Legal Aspects of 5150 Holds

Transcription

1 Legal Aspects of 5150 Holds Mental Health Advocacy Project Santa Clara County Mental Health Advocacy Project 152 N. Third Street, 3rd Floor San Jose, CA (408) and MHAP

2 Training Road Map Legal aspects of 5150 Holds 1. Legal Framework 2. Grounds and Legal Standard 3. Scope of 5150 Holds 4. Additional issues Clinical aspects of 5150s

3 Mental Health Advocacy Project State mandated to protect rights of mental health consumers Since 1978, Mental Health Advocacy Project has been designated as the Patients Rights Advocates for Santa Clara County Investigate and resolve complaints regarding denial or punitive withholding of statutory patients rights Monitor mental health facilities for compliance with patients rights provisions

4 1. Legal Framework of 5150s -LPS Act -Purpose and effect of 5150 holds -Who may write 5150s

5 Lanterman-Petris-Short Act (LPS) Enacted in 1969 to end the inappropriate, indefinite, and involuntary commitment of individuals with mental health disabilities (Welf. & Inst. Code 5001(a)) Intent was to balance the need for public safety while safeguarding the individual rights General rule: least restrictive and clientcentered (participation in treatment decisions) Establishes patients due process rights

6 What is a 5150? 72-hour legal hold imposed on a person that is believed to be in need of involuntary psychiatric treatment in the state of California Person is detained and transported to the hospital by the police officer, clinician, or other authorized person At hospital client receives an evaluation No right to hospital hearing during a 5150 hold

7 Who can initiate an involuntary hold? Selected members of attending staff at evaluation facilities/hospitals that are designated for involuntary detainment by the county; or Peace Officers, including Sheriffs, State Park Rangers, State University Peace Officers Other clinicians approved by the county mental health department ** Turn to page 8 in SCC manual for specific provisions. Different rules for licensed and unlicensed professionals

8 5150 and Hospital Admission A 72-hour hold is an application for involuntary admission, NOT a direct admission form. The 5150 gets the individual to the door. Hospital conducts face-to-face assessment: Does individual need involuntary treatment? If yes: client stays in hospital on 5150 hold If no: hospital still must Consider voluntary inpatient hospitalization Provide crisis intervention Work on outpatient services

9 Grounds -Legal criteria -Probable cause standard -Specifics of each ground

10 Welfare & Institutions Code Section 5150 When any person, AS A RESULT OF A MENTAL DISORDER is a danger to others, or to himself or herself, or gravely disabled... -a peace officer, -member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, or -other professional person designated by the county, may, upon probable cause, take the person into custody and place him or her in a facility designated by the county as a facility for 72 hour treatment and evaluation

11 Nexus Requirement: As a result of a mental disorder DS/DO/GD Behavior 5150 Mental Illness

12 Describing Behavior on 5150 Form A 5150 is a LEGAL rather than a clinical document Statements need to be anchored in observable, describable behavior Remember: Link between behavior and mental illness Symptoms vs. Behavior

13 Sample 5150 Hold: What do you think? Individual was brought to facility by her parents. She has a diagnosis of chronic paranoid schizophrenia and is in treatment with Community Solutions. She is paranoid and delusional regarding her parents and boss. She requires involuntary treatment at this time and is unable to care for her needs in the community.

14 Standard: Probable Cause Probable cause is: State of facts known to you that would lead a person of ordinary care and prudence (reasonable person) to believe or entertain a strong suspicion that person detained as a result of a mental disorder meets one of the three criteria (GD, DS, DO) Meeting probable cause standard: Rational inferences Historical Course of Treatment/Past Conduct Third Parties

15 Origin of Probable Cause Standard People v. Triplett (1983) 144 Cal.App.3d 283 At disturbance call, officer sees upset, intoxicated woman Right hand full of blood with 3-4 light lacerations across wrist Detention leads to discovery of drugs A dereliction of duty if he had left her unattended and at risk

16 5150 Criteria Danger to Self Danger to Others Grave Disability

17 Presentness standard For all three grounds, apply the presentness standard: Is the individual PRESENTLY GD/DO/DS? Not a prospective or predictive process

18 Hold Criteria: Danger to Self (DS) Intent to commit suicide or inflict serious bodily harm, or disregard for personal safety to the point that injury is imminent Factors to consider: Words or actions showing intent for self harm or suicide; Words or actions indicating a specific plan; Means available to carry out plan

19 Hold Criteria: Danger to Others (DO) May be inferred from words or actions that person intends to cause harm to a particular individual, or intends to engage in dangerous acts with disregard for the safety of others Factors to consider: Threats against or attempts to harm certain individuals Means available to carry out threats or repeated attempts

