Amendment #13 to H4879

Assisted Outpatient Treatment for Severe Mental Illness

Mr. Muratore of Plymouth moves to amend the bill by adding the following 6 sections:-

"SECTION XXXX. Section 1 of Chapter 123 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting before the definition of “Commissioner” the following 2 definitions:-

“Assisted outpatient”, a person subject to a court order for assisted outpatient treatment.

"Assisted outpatient treatment", treatment and services provided under court order on an outpatient basis to a person with mental illness, designed to enable the person to maintain safety and stability in the community.

SECTION XXXX. Section 6 of said chapter 123, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence: - No person shall be retained at a facility or at the Bridgewater state hospital except under the provisions of paragraph (e) of section 8½, paragraph (a) of section 10, the provisions of paragraphs (a), (b), and (c) of section 12, section 13, paragraph (e) of section 16 and section 35 or except under a court order or except during the pendency of a petition for commitment or to the pendency of a request under section 14.

SECTION XXXX. Said chapter 123 is hereby further amended by inserting after section 7 the following section:-

Section 7A. (a) A petition for assisted outpatient treatment may be filed in the district court for the county in which the respondent is present or reasonably believed to be present by:

(i) any physician licensed pursuant to section 2 of chapter 112 after examining a patient;

(ii) the department of mental health;

(iii) any person 18 years of age or older with whom the respondent resides;

(iv) the parent, spouse, adult sibling or adult child of the subject of the petition; or

(v) the superintendent of any public or private facility or hospital authorized for the commitment or treatment of mentally ill persons pursuant to subsection (a) of section 8  or subsection (a) of section 12.

(b) The district court may grant a petition for assisted outpatient treatment upon finding by clear and convincing evidence that the respondent:

(i) is an adult present within the jurisdiction of the court;

(ii) has a primary diagnosis of a mental illness;

(iii) has a history of noncompliance with treatment for mental illness that has:

(1) at least twice within the last 48 months, been a significant factor in necessitating hospitalization or necessitating receipt of services in a forensic or other mental health unit of a correctional facility; provided, that the 48 month period shall be extended by the length of any hospitalization, incarceration or detention of the respondent that occurred within the 48 month period; or

(2) resulted in 1 or more acts, attempts or threats of serious violent behavior toward self or others  within the last 48 months; provided, that the 48 month period shall be extended by the length of any hospitalization, incarceration or detention of the respondent that occurred within the 48 month period; or

(3) resulted in the respondent being hospitalized, incarcerated or detained for 6 months or more and the respondent is to be discharged or released within the next 30 days or was discharged or released within the last 60 days;

(iv) is unwilling or unlikely, as a result of mental illness, to maintain voluntary participation in outpatient treatment that would enable the respondent to live safely in the community without court supervision;

(v) is in need of assisted outpatient treatment as the least restrictive appropriate alternative to prevent a relapse or deterioration likely to result in serious harm to self or others; and

(vi) is likely to benefit from receiving assisted outpatient treatment.

(c) The petition shall allege that the respondent meets the criteria stated in subsection (b), and, for each criterion, allege facts that support such allegation. The petition shall be accompanied by a written outpatient treatment plan prepared, to the extent possible, in consultation with those familiar with the respondent's case history, the superintendent or physician in charge of the respondent's care and the respondent. The plan shall include each of the following:

(1) A statement of the respondent's requirements for supervision, medication and assistance in obtaining basic needs such as employment, food, clothing and shelter.

(2) If known, the address of the respondent’s residence and the name of any person in charge of the residence.

(3) The name and address of any person, agency or organization who shall be responsible for supervising the implementation and maintenance of the outpatient treatment plan for the respondent.

(4) The conditions for continued outpatient treatment, which may require reporting, continuation of medication, submission to testing or other such reasonable conditions.

(d) The hearing shall be held within 4 days of the filing of the petition. The period of time prescribed or allowed pursuant to the provisions of this section shall be computed pursuant to Rule 6 of the Massachusetts Rules of Civil Procedure. Adjournments shall be permitted only for good cause shown. In granting adjournments, the court shall consider the need for further examination by a physician or the potential need to provide treatment expeditiously.

(e) A petition for assisted outpatient treatment may be filed along with, and in the alternative to, a petition for inpatient commitment brought pursuant to section 7.

SECTION XXXX. Said Chapter 123 is hereby further amended by inserting after section 8 the following 2 sections:-

Section 8A. (a) After a hearing, the court may enter an order for assisted outpatient treatment upon finding that the criteria, as stated in section 7A, have been met and upon the approval of a written treatment plan presented to the court, which conforms to the requirements of said section 7A.

(b) An order for assisted outpatient treatment shall:

(i) direct the assisted outpatient to adhere to the treatment and services included in the approved treatment plan; provided, that an assisted outpatient’s failure to comply with such directive shall not be grounds for a finding of contempt of court; and

(ii) identify the person, agency or organization identified in the approved treatment plan as responsible for supervising the implementation and maintenance of the plan and direct such responsible party to perform such function and to inform the court of any change in circumstance impacting the availability to the assisted outpatient of any treatment or service included in the plan.

(c) A court may order only that portion of the treatment plan submitted pursuant to section 7A which, considering all available alternatives for treatment, it determines appropriate and the least restrictive of any alternative treatment available.

(d) If the court finds by clear and convincing evidence that the subject of the petition meets the criteria for assisted outpatient treatment, the court may order the director of appropriate treatment program to oversee such plan.

(e) The first order for assisted outpatient treatment shall not exceed 365 days and any subsequent order shall not exceed 365 days.

(f) If a court orders outpatient treatment pursuant to this section, all of the following will apply:

(1) During any period of the assisted outpatient treatment, if the court, on motion by the supervising mental health professional in charge of a patient's assisted outpatient treatment, determines that the assisted outpatient is not complying with the terms of the order and that the outpatient plan no longer remains appropriate, the court may enter an order amending its original order. The amended order may alter the outpatient treatment plan, or request an emergency evaluation to determine whether the failure to hospitalize such person would create a likelihood of serious harm.

(2) If an assisted outpatient refuses to comply with an amended outpatient plan, further amendments may be made as the court deems necessary, including the inpatient commitment of the assisted outpatient where the court finds that failure to hospitalize such person would create a likelihood of serious harm.

(3) If the court determines the person meets the standard for inpatient commitment and the assisted outpatient refuses to comply with an amended order, the court may authorize and direct a peace officer to take the assisted outpatient into protective custody and transport him to the agency specified for inpatient treatment.

(4) When reporting or being returned to a treatment facility for inpatient treatment pursuant to an amended order, the assisted outpatient shall retain all rights to judicial review and the right to counsel.

Section 8A½  . (a) Before commitment for assisted outpatient treatment, the respondent shall be provided with copies of the court order and a full explanation of the approved treatment plan. The approved treatment plan shall be filed with the court and the supervising mental health professional in charge of the respondent 's outpatient treatment.

(b) The supervising mental health professional shall require periodic reports, not more than every 30 days, concerning the condition of an assisted outpatient from any person, agency or organization assigned to supervise the assisted outpatient.

(c) The supervising mental health professional shall review the condition of an assisted outpatient at least once every 30 days.

(d) The supervising mental health professional may amend any part of the outpatient treatment plan during the course of commitment, subject to judicial review after notice to and objection of the assisted outpatient.

(e) The supervising mental health professional may, at any time during the course of the ordered outpatient treatment, petition the court for inpatient commitment of the assisted outpatient if, in the supervising mental health professional's judgment, the assisted outpatient has failed to comply with a term of the outpatient treatment plan and outpatient treatment no longer remains appropriate.

(f) The supervising mental health professional may, at any time, petition the court for termination of an assisted outpatient treatment order if the supervising mental health professional determines that assisted outpatient treatment is no longer the least restrictive appropriate treatment available.

(g) Nothing in this section shall prevent the supervising mental health professional from authorizing involuntary commitment and treatment in an emergency pursuant to section 12.

SECTION XXXX. Section 9 of said chapter 123, as so appearing, is hereby amended by adding the following sentence:- Any person may apply to the court stating his or her belief that an assisted outpatient no longer meets the criteria for assisted outpatient treatment pursuant to Section 7A.

SECTION XXXX. Said chapter 123 is further hereby amended by inserting after section 36C the following section:-

Section 36D.  The department, in collaboration with the department of public health, shall establish a comprehensive program of assisted outpatient treatment to increase the availability of mental health and other services that enhance community participation and improve the engagement, quality of life and satisfaction level of at-risk service recipients. The department shall: (i) create specific criteria to identify at-risk individuals and assess the necessity of assisted outpatient treatment and (ii) where necessary, develop a plan and seek an assisted outpatient treatment plan for at-risk individuals, including case management and other services the department deems necessary."

Additional co-sponsor(s) added to Amendment #13 to H4879

Assisted Outpatient Treatment for Severe Mental Illness