if there is
probable cause (reason) to believe the
allegations, and cause to detain and treat the
individual at a mental health facility.
Probable Cause Hearing:
Four Possible Outcomes
1)
2)
3)
4)
Case is dismissed for lack of sufficient evidence that
the individual is mentally ill or dangerous.
Settlement Agreement is approved by the court.
Case is converted to temporary guardianship and
protective placement or services, if the individual is
developmentally disabled and not treatable.
Probable cause is found:
•
Final hearing is scheduled within 14 days of
detention
•
Two doctors are appointed by the court to examine
the individual and to submit written reports, with their
opinions and recommendations, to the court.
Final Hearing (Trial)



Court hearing held within 14 days of the individual’s
detention at a mental health facility, or 30 days if there
is no detention after probable cause hearing.
Witnesses testify from personal observations about the
dangerous behavior, and court appointed examiners
(psychologists and/or psychiatrists) testify about mental
illness, disability or dependence, and treatment.
After the hearing, the judge determines if there is clear
and convincing evidence to commit the individual either
inpatient or outpatient initially, and whether the
individual is competent to refuse psychotropic
medications.
Final Hearing:
Four Possible Outcomes
1)
2)
3)
4)
Case is dismissed for lack of clear and
convincing evidence that the individual is
mentally ill, or is dangerous, or is treatable.
Settlement Agreement is approved by court.
Conversion to guardianship and protective
placement/services if untreatable condition.
Order of Involuntary Civil Commitment for
treatment.
Chapter 51 Court Hearings:
Rights of Minors
Minors have the right to:
• be represented by adversary counsel at
public expense.
• have a closed hearing.
• request an open hearing.
• remain silent.
• present and cross-examine witnesses.
• have a jury trial.
Chapter 51 Court Hearings:
Rights of Parents or Legal Guardians
Parents/Legal Guardians have the right to:
• participate in the court hearing(s).
• be represented by counsel (at their own
expense).
Settlement Agreement



A negotiated contract for treatment between
the individual, his/her attorney, and the
County Corporation Counsel, and approved
by the court.
Waives the court hearings for a specified
period of time, up to 90 days.
Cannot be extended at end of time period, if
individual is compliant with treatment.
Settlement Agreement (cont.)


Includes a list of treatment conditions the
individual must comply with, including the
maximum time (number of days) of inpatient
treatment.
Failure to comply with the treatment
conditions may result in return to a mental
health facility and continuation of court
proceedings.
Order of Involuntary Civil Commitment
for Treatment
If there is clear and convincing evidence that
the individual is mentally ill, developmentally
disabled, or drug dependent, and dangerous
to self or others, and a proper subject for
treatment, an individual may be committed
by court order to the care and custody of the
county department of community programs
for inpatient and/or outpatient treatment for
up to 6 months.
Outpatient Treatment Conditions



Committed individuals are given this document
upon discharge to outpatient treatment,
informing them to comply with the listed
conditions deemed necessary to ensure
treatment and safety in the community.
The individual’s failure to comply with the
conditions may result in his/her return to a
mental health facility by law enforcement.
Psychotropic medications may not be
administered involuntarily (forcibly) as an
outpatient treatment condition.
Order To Treat
The court may order that medication may be
administered to an individual regardless of
his/her consent (involuntarily and/or forcibly):
•
•
After a finding of probable cause, effective only
until the final hearing.
After an order of commitment is granted, effective
for the duration of the commitment.
Order To Treat (cont.)
The court must find sufficient evidence to believe
that the individual is not competent to refuse,
due to illness/disability/dependence, because
he/she is:
•
•
Incapable of expressing an understanding of the
risks, benefits, and alternatives of medications; OR
Incapable of applying an understanding of the
medications to his/her own condition to make an
informed choice to accept or refuse.
Extension of Commitment
(Recommitment)



Prior to expiration of a commitment, the county
department to which an individual is committed may
file a recommendation to extend the commitment.
County Corporation Counsel files petition for
recommitment alleging the individual continues to
need treatment, is dangerous without treatment, and
is unlikely to comply without court ordered treatment.
Order of Extension of Commitment can be up to 12
months, if the court finds that there is a “substantial
likelihood that the individual would become a proper
subject for commitment if treatment was withdrawn.”
Monitoring Settlement Agreement/
Treatment Conditions of Commitment



Noncompliance does not automatically result in
returning the individual to a more restrictive
environment (redetention to a mental health facility).
Need for redetention is based on level of
noncompliance, dangerous behavior, and/or
potential for dangerousness.
If individual is unstable and in need of inpatient
treatment and willing to comply, he/she can be
voluntarily admitted without court involvement.
Why Are Minor Children ED’d?


Effective 8/1/06, Wisconsin law permits
parents/legal guardians to sign their minor
child into a psychiatric hospital for treatment
without the child’s consent.
However if the child is physically combative
and/or unwilling to accept treatment,
voluntary admission may be inappropriate or
unavailable.
Where Are Minor Children
Admitted for ED’s?

Mendota Mental Health Institute, Madison
–
–
–

Winnebago Mental Health Institute, Oshkosh
–

Adolescent males
Children under 12 (only until January 1, 2010)
No adolescent females
Male and female children and adolescents
Private hospitals and county facilities
–
Unlike the state institutions, these hospitals/facilities
are not required to accept emergency detentions, but
some do at their discretion.
Are There Specialty Treatment Units
For Minor Children?


Developmental Disabilities: Winnebago and
Mendota must accept EDs but often transfer
to Northern or Central WI Center.
Alcohol and Drug Treatment: Anchorage Unit
at Winnebago treats dual diagnoses (AODA
and mental illness).
What Can Families Expect from the
Treatment Facility?





Consultation with social worker and/or treating
psychiatrist.
Information about assessment of the child and
treatment recommendations.
Parental consent must be obtained prior to
administering any medication changes.
Family phone calls and visits allowed as
appropriate.
Social worker will coordinate discharge plan with
family and community providers.
What Can Families Expect After
Discharge to Outpatient Treatment?


If case is dismissed, there is no further court
involvement unless a new involuntary civil
commitment case is initiated.
If individual is discharged under settlement
agreement or treatment conditions of
commitment, county of residence will provide
services and monitoring, and will determine
if/when individual needs to return to inpatient
treatment.
Contact Information
Galen Strebe
Dane County Assistant Corporation Counsel
210 Martin Luther King Blvd Rm 419
Madison, WI 53703
Phone: 608-266-9004
Fax: 608-267-2504
E-mail: [email protected]
Sarah Henrickson, LCSW
Youth Crisis, Mental Health Center of Dane County
625 W. Washington Avenue
Madison, WI 53703
Phone: 608-280-2610
Fax: 608-280-2704
E-mail: [email protected]