Outpatient Services Programs Workgroup: Dangerousness Standard and Training August 8, 2014

1. Outpatient Services Programs Workgroup: Dangerousness Standard and TrainingAugust 8, 2014

2. Continuity of Care Workgroup • Anecdotal data suggested that while the language of the dangerousness standard is clear, its application in the field varies widely, both with regard to emergency petitions and civil commitment

3. Legislative charge – SB882, §(a) To clarify and remedy this, the legislature has required the Department to convene a stakeholder workgroup to (among other things)… • evaluate the dangerousness standard for involuntary admissions and emergency evaluations of individuals with mental disorders, including: • how the standard should be clarified in statute or in regulations adopted by the Department; and • initiatives the Department should adopt and implement to promote the appropriate and consistent application of the standard by health care professionals, administrative law judges, the Office of the Public Defender, consumers, and other individuals.

4. Proposed language “Danger to the life or safety of the individual or of others" means, in consideration of the individual's current condition and, if available, personal and medical history, that: • There is a substantial risk that the individual will cause harm to the person or others if admission is not ordered; or • The individual so lacks the ability to care for himself or herself that there is a substantial risk of death or serious bodily injury if admission is not ordered.

5. Training content: How to apply the standard in civil cases: Define the highlighted terms “Dangerto the life or safety of the individual or of others” means, in consideration of the individual's current condition and, if available, personal and medical history, that: • There is a substantial risk that the individual will cause harm to the person or othersif admission is not ordered; or • The individual so lacks the ability to care for himself or herselfthat there is a substantial risk of death or serious bodily injuryif admission is not ordered. Standards of proof: • EP: probable cause • Commitment: clear and convincing evidence

6. Possible training techniques/technology • Case-based training • Modules designed for specific audiences (see next slide) • Webinars for self-paced training • Pre-test/post-test • New employee training • Periodic inservice training

7. Training needs Buy-in needed • EMS and Law Enforcement • MD Hospital Association • MPS/MPA/NASW-MD/etc • MD Hospital Assn/MHA/UMD and JHU training programs • OAH • OPD • First responders • Emergency department clinicians • Mental health clinicians • Inpatient psychiatric staff • Hospital presenters • Administrative law judges • Public defenders