20 Hold Criteria: Gravely Disabled (GD) As a result of a mental disorder, has the inability to provide for basic needs (food, clothing, shelter) Factors to consider: Signs of malnourishment or dehydration Unable to articulate plan for obtaining food, or no food in the home Irrational belief, e.g., food is poisoned, contains tracking devices Eviction from housing for behavioral problems Destruction of, throwing or giving away clothing to the point where person cannot clothe self Homelessness alone does NOT constitute GD

21 Grave Disability: Special Considerations Odd or eccentric behavior is not equivalent to grave disability Behavior must be viewed through cultural lens

22 Grave Disability: Third Party Assistance Courts have ruled that if a person can survive safely in freedom with the help of willing and responsible family members, friends, or third parties, then he or she is not considered gravely disabled

23 Grave Disability: Standard for Minors Different definition of grave disability: The minor is unable to provide for his/her food, clothing, and/or shelter or to make appropriate use of them even if these are supplied directly by others Minors have to be able to utilize the elements of life (food, clothing, and shelter) (WIC )

24 3. Scope of 5150 Holds Minors rights on 5150s What does not meet 5150 criteria Developmental disability alone Substance use alone Conservatorships Treatment for medical issues LPS and Non-LPS facilities

25 Special Rights for Minors on Holds Parents do not have absolute authority to admit child to hospital for in-patient mental health treatment: Minors, admitted as a voluntary patient by parent s signature, have the right to an independent clinical review or Roger S. hearing (WIC ) Legally emancipated minors are considered adults. This includes: Married individuals; By court order; Emancipated due to military service

26 What does not meet the criteria for a 5150?

27 Does not meet the criteria for a 5150: Developmental Disability Alone Grave disability does not include mentally retarded persons by reason of being mentally retarded alone (WIC 5008(h)(3)) Separate body of law governs involuntary treatment of individuals with developmental disabilities

28 Does not meet the criteria for a 5150: Drug and Alcohol Use Alone Drug use and chronic alcoholism alone is not a proper ground for a 5150 Alcoholism, other drug abuse, or repeated antisocial behavior do not, by themselves, constitute a mental disorder

29 Does not meet the criteria for a 5150: Conservatorship Clients on conservatorship should never be placed on a 5150 Decision to move to acute care should be made by conservator, who does not need to write a 5150 to do this. Conservatees are already considered GD, so Should only be placed in hospital if DO or DS

30 5150s Cannot be Used to Authorize Medical Treatment 5150s authorize psychiatric treatment, not medical treatment A person on a 5150 cannot be given nonpsychiatric medical treatment against their will. Emergency Exception: If the person s condition will become life threatening or pose a serious threat to his or her health, and the person is unable to give an informed consent, the court may be petitioned for medical authorization (Probate Code )

31 LPS Designated Facilities in Santa Clara County Valley Medical Center/EPS Stanford Hospital Veterans Administration Hospital El Camino Hospital Good Samaritan Hospital Main Jail 8A Psychiatric unit Kaiser PHF Santa Clara (opened 11/2010) Crestwood PHF (opened 4/2011)

32 Detentions in Non-LPS Designated Facilities 24 Hour Bed Holds Person may not be detained on a 5150 in a non-lps designated facility (ex: O Connor Hospital) Therefore, statute establishes procedure called a 24 Hour Bed Hold, which is used to transfer a person to a designated facility when they are medically stable Initiated by treating MD, surgeon, or psychologist after person medically cleared, but continues to meet 5150 criteria

33 Arranging Transfer on a 24 Hour Bed Hold NOT Medically Stable Preparations for transfer must begin before medically stable Medically Stable Patient is transferred to LPS facility 72-Hour 5150 Clock Starts 24 hours maximum

34 4. Additional issues -Liability and confidentiality -Cultural competency -Other types of holds

35 Liability and the 5150 Process Strong protections for 5150 writers: Liable only if you knowingly or willfully detain an individual in violation of the statutes NOT liable for actions by a person released before the end of the 72- hours (WIC 5154, ) Liability for a third party providing information: Liable only if s/he knowingly provides false information leading to a 5150 detention

36 Confidentiality A 5150 is part of patient s medical record Therefore, same confidentiality standards apply to 5150s

37 Confidentiality Exceptions Police: Officer writing 5150 can request information if possibility of related criminal charges Information released is limited to name, address, date of admission for 72-hour evaluation and treatment, and date of release (WIC ) Current providers: LPS facilities can communicate with current mental health providers without patient consent (WIC 5328(a))

38 Cultural Competency Santa Clara County s Five Threshold Languages Spanish Vietnamese Mandarin Cantonese and Tagalog Communication requirements Advisement Assessment

39 Handout on Specific Types of Holds Authorized in Santa Clara County

40 Mental Health Advocacy Project Free legal services and advice 3 Units Patients Rights, Economic Rights, and Housing Rights 152 N. Third St., 3rd Floor San Jose, CA (408) and MHAP