Title 36 Court-Ordered Evaluation and Treatment Self Study Module August 2011
Title 36 Introduction When are Title 36 rules used? If an individual will not consent to an evaluation or treatment, or does not have the mental capacity to consent, then the petition process (Title 36) can be initiated.
Title 36 Introduction Arizona laws that apply to or cover the Court-Ordered Evaluation and Treatment process are found in the Arizona Revised Statutes (A.R.S.) Title 36, Sections 504-544. This module will help you become familiar with these Statutes, as it explores the process of Court-Ordered Evaluation and Treatment. The Provider Manual also contains information on Court-Ordered Evaluation and Treatment in Section 3.18
Module Objectives After completing this module, learners should: • Understand the steps in the Court-Ordered Evaluation and Treatment process, including: • Who this process applies to • How this process is initiated; the two types of petitions • The steps in the evaluation and treatment process • What happens after the court orders treatment • Know their role in this process • Know where to access the relevant Statutes • Be able to identify available resources for additional information and assistance with the Title 36 process Let’s begin with an overview of Title 36…
Who can be petitioned for involuntary services? The individual meets these two criteria: 1) Must have a mental disorder: • Defined as follows: a substantial disorder of the person’s emotional processes, thought, cognition or memory. • excludes conditions which are primarily caused by drug abuse, alcoholism and mental retardation, unless person also has a mental disorder • excludes declining mental abilities that directly accompany impending death • excludes antisocial behavior patterns 2) The individual is unable, or unwilling to participate in treatment.
How the petition process begins • Any responsible individual may apply for a Court-Ordered Evaluation of a person who they believe meets one of the fourcommitment standards: • Danger to Self (DTS) • Danger to Others (DTO) • Persistently or Acutely Disabled (PAD) • Gravely Disabled (GD) • There are two types of Applications: • Emergency - Application for Emergency Admission for Evaluation • Non-emergency (Pre-petition screening) - Application for Involuntary Evaluation We’ll define the four commitment standards and then look more closely at the two types of Applications…
Danger to Self Definition: Behavior which, as a result of a mental disorder, constitutes a danger of inflicting serious physical harm upon oneself, including attempted suicide or the serious threat thereof, if the threat is such that, when considered in the light of its context and in light of the individual’s previous acts, it is substantially supportive of an expectation that the threat will be carried out. Behavior which, as a result of a mental disorder, will, without hospitalization, result in serious physical harm or serious illness to the person, except that this definition shall not include behavior which establishes only the condition of gravely disabled.
Danger to OthersDefinition: The judgment of a person who has a mental disorder is so impaired that he is unable to understand his need for treatment, and as a result of his mental disorder his continued behavior can reasonably be expected, on the basis of competent medical opinion, to result in serious physical harm.
Persistently or Acutely Disabled Definition: A severe mental disorder that meets all of the following criteria: • If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional or physical harm that significantly impairs judgment, reason, behavior or capacity to recognize reality. • Substantially impairs the person’s capacity to make an informed decision regarding treatment and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person. • Has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient and outpatient treatment.
Gravely Disabled Definition: A condition evidenced by behavior in which a person, as a result of a mental disorder, is likely to come to serious physical harm or serious illness because he is unable to provide for his basic physical needs.
Application for Emergency Admission for Evaluation (Emergency) • This process may be initiated by calling the Community-wide Crisis Line (520) 622-6000. • Person must have a mental disorder and is DTS or DTO. • Person with direct knowledge of the facts must complete the emergency application, on prescribed form. • Allows psychiatric or hospital facility to hold individual for up to 24 hours (excluding weekends and holidays). • Law enforcement can receive telephonic authorization from admitting physician to take to facility. • Law enforcement must have probable cause to believe, based upon personal observations, that individual is mentally ill and a DTS or DTO. • Law enforcement will typically be directed to take the person under Application to the Crisis Response Center.
