Handout 2 - Wisconsin Department of Health Services

5/24/2013
Wisconsin Public Psychiatry Network Teleconference
(WPPNT)
• This teleconference is brought to you by the Wisconsin
Department of Health Services (DHS) Bureau of
Prevention, Treatment, and Recovery and the University
of Wisconsin-Madison, Department of Psychiatry.
• The Department of Health Services makes no
representations or warranty as to the accuracy,
reliability, timeliness, quality, suitability or completeness
of or results of the materials in this presentation. Use of
information contained in this presentation may require
express authority from a third party.
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Chapter 51
Civil Commitment Process
Galen Strebe, Dane County
Assistant Corporation Counsel
Sarah Henrickson, LCSW,
Journey Mental Health Center
May 30, 2013
Mental Health Act
Chapter 51, Wisconsin Statutes
Criteria for Involuntary
Civil Commitment
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.
1) The individual has a mental illness,
developmental disability, or drug/alcohol
dependence.
2) The individual’s illness/disability/
dependence is treatable.
3) The individual is dangerous to him/herself
or others, due to the illness/disability/
dependence.
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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.
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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.
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Alcohol and Drug Commitments
Standards of Dangerousness Required
for Involuntary Civil Commitment
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• 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.
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1) Recent acts, attempts or threats of suicide or
serious bodily harm to self.
2) Recent acts, attempts, or threats of serious
bodily harm to others, or violent behavior
which places others in reasonable fear of
serious physical harm.
3) A pattern of recent acts or omissions which
evidences impaired judgment causing the
individual to be an inadvertent danger to self.
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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.
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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.
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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 detention 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.
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Law Enforcement
Emergency Detention (cont.)
Treatment Director
Emergency Detention (ED)
• Law enforcement officers must consult with
crisis/mental health staff of the county of detention
department of community programs.
• County department crisis staff must approve the
need for detention of the individual before law
enforcement officers can complete an ED.
• The receiving mental health detention 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 and treatment needs.
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The Treatment Director of a mental health
facility/unit may file a statement of Emergency
Detention (ED) and detain a patient who has been
admitted to the psychiatric facility/unit.
ED must allege that the patient is mentally ill,
developmentally disabled, or drug dependent, and
dangerous to self or others.
Treatment Director ED usually occurs when an
individual is voluntarily admitted to a facility/unit, and
later refuses treatment and/or requests discharge.
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Three Party - Petition for Examination
Three Party - Petition for Examination
(cont.)
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• Three adults sign a sworn petition that is
drafted by the County Corporation Counsel.
• At least one of the 3 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.
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• 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 detention facility,
or may just set the case for a probable cause
hearing without ordering detention.
• This process may take several days or more, so
it should not be used for emergency situations.
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Probable Cause Hearing
Probable Cause Hearing:
Four Possible Outcomes
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• Court hearing must be held within 72 hours of
individual’s custody/detention by law enforcement
(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 decides if there is
probable cause (sufficient reason) to believe the
allegations, and probable cause to detain and treat
the individual at a mental health facility.
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1) Case is dismissed for lack of sufficient evidence that
the individual is mentally ill, developmentally disabled,
drug dependent, or has been dangerous recently.
2) Settlement Agreement is approved by the court.
3) Case is converted to temporary (30 days) guardianship
and protective placement or services if the individual’s
condition is permanent and not treatable.
4) Probable cause is found:
• Final hearing is scheduled within 14 days of initial
detention at mental health facility.
• Two doctors are appointed by the court to examine
the individual, and to submit written reports, with
their findings, opinions and recommendations.
Final Hearing (Trial)
Final Hearing:
Four Possible Outcomes
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• Court hearing held within 14 days of the individual’s
detention at a mental health facility, or 30 days if there
is no inpatient 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 decides if there is clear and
convincing evidence to commit the individual to either
inpatient (initially) or outpatient treatment, and whether
the individual is competent to refuse psychotropic
medications.
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1) Case is dismissed for lack of clear and
convincing evidence that the individual is
mentally ill, developmentally disabled, or drug
dependent; or has been recently dangerous.
