There was a case I handled while working as a prosecutor in Rusk County in East Texas, and this case is repeated daily in our state.
The patient, called Jane Doe, was a woman in her late 40s who was unable to support herself. She moved in with her parents to cope with her declining physical and mental health. Her resources were limited, her physical health was treated with the exception of her mental health, and despite her parents’ efforts, her mental health continued to decline. Her parents did their best to deal with the problem, but they eventually lost control over the situation. In anger caused by her mental health issues and her excessive alcohol consumption, the troubled woman assaulted her mother.
When officers arrived on the scene, Jane’s parents spoke of Jane’s physical and mental health problems. However, police officers could not ignore the clear evidence of her domestic violence and arrested the woman.
But what if there was a way for Jane to get the help she needed before she assaulted her mother?
There is It’s a tool for dealing with the growing number of mental illnesses, many of whom are homeless. This is called involuntary civil involvement.
Texas is woefully under-resourced to deal with individuals suffering from severe mental illness. Loved ones are often the first to call to get someone’s mental health treatment, and they are hesitant to call the police on their own family. slowly deteriorates until the kettle boils and the person commits a criminal act.
Involuntary civic commitment is one of the few real statewide tools available to deal with this dynamic. These are court-ordered hospitalizations for the purpose of treating mental illness so serious that there is a significant risk of harm to the person or others. Here’s how it works:
These efforts typically begin with a 911 call from a loved one or interested citizen. The resources available to deal with this first encounter can change dramatically. Some areas have crisis intervention and response teams that partner with specially trained law enforcement officers and mental health professionals. Other regions may only have the nearest officer in charge at the time. Anyone arriving at the scene will be informed whether the person has a mental illness and, because of that mental illness, is at risk of serious harm to that person or a third party unless the person is immediately restrained. A final determination must be made as to whether or not there is
If the patient meets Health and Safety Act standards, officers will immediately detain the person unless there is sufficient time to obtain a warrant in advance. Unfortunately, the patient’s condition has usually deteriorated to that extent by the time 911 is called, so there is rarely enough time to obtain a warrant. When a person is detained, security officials should immediately transfer the person to the nearest appropriate mental health facility. Prisons or other criminal holding facilities are only permitted in the most extreme of emergencies.
Clearly, there are serious due process concerns in such situations. That is, a legal requirement to protect patient rights.
In the event of a warrantless arrest by a member of the security forces, file a detention notice stating the specific facts leading to the detention at the mental health facility and notify the probate court having jurisdiction over the matter by next business; is needed. Day.
Upon admission to a mental health facility, patients are evaluated by a physician. Physicians should be sure that the person has a mental illness, poses a substantial risk of harm to the patient or others, and emergency admission is the least restrictive means of providing the necessary treatment. there is. If the doctor does not show these findings, the person should be released.
If the doctor makes the required findings and the patient’s condition improves so that one of these required findings is no longer applicable, the patient must be released. Fortunately, many people detained under such emergencies are released soon afterward as their health improves.
If the patient’s condition does not improve, the local county or district attorney should file an application for court-ordered mental health services. Since the interests of the patient’s liberty are at issue in such proceedings, he must hold a hearing within 72 hours of the patient’s detention and admit the patient while the application is submitted. It is necessary to determine if the situation exists. On hold.
A hearing on the application itself must be set within 14 days of the application. Two medical certificates must be submitted to the court before the hearing. The certifying physician must have seen the patient within the last 30 days, and at least one of the physicians must be a psychiatrist.
The district or county attorney’s office has the burden of proof at the hearing. Patients are released if the judge decides they have not proven their claim. If the prosecution proves the facts, there are two possible outcomes. Outpatient services may be ordered when the patient is no longer a threat to themselves or others. or if a judge or, in rare cases, a jury, finds clear and convincing evidence that the patient has a mental illness and that the patient may be seriously harmed as a result of the mental illness; Patients may be sent to inpatient care. yourself or someone else.
Throughout this process, from the first consultation to the final hearing, the goal is to provide the support the patient needs in the least restrictive way possible. The goal is not to lock in individuals whose mental illness is an inconvenience or annoyance. Likewise, it should not be used as a means of detaining suspects where state evidence is lacking. Each step in the process is aimed at getting individuals who are unable to get treatment for themselves to get the treatment they need.
Properly applied, properly understood by local governments, and properly funded by state and local governments, laws can create many public benefits.
Troubled neighbors like Jane Doe need our help. Involuntary civic commitment is one way she delivers it.
Zack Wavrusa is an Associate Attorney in the Inspector General’s Office for the Texas Board of Health and Human Services and a former Assistant District Attorney for Rusk County. He wrote this column for his Dallas Morning News.
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