Expand Mental Health Treatment Options

Section 1. Short title. This act shall be known and may be cited as "The Supportive Interventions Act".

§ 2. Legislative findings. The legislature finds that with proper support, the great majority of New Yorkers with severe mental illness can thrive in outpatient settings as fully-integrated members of the communities of our state.

The legislature further finds that a core function of our mental health system is to help each person with severe mental illness maximize their potential for a self-directed life. Fulfilling this responsibility requires a flexible approach that acknowledges the challenges that individuals with severe mental illness may face at certain junctures in recognizing their own illness and need for treatment. To empower a person to gain command of their own mental health recovery in due course, it is sometimes necessary to extend a lifeline through a period of mandated treatment.

The legislature further finds that it is always preferable for an individual in psychiatric crisis or at risk thereof to accept mental health treatment voluntarily, and that care providers be encouraged to make diligent efforts to exhaust such possibilities before resorting to involuntary care.

The legislature further finds that while New York law appropriately limits involuntary hospitalization to circumstances where a person's mental illness is deemed "likely to result in serious harm," a lack of

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD00502-01-5

statutory guidance has led to tragically narrow interpretations of this standard. The serious harm likely to result from egregious self-neglect, including psychiatric deterioration likely to result from an extended period of untreated psychosis, is too often not considered in the clinical evaluation of those in crisis.

The legislature further finds individuals not receiving essential mental health care because they are unable to recognize their own need for it may face "revolving door" hospitalization, and intolerable rates of victimization and premature death.

The legislature further finds that while assisted outpatient treatment, as established by "Kendra's Law" in 1999, has been highly effective in helping New Yorkers with severe mental illness live safely in the community and avoid hospitalization and criminal justice involvement, gaps and barriers in the law have prevented the participation of many individuals who meet the legal eligibility criteria and stand to benefit from this essential intervention.

The legislature intends and expects that the supportive interventions facilitated by this act will save lives, raise the quality of life for New Yorkers with severe mental illness and their loved ones, enhance public safety, reduce criminalization of mental illness, and improve the efficiency and cost-effectiveness of our public mental health system.

The legislature further finds that there is no choice to be made between the reforms enacted herein and the additional need to increase investments in community-based mental health. Ongoing efforts to expand availability of mental health treatment and services, supportive housing, and opportunities for social connection must continue, and offer great promise to reduce the need for the crisis response mechanisms addressed in this act.

§ 3. Section 9.01 of the mental hygiene law, as amended by chapter 723 of the laws of 1989, the seventh undesignated paragraph as amended by chapter 595 of the laws of 2000, is amended to read as follows: § 9.01 Definitions.

As used in this article:

"in need of care and treatment" means that a person has a mental illness for which in-patient care and treatment in a hospital is appropriate.

"in need of involuntary care and treatment" means that a person has a mental illness for which care and treatment as a patient in a hospital is essential to such person's welfare and [whose] that so impairs the person's judgment [is so impaired] that [he] the person is unable to understand the need for such care and treatment. Care and treatment in a hospital shall be considered essential to a person's welfare if, in the absence of such care and treatment, the person's mental illness is likely to result in serious harm to self or others.

["likelihood to result in serious harm" or] "likely to result in serious harm to self or others" means [(a)] presenting a substantial risk of: (a) physical or psychiatric harm to the person as manifested by: (i) threats of or attempts at suicide or serious bodily harm; (ii) substantial inability of the person to meet such person's basic need for food, clothing, shelter or medical care; or (iii) other conduct demonstrating that the person is dangerous to [himself or herself] self, or (b) [a substantial risk of] physical harm to other persons as manifested by homicidal or other violent behavior or threats by which others are placed in reasonable fear of serious physical harm.

"need for retention" means [that] the need of a person who has been admitted to a hospital pursuant to this article [is in need] for a further period of involuntary care and treatment in a hospital [for a further period].

"record" of a patient shall consist of admission, transfer or retention papers and orders, and accompanying data required by this article and by the regulations of the commissioner.

"director of community services" means the director of community services for the mentally disabled appointed pursuant to article fortyone of this chapter.

"qualified psychiatrist" means a physician licensed to practice medicine in New York state who: (a) is a diplomate of the American board of psychiatry and neurology or is eligible to be certified by that board; or (b) is certified by the American osteopathic board of neurology and psychiatry or is eligible to be certified by that board.

"qualified clinical examiner" means a psychiatric nurse practitioner certified by the department of education, a psychologist licensed pursuant to article one hundred fifty-three of the education law, or a clinical social worker licensed pursuant to article one hundred fifty-four of the education law.

"qualified mental health professional" means a qualified clinical examiner, a professional nurse registered pursuant to article one hundred thirty-nine of the education law, or any of the following working under the supervision of a physician or qualified clinical examiner: a master social worker licensed pursuant to article one hundred fiftyfour of the education law, a mental health counselor licensed pursuant to article one hundred sixty-three of the education law, or a marriage and family therapist licensed pursuant to article one hundred sixtythree of the education law.