2) Settlement Agreement is approved by court.
3) Conversion to temporary guardianship and
protective placement/services if condition is
permanent and not treatable.
4) Order of Involuntary Civil Commitment for
treatment for up to 6 months.
Chapter 51 Court Hearings:
Rights of Minors
Chapter 51 Court Hearings:
Rights of Parents or Legal Guardians
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.
Parents/Legal Guardians have the right to:
• be represented by counsel (at their own
expense).
• present and cross-examine witnesses.
• make a statement to the court.
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Settlement Agreement
Settlement Agreement (cont.)
• A negotiated contract for treatment signed by 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.
• Can be rescinded by County Corporation Counsel if
the individual fails to comply with the treatment
conditions.
• Includes a list of treatment conditions the
individual must comply with, including the
maximum days of inpatient treatment.
• Failure to comply with the treatment
conditions may result in the individual’s
detention at a mental health facility for further
commitment proceedings.
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Order of Involuntary Civil Commitment
for Treatment
Outpatient Treatment Conditions
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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, the court may commit an
individual to the care and custody of the
county department of community programs
for inpatient and/or outpatient treatment for
up to 6 months.
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• Given to committed individuals upon transfer to
outpatient treatment, requires them to comply
with the listed conditions determined necessary
to ensure treatment and safety in the
community.
• The individual’s failure to comply with the
conditions may result in his/her transfer back to
a mental health facility by law enforcement.
• Psychotropic medications may be administered
only voluntarily as an outpatient treatment
condition.
Order To Treat
Order To Treat (cont.)
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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, but the order is
effective only until the final hearing.
• At or after an order of commitment is granted, and
is effective for the duration of the commitment.
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The court must find sufficient evidence to believe
that the individual is not competent to refuse
psychotropic medications, due to mental illness/
disability/dependence, because he/she is either:
• Incapable of expressing an understanding of the
risks, benefits, and alternatives of the medications;
OR
• Incapable of applying an understanding of the
medications to his/her own condition to make an
informed choice to accept or refuse the medications.
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Extension of Commitment
(Recommitment)
Monitoring Settlement Agreement/
Treatment Conditions of Commitment
• 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.”
• Noncompliance with the treatment conditions does
not automatically result in transferring the individual
back to a mental health detention facility.
• Need for redetention is based on level of
noncompliance, mental stability, 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.
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Why Are Minor Children ED’d?
Where Are Minor Children
Admitted for ED’s?
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• Effective 8/1/06, Wisconsin law permits
parents/legal guardians to sign their minor
child (under age 18) 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.
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• Winnebago Mental Health Institute,
– 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?
What Can Families Expect from the
Treatment Facility?
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• Developmental Disabilities: Winnebago must
accept EDs but may transfer to Northern or
Central Wisconsin Center.
• Alcohol and Drug Treatment: Youth Services
Unit at Winnebago treats dual diagnoses
(AODA and mental illness).
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• Consultation with social worker and/or treating
psychiatrist.
• Information about assessment of the child’s
condition, and treatment recommendations.
• Parental consent must be obtained prior to
administering any medication or changes.
• Family phone calls and visits are allowed as is
appropriate.
• Social worker will coordinate outpatient plan with
family and community providers.
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What Can Families Expect After
Discharge to Outpatient Treatment?
Contact Information
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• If commitment case is dismissed, there is no
further court involvement until/unless a new
involuntary civil commitment is initiated.
• When individual is transferred to outpatient
with settlement agreement or treatment
conditions, the individual’s county of
residence will provide services and
monitoring, and will decide if/when individual
needs to return to inpatient treatment.
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Galen Strebe
Dane County Assistant Corporation Counsel
210 Martin Luther King Blvd., Room 419
Madison, WI 53703
Phone: 608-266-9004
Fax: 608-267-2504
E-mail: strebe@countyofdane.com
Sarah Henrickson, LCSW
Emergency Services Unit, Journey Mental Health Center
625 W. Washington Avenue
Madison, WI 53703
Phone: 608-280-2600
Fax: 608-280-2703
E-mail: sarah.henrickson@journeymhc.org
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