HOUSE DOCKET, NO. 3255        FILED ON: 1/20/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1980

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Marjorie C. Decker

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to ending unnecessary hospitalizations and reducing emergency department boarding.

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PETITION OF:

HOUSE DOCKET, NO. 3255        FILED ON: 1/20/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1980

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 3962 OF 2021-2022.]

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Third General Court
(2023-2024)

_______________

An Act relative to ending unnecessary hospitalizations and reducing emergency department boarding.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Section 12 of chapter 123 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-

(a) (i) For the purposes of this subsection, “mental health professional” shall, unless the  context clearly requires otherwise, mean a physician who is licensed pursuant to section 2 of chapter 112; a qualified psychologist licensed pursuant to sections 118 to 129, inclusive, of said chapter 112; a qualified psychiatric nurse mental health clinical specialist authorized to practice as such under regulations promulgated pursuant to section 80B of said chapter 112; a nurse authorized to practice in advanced practice nursing by the board of registration in nursing pursuant to said section 80B of said chapter 112; a licensed independent clinical social worker licensed pursuant to sections 130 to 137, inclusive, of said chapter 112; or other less restrictive and voluntary community mental health services.

(ii) A mental health professional may only seek involuntary hospitalization of an individual if no less restrictive alternative exists to reduce the likelihood of serious harm by reason of mental illness, as defined in section 1. To prevent unnecessary hospitalization, a mental health professional shall exhaust community-based treatment alternatives, including, but not limited to: (i) the nationally-mandated 988 Suicide and Crisis Lifeline; (ii) the Behavioral Health Help Line of the Roadmap for Behavioral Health Reform; (iii) services offered through Community Behavioral Health Centers including mobile crisis intervention, behavioral health urgent care, and community crisis stabilization; (iv) peer respite and other peer-run alternatives to emergency department visits and hospitalization; (v) Children’s Behavioral Health Initiative (CBHI) or Behavioral Health Services for Children and Adolescents (BHCA) services; (v) family supports; and (vi) technologically-supported behavioral health services, prior to seeking involuntary transportation, restraint and hospitalization pursuant to this section. The mental health professional shall document on the application for hospitalization that the mental health professional has exhausted community-based alternatives, the reasons for the restraint of such person and any other relevant information that may assist the admitting physician or physicians.

If the mental health professional has exhausted all community-based alternatives to reduce the likelihood of serious harm by reason of mental illness, the mental health professional, after examining a person or, in the event that examination is not possible because of the emergency nature of the case and because of the refusal of the person to consent to such examination, based on the facts and circumstances, may complete an application for evaluation and treatment, which shall authorize law enforcement officers, as defined in section 1 of chapter 6E, or emergency medical technicians to transport the individual to the regional crisis stabilization program.

In an emergency if a mental health professional is not available to evaluate the individual for involuntary hospitalization, a law enforcement officer, who believes that failure to restrain a person would create a likelihood of serious harm by reason of mental illness shall take the individual directly to the nearest Community Behavioral Health Center for evaluation and treatment. If the director of the Community Behavioral Health Center or designee determines and documents, after a personal evaluation, that the Community Behavioral Health Center is unable to prevent the individual from harming themself or others, or if the individual does not agree to accept treatment voluntarily through the crisis stabilization program, the law enforcement officer or emergency medical technician may transport the person directly to the nearest inpatient psychiatric facility with a bed available, utilizing the centralized database established pursuant to section 12A. The individual may only be transported to a hospital emergency department if there is no availability within a 30-mile radius of the initial restraint.

If there is no availability at an inpatient psychiatric facility, and the individual is transported to an emergency department of a general hospital, then within 12 hours of arrival at the emergency department, the person shall be informed of their right to speak with an attorney and to request a probable cause hearing. The emergency department staff shall provide the individual with notice of their rights pursuant to this section and, if the person requests counsel, shall promptly contact the mental health litigation division of the committee for public counsel services to request appointment of counsel in accordance with chapter 211D. The committee for public counsel services shall appoint counsel forthwith.

Any individual who remains in an emergency department for 48 hours from the time of arrival shall be entitled to a probable cause hearing upon request to determine if the person meets the criteria for emergency detention. The hearing shall be held by the district or municipal court with jurisdiction over the hospital no later than the next business day. The hearing shall be conducted at the hospital where the individual is admitted, with all participants attending either in-person or virtually.

SECTION 2. Said section 12 of said chapter 123, as so appearing, is hereby further amended by adding the following subsection:-

(f) The department shall collect information regarding all applications pursuant to this section. The department shall annually, not later than July 31, report to the house and senate committees on ways and means, joint committee on public health and the joint committee on mental health, substance use and recovery the number of applications pursuant to said section 12, such other information as may be relevant, and any actions the department has taken in response to the information it has received, including any licensing actions.

SECTION 3. Said chapter 123 of the General Laws is hereby amended by inserting after section 12 the following section:-

Section 12A. The department shall establish and maintain a database of inpatient psychiatric facilities licensed pursuant to section 19 of chapter 19 within the Commonwealth for use by law enforcement officers, as defined in section 1 of chapter 6E, emergency medical technicians and healthcare professionals. The database shall be updated daily and show available capacity at all inpatient psychiatric facilities.