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8 LONG TITLE
9 General Description:
10 This bill creates a process for the provision of assisted outpatient treatment for an
11 individual with mental illness.
12 Highlighted Provisions:
13 This bill:
14 ▸ defines "assisted outpatient treatment";
15 ▸ describes the services provided to an individual receiving assisted outpatient
16 treatment;
17 ▸ describes the process whereby an individual is court ordered to receive assisted
18 outpatient treatment;
19 ▸ requires a designated examiner to consider assisted outpatient treatment when
20 evaluating a proposed patient for civil commitment; and
21 ▸ makes technical changes.
22 Money Appropriated in this Bill:
23 None
24 Other Special Clauses:
25 None
26 Utah Code Sections Affected:
27 AMENDS:
28 17-43-301, as last amended by Laws of Utah 2018, Chapters 68 and 407
29 62A-15-602, as last amended by Laws of Utah 2018, Chapter 322
30 62A-15-618, as renumbered and amended by Laws of Utah 2002, Fifth Special Session,
31 Chapter 8
32 62A-15-631, as last amended by Laws of Utah 2018, Chapter 322
33 62A-15-703, as last amended by Laws of Utah 2018, Chapter 322
34 ENACTS:
35 31A-22-650, Utah Code Annotated 1953
36 62A-15-630.4, Utah Code Annotated 1953
37 62A-15-630.5, Utah Code Annotated 1953
38
39 Be it enacted by the Legislature of the state of Utah:
40 Section 1. Section 17-43-301 is amended to read:
41 17-43-301. Local mental health authorities -- Responsibilities.
42 (1) As used in this section:
43 (a) "Assisted outpatient treatment" means the same as that term is defined in Section
44 62A-15-602.
45 [
46 62A-15-1301.
47 [
48 Section 63C-18-102.
49 [
50 58-60-102.
51 [
52 [
53 Section 63C-18-102.
54 (2) (a) (i) In each county operating under a county executive-council form of
55 government under Section 17-52a-203, the county legislative body is the local mental health
56 authority, provided however that any contract for plan services shall be administered by the
57 county executive.
58 (ii) In each county operating under a council-manager form of government under
59 Section 17-52a-204, the county manager is the local mental health authority.
60 (iii) In each county other than a county described in Subsection (2)(a)(i) or (ii), the
61 county legislative body is the local mental health authority.
62 (b) Within legislative appropriations and county matching funds required by this
63 section, under the direction of the division, each local mental health authority shall:
64 (i) provide mental health services to [
65 (ii) cooperate with efforts of the Division of Substance Abuse and Mental Health to
66 promote integrated programs that address an individual's substance abuse, mental health, and
67 physical healthcare needs, as described in Section 62A-15-103.
68 (c) Within legislative appropriations and county matching funds required by this
69 section, each local mental health authority shall cooperate with the efforts of the Department of
70 Human Services to promote a system of care, as defined in Section 62A-1-104, for minors with
71 or at risk for complex emotional and behavioral needs, as described in Section 62A-1-111.
72 (3) (a) By executing an interlocal agreement under Title 11, Chapter 13, Interlocal
73 Cooperation Act, two or more counties may join to:
74 (i) provide mental health prevention and treatment services; or
75 (ii) create a united local health department that combines substance abuse treatment
76 services, mental health services, and local health department services in accordance with
77 Subsection (4).
78 (b) The legislative bodies of counties joining to provide services may establish
79 acceptable ways of apportioning the cost of mental health services.
80 (c) Each agreement for joint mental health services shall:
81 (i) (A) designate the treasurer of one of the participating counties or another person as
82 the treasurer for the combined mental health authorities and as the custodian of money
83 available for the joint services; and
84 (B) provide that the designated treasurer, or other disbursing officer authorized by the
85 treasurer, may make payments from the money available for the joint services upon audit of the
86 appropriate auditing officer or officers representing the participating counties;
87 (ii) provide for the appointment of an independent auditor or a county auditor of one of
88 the participating counties as the designated auditing officer for the combined mental health
89 authorities;
90 (iii) (A) provide for the appointment of the county or district attorney of one of the
91 participating counties as the designated legal officer for the combined mental health
92 authorities; and
93 (B) authorize the designated legal officer to request and receive the assistance of the
94 county or district attorneys of the other participating counties in defending or prosecuting
95 actions within their counties relating to the combined mental health authorities; and
96 (iv) provide for the adoption of management, clinical, financial, procurement,
97 personnel, and administrative policies as already established by one of the participating
98 counties or as approved by the legislative body of each participating county or interlocal board.
99 (d) An agreement for joint mental health services may provide for:
100 (i) joint operation of services and facilities or for operation of services and facilities
101 under contract by one participating local mental health authority for other participating local
102 mental health authorities; and
103 (ii) allocation of appointments of members of the mental health advisory council
104 between or among participating counties.
105 (4) A county governing body may elect to combine the local mental health authority
106 with the local substance abuse authority created in Part 2, Local Substance Abuse Authorities,
107 and the local health department created in Title 26A, Chapter 1, Part 1, Local Health
108 Department Act, to create a united local health department under Section 26A-1-105.5. A local
109 mental health authority that joins with a united local health department shall comply with this
110 part.
111 (5) (a) Each local mental health authority is accountable to the department, the
112 Department of Health, and the state with regard to the use of state and federal funds received
113 from those departments for mental health services, regardless of whether the services are
114 provided by a private contract provider.
115 (b) Each local mental health authority shall comply, and require compliance by its
116 contract provider, with all directives issued by the department and the Department of Health
117 regarding the use and expenditure of state and federal funds received from those departments
118 for the purpose of providing mental health programs and services. The department and
119 Department of Health shall ensure that those directives are not duplicative or conflicting, and
120 shall consult and coordinate with local mental health authorities with regard to programs and
121 services.
122 (6) (a) Each local mental health authority shall:
123 (i) review and evaluate mental health needs and services, including mental health needs
124 and services for [
125 (A) an individual incarcerated in a county jail or other county correctional facility; and
126 (B) an individual who is a resident of the county and who is court ordered to receive
127 assisted outpatient treatment under Section 62A-15-630.5;
128 (ii) in accordance with Subsection (6)(b), annually prepare and submit to the division a
129 plan approved by the county legislative body for mental health funding and service delivery,
130 either directly by the local mental health authority or by contract;
131 (iii) establish and maintain, either directly or by contