Provides for the emergency or involuntary admission of persons with mental illness when there is a risk of serious physical harm or serious psychiatric harm

The bill will improve care for people with serious mental illness by clarifying that involuntary inpatient care of persons with mental illness is appropriate when there is a risk of serious physical harm or serious psychiatric harm.

Summary of specific provisions

Section 1 of the bill amends Mental Hygiene Law (MHL) § 9.01 to clarify key definitions used in the process of involuntarily hospitalizing people with mental illness, including:

"Likely to result in serious harm," which is divided into two new terms: "likely to result in serious physical harm," and "likely to result in serious psychiatric harm."

The inability of a person with mental illness to meet his or her needs for nourishment, medical care, shelter or self-protection without the assistance of others is included as one potential basis for a finding that the person's mental illness is likely to result in serious physical harm.

Also, the definition of the term "need for retention" is supplemented to provide guidance to physicians in determining the need to retain an involuntarily hospitalized person for an additional period. The new language requires the decision-maker to consider not just the person's current mental condition, but also his or her preparedness to maintain such condition in the community by adhering to outpatient treatment and avoiding high-risk behaviors.

Sections 2 and 3 amend MHL § 9.37(a)&(c) to incorporate the newly-clarified commitment criteria in the determination of a director of community services or an examining physician that a patient should be admitted to a hospital.

Section 4 amends MHL § 9.39(a) to incorporate the newly-clarified commitment criteria in the determination of a hospital director to receive a patient and retain him or her for a period of fifteen days.

Section 5 amends MHL § 9.40(a)&(b) to incorporate the newly-clarified commitment criteria in the determination of a director of a comprehensive psychiatric emergency program to receive a patient and retain him or her for a period of up to 72 hours.

Sections 6 and 7 amend MHL § 9.41 to partially incorporate the newly-clarified commitment criteria in the determination of a peace officer or police officer to direct the removal of a person in the

community to a hospital. The amendment would allow the peace officer to apply the newly-clarified definition of "likely to result in serious physical harm," but would not allow the officer to consider the likelihood of psychiatric harm.

Sections 8 and 9 amend MHL § 9.43 to partially incorporate the newly-clarified commitment criteria in a judge's determination of the need for a mental health warrant. The amendment would allow the judge to apply the newly-clarified definition of "likely to result in serious physical harm," but would not allow the judge to consider the likelihood of psychiatric harm.

Sections 10 and 11 amend MI-IL § 9.45 to incorporate the newly-clarified commitment criteria in the report which may form the basis of a decision by the director of community services to direct the emergency removal of a person.

Sections 12 and 13 amend MHL § 9.55 to incorporate the newly-clarified commitment criteria in the determination of a qualified psychiatrist to direct the emergency removal of a person.

Sections 14 and 15 amend MHL § 9.57 to incorporate the newly-clarified commitment criteria in the determination of an examining emergency room physician to request the emergency removal of a person.

Section 16 amends MHL § 9.58 to incorporate the newly-clarified commitment criteria in the determination of a member of a mobile crisis outreach team to effectuate the emergency removal of a person.

Section 17 provides for the effective date.

Justification

Involuntary commitment to a hospital is always the last resort to secure desperately-needed medical care for a person in psychiatric crisis. While it is undeniably preferable for the person to accept treatment voluntarily, this is not always a realistic option. Sometimes, due to anosognosia, a biologic condition of brain dysfunction, individuals with severe illnesses such as schizophrenia and bipolar disorder are simply unable to recognize their own illness or the damage that has been wreaked upon their lives, and accordingly refuse offers of voluntary assistance.

For this reason, offering involuntary hospital care to those in need is an essential function of the public mental health system. The availability of such treatment is not only a question of resources; it is also highly dependent on the criteria stated in commitment laws, which must strike a delicate balance between the individual's right to make his or her own medical treatment decisions and society's need to protect the person and the community from serious dangers to life or safety.

To commit a person to inpatient treatment in New York, it must be established that the person's mental illness is "likely to result in serious harm." On its face, this standard (commonly known as the "dangerousness standard") is both reasonable and constitutionally

appropriate. But the dangerousness standard is often applied in a disturbingly narrow manner.

Mental health professionals, courts and police sometimes interpret dangerousness to mean a risk of violence or suicide, and nothing more. Families desperately seeking care for a mentally ill loved one are told that nothing can be done until the person demonstrates some intent to hurt someone. Too often, the person ultimately proves such "dangerousness" by committing a violent act, and then receives overdue treatment as an inmate in the correctional system.

The narrow view of dangerousness is actually bolstered by the New York statute, which lists "homicidal or other violent behavior" and "threats of or attempts at suicide or serious bodily harm" as the only concrete examples of conduct establishing a basis for commitment. While the law also allows for the possible relevance of "other conduct demonstrating that the person is dangerous to himself," it provides no guidance on what sort of conduct that might include.

This bill would not expand the availability of commitment to non-dangerous individuals. Rather, it would make explicit that there are ways to be dangerous to oneself without having any intent of self-harm. Specifically, it would clarify that when mental illness prevents a person from meeting his or her essential human needs of nutrition, medical care, shelter and self-protection - or renders him or her unable to seek care to prevent severe deterioration of brain function - danger to self within the meaning of the commitment law is established.

This is not a trailblazing bill. On the contrary, New York is currently one of only four states whose commitment laws do not explicitly acknowledge inability to meet basic survival needs as a permissible basis for commitment. The need to protect an individual from psychiatric harm is also recognized by many states, including Arizona, Wisconsin, Hawaii, Oregon and Michigan.

A published study indicates that broadening state commitment standards does not lead to a deluge of new hospital patients, but rather it leads to many individuals who would eventually have been hospitalized under the old law, instead receiving hospital care at an earlier, more treatable and cost-effective stage of mental illness. (Miller, Am. J. Psychiatry, Oct. '92.) Another study recently found a statistically significant correlation between progressive commitment standards and lower state homicide rates. (Segal, Soc. Psychiatry Psychiatr Epidemiol, Nov. 2011.)

Prior legislative history

New Bill.

Fiscal implications

Undetermined. Costs savings anticipated in the long run due to decrease in recidivism of incarcerations and inpatient hospitalizations.

Effective date

This act shall take effect on the thirtieth day after it shall have become a law.