Application for Involuntary Evaluation (Non-emergency) • Not imminently dangerous to self or others - Non-emergency. • Application may be filed by any responsible individual. • In Pima County (GSA 5), pre-petition screening conducted by Southern Arizona Mental Health Center (SAMHC)(520) 617-0043. • Screening agency (SAMHC) must perform screening within 48 hours and make a report. • The medical director at the screening agency decides whether there is sufficient evidence to support the allegations in the application. • If there is sufficient evidence, then the screening agency must prepare a petition for Court-Ordered Evaluation…
If the court agrees that there is sufficient evidence to warrant an involuntary evaluation, it will issue an Order for Evaluation. Otherwise, petition is dropped. Evaluations may be conducted inpatient or outpatient. Two Psychiatrists must evaluate within 72 hours of Petition for Evaluation being filed if patient is hospitalized. If outpatient, evaluations must be performed by the fourth day following the first appointment. Petition for Court-Ordered Evaluation is valid for 14 days if individual is not in the hospital. During the evaluation process, a patient may not be treated psychiatrically unless he consents, except that seclusion and mechanical or pharmacological restraints may be employed in the case of emergency for the safety of the person or others. Court-Ordered Evaluation This evaluation will determine if criteria are met for court-ordered treatment…
Is Court-Ordered Treatment Necessary? • No: • The evaluators find the person does not meet criteria under any of the commitment standards. The petition process is terminated. The person is discharged from the hospital if an inpatient. • The evaluators find the person is able to agree to voluntarily participate in treatment. The petition process is terminated. The person is discharged from the hospital if an inpatient. • Yes: • The evaluators find the person appears to meet criteria under one or more of the commitment standards. A Petition for Court-Ordered Treatment is filed, and a Title 36 court hearing is scheduled… Note: At every juncture from the filing of the application forward, the individual must be given the opportunity to consent to voluntary treatment - up until the Title 36 hearing. Let’s look at the hearing process…
Hearing must be held within 6 days of petition (excluding weekends and holidays). Patient must be personally served with petition. Patient has right to an attorney. Patient can testify. Patient has right to an independent evaluation by another psychiatrist or psychologist. Two psychiatrists and two acquaintance witnesses must testify. Rules of evidence apply. Burden of Proof - clear and convincing evidence. Court-Ordered Treatment Hearing Process
Court-Ordered Treatment Hearing Process Court-Ordered Outpatient Treatment Plan • Comprehensive Service Provider submits Court-Ordered Outpatient Treatment Plan at initial T-36 hearing: • Must be approved by CSP Medical Director, or physician designee • Submitted when inpatient and outpatient teams agree to discharge plan • When the Court-Ordered outpatient Treatment Plan is signed by the Judge, member is able to be discharged from the hospital. • Member can appeal the services in the treatment plan through the appeals process at CPSA. However, the member cannot appeal the court order itself with CPSA. • Revisions to the Court-Ordered Outpatient Treatment Plan are made on the client’s Individual Service Plan (ISP): • Not submitted to court after initial hearing; kept in clinical record • Submitted to court when there is a request to change venue (member moved to another county) or there is a request to change supervising agency
If the Court decides a person meets the standards for commitment, it will find one of two things: Court-Ordered Treatment is necessary and the patient is to remain in the hospital until the inpatient treatment team believes the patient is ready for discharge Court-Ordered Treatment is necessary, but the person is well enough to begin the outpatient portion of the court order. The person is discharged if inpatient. The Court-Ordered period of treatment may not exceed 365 days. The order may include inpatient treatment only or a combination of inpatient and outpatient treatment. Court-Ordered Treatment Hearing Process
Post Court-Ordered Treatment Once Court-Ordered Treatment has been established your role in the post court ordered treatment process will include: • Revocations • Judicial Review • Terminations • Rollovers Let’s examine each of these…
Revocations If patient fails to comply with treatment plan or needs to be hospitalized, medical director can rescind outpatient treatment. Request can be telephonic (emergent), or written (non emergent): Emergent - telephonic: Agreement must be obtained from the inpatient facility psychiatrist by the outpatient psychiatrist. The outpatient psychiatrist provides verbal authorization to law officer allowing transport of client/member to the inpatient facility. Following admission, revocation paperwork must be submitted no later than the next working day following the admission. The hospital may detain the individual for a period of no more than 48 hrs. Non-emergent - written: A Law Enforcement Committal Information Form and Request for Revocation of Outpatient Treatment Plan is required Documents must be signed by the outpatient psychiatrist. The individual must be informed of right to judicial review and right to legal counsel. If revocation has been filed and member agrees to participate in services on a voluntary basis, the revocation can be quashed.
Judicial Reviews Every 60 days and upon revocation you must inform the member of his/her right to request the court to review his/her case. Court requires sufficient clinical information to render a decision. Psychiatrist progress note or written evaluation that discusses current symptoms, willingness to participate in services and insight/judgment regarding mental illness Hearing can be requested by the Judge or the Defense Attorney.
Termination The court order can be terminated early if the following apply: The member has developed insight, engages with treatment on a voluntary basis, and is compliant with treatment. There is a change in diagnosis to the exclusions listed earlier. The member has requested to move out of state; move is in the best interest of the member and ongoing treatment has been coordinated. Court requires sufficient clinical information to render a decision.
Rollovers This process only applies to Persistently or Acutely Disabled (PAD) and Gravely Disabled (GD) orders. Order may be renewed through the filing of a request for an annual examination and review, which includes the written opinion of the psychiatrist. For GD and PAD, an annual examination must be completed regardless if a request to extend the order will be submitted. An Adult Recovery Team Meeting must be conducted and documented in the clinical record. A hearing is only conducted if requested by the Judge or the Defense Attorney.
Where do I go to file T-36 paperwork? • Emergency Application: Crisis Response Center • Pre-Petition: SAMHC • Original Outpatient Court-Ordered Treatment Plan: T-36 Hearing • Any paperwork following the court order: CPSA Broadway Office Kathleen Dostalik, Esq. 4575 E. Broadway Blvd. Tucson, AZ 85711 This includes: revocations, judicial reviews, request to terminate COT, Quash Request to Revoke, Rollovers, original treatment if not submitted at original T-36 hearing, status reports, request to change venue, etc. Questions? Call the CPSA T-36 Coordinator: 901-2300
T-36 Summary This module has familiarized you with the Title 36 process, Court-Ordered (Involuntary) Evaluation and Treatment: • When this process is utilized. • The steps in the process: • Application and Petition for Court-Ordered Evaluation • Court-Ordered Evaluation • Court-Ordered Treatment • Post Court-Ordered Treatment • Where paperwork is filed and who to contact with questions or for assistance. Please complete the Post Test / Final Exam at this time