Lawrence is the Chair for Obermayer’s Health Care Law Department and Election Law Practice Group. Lawrence’s Health Care Law legal experience includes the representation of Pennsylvania County governments in Behavioral Health Managed...Read More by Author
Pennsylvania Legislature Exploring Court-Ordered Outpatient Treatment
The Pennsylvania legislature is currently considering legislation that would amend the Pennsylvania Mental Health Procedures Act (the “Act”) to provide for court-ordered outpatient treatment for those suffering from mental illness or other impairment covered by the Act. The legislation, known as House Bill 1233: A Better Standard for Outpatient Commitment for Persons with Serious Mental Illness (“HB 1233”), would allow for involuntary outpatient treatment where there is clear and convincing evidence that a person would benefit from it. If passed, HB 1233 would add Pennsylvania to a list of 46 other states that have established standards for court-ordered outpatient mental health treatment.
Currently, the Act only allows for involuntary inpatient treatment and only once the person being involuntarily admitted is a “clear and present danger” to themselves or others. Under the Act, “danger to self” can be found in any of the following circumstances:
- The person would be without the care, supervision, and assistance of others to satisfy his/her need for nourishment, personal or medical care, shelter or self-protection or safety and that death or serious physical debilitation would occur within 30 days unless treatment was provided;
- The person has attempted suicide or the person has made threats to commit suicide and committed acts in furtherance of the threats; or
- The person has mutilated himself/herself or the person has made threats to mutilate and committed acts in furtherance of the threats.
“Danger to others” can be shown by establishing that, “within the previous 30 days the person has inflicted or attempted to inflict serious bodily harm on another or has threatened serious bodily harm and has committed acts in furtherance of the threat to commit harm to another.” Under the Act, a person being involuntarily committed is entitled to a hearing to challenge the commitment.
HB 1233, which has been passed in the Pennsylvania House of Representatives and referred to the Health and Human Services Committee of the Senate, would establish a mechanism for the imposition of court-ordered outpatient treatment for those with a mental illness that does not yet rise to a level where the person presents a clear and present danger to themselves or others. Instead, if HB 1233 is signed into law, a court would be able to order “assisted outpatient treatment” for a person whose behavior, based on clear and convincing evidence, indicates all of the following conditions:
- The person is unlikely to survive safely in the community without supervision, based on a clinical determination;
- The person has a history of lack of voluntary adherence to treatment for mental illness and one of the following applies:
- At least twice within the 36 months prior to the filing of a petition seeking assisted outpatient treatment, the person’s failure to adhere to treatment has been a significant factor in necessitating involuntary inpatient hospitalization or receipt of services in a forensic or other mental health unit of a correctional facility…. or
- Within the 48 months prior to the filing of a petition seeking court-ordered assisted outpatient treatment, the person’s failure to adhere to treatment resulted in one or more acts of serious violent behavior toward others or himself or threats of, or attempts at, serious physical harm to others or himself….
- The person, as a result of the person’s mental illness, is unlikely to voluntarily participate in necessary treatment; and
- Based on the person’s treatment history and current behavior, the person is in need of treatment in order to prevent a relapse or deterioration that would be likely to result in substantial risk of harm to others or himself.
Under HB 1233, after a hearing to provide due process and a finding that these conditions are met, a court could order the person to undergo community psychiatric supportive treatment, medication assistance, individual or group therapy, financial services, housing services, and/or any other service prescribed to assist the patient.
HB 1233 would not modify the standard for involuntary inpatient treatment and the clear and present danger standard described above would still apply.
The Health Law Gurus will continue to monitor the status of HB 1233 as it makes its way through the legislative process.
For a copy of the legislation, as it is currently drafted, click here.