§ 4. The mental hygiene law is amended by adding a new section 9.04 to read as follows: § 9.04 Clinical determination of risk of harm.

A clinical determination of whether a person's mental illness is likely to result in serious harm to self or others shall take account of:

(a) all relevant information presented to the evaluating facility's staff, including credible reports of the person's recent behavior and any known information related to the person's medical and behavioral history;

(b) the person's current ability, with available support, to adhere to outpatient treatment; and

(c) the expected long-term impact on the person's health or safety of actions or self-neglect caused by mental illness.

§ 5. Section 9.05 of the mental hygiene law, as renumbered by chapter 978 of the laws of 1977, is amended to read as follows: § 9.05 Examining physicians, qualified clinical examiners, and medical

certificates.

(a) A person is disqualified from acting as an examining physician or qualified clinical examiner in the following cases:

1. if [he] such person is a relative of the person applying for the admission or of the person alleged to be mentally ill.

2. if [he] such person is a manager, trustee, visitor, proprietor, officer, director, or stockholder of the hospital in which the patient is hospitalized or to which it is proposed to admit such person, except as otherwise provided in this chapter, or if [he] such person has any pecuniary interest, directly or indirectly, in such hospital, provided that receipt of fees, privileges, or compensation for treating or examining patients in such hospital shall not be deemed to be a pecuniary interest.

3. if [he] such person is on the staff of a proprietary facility to which it is proposed to admit such person.

(b) A certificate, as required by this article, must show that the person is mentally ill and shall be based on an examination of the person alleged to be mentally ill made within ten days prior to the date of admission. The date of the certificate shall be the date of such examination. All certificates shall contain the facts and circumstances upon which the judgment of the physicians or qualified clinical examiners is based and shall show that the condition of the person examined is such that [he] such person needs involuntary care and treatment in a hospital, and such other information as the commissioner may by regulation require.

§ 6. The section heading and subdivisions (a), (d), (e), and (i) of section 9.27 of the mental hygiene law, section 9.27 as renumbered by chapter 978 of the laws of 1977 and subdivision (i) as amended by chapter 847 of the laws of 1987, are amended to read as follows:

Involuntary admission on [medical] clinical certification.

(a) The director of a hospital may receive and retain therein as a patient any person alleged to be mentally ill and in need of involuntary care and treatment upon the certificates of two examining physicians, two examining qualified clinical examiners or a combination of an examining physician and an examining qualified clinical examiner, accompanied by an application for the admission of such person. The examination may be conducted jointly but each examining physician or qualified clinical examiner shall execute a separate certificate.

(d) Before an examining physician or qualified clinical examiner completes the certificate of examination of a person for involuntary care and treatment, [he] the physician or qualified clinical examiner shall consider alternative forms of care and treatment that might be adequate to provide for the person's needs without requiring involuntary hospitalization. If the examining physician or qualified clinical examiner knows that the person [he] such examining physician or qualified clinical examiner is examining for involuntary care and treatment has been under prior treatment, [he] such examining physician or qualified clinical examiner shall, insofar as [possible] reasonable, consult with the physician or [psychologist] qualified mental health professional furnishing such prior treatment prior to completing [his] the certificate. Nothing in this section shall prohibit or invalidate any involuntary admission made in accordance with the provisions of this chapter.

(e) The director of the hospital where such person is brought shall cause such person to be examined forthwith by a physician or qualified clinical examiner who shall be a member of the psychiatric staff of such hospital other than the original examining physicians or qualified clinical examiner whose certificate or certificates accompanied the application, and[,] if such person is found to be in need of involuntary care and treatment, [he] such person may be admitted thereto as a patient as herein provided.

(i) After an application for the admission of a person has been completed and both physicians or qualified clinical examiners have examined such person and separately certified that [he or she] such person is mentally ill and in need of involuntary care and treatment in a hospital, either physician or qualified clinical examiner is authorized to request peace officers, when acting pursuant to their special duties, or police officers[,] who are members of an authorized police department or force or of a sheriff's department, to take into custody and transport such person to a hospital for determination by the director whether such person qualifies for admission pursuant to this section. Upon the request of either physician or qualified clinical examiner, an ambulance service, as defined by subdivision two of section three thousand one of the public health law, is authorized to transport such person to a hospital for determination by the director whether such person qualifies for admission pursuant to this section.

§ 7. The section heading and subdivision (a) of section 9.29 of the mental hygiene law, section 9.29 as renumbered by chapter 978 of the laws of 1977 and subdivision (a) as amended by chapter 789 of the laws of 1985, are amended to read as follows:

Involuntary admission on [medical] clinical certification; notice of admission to patients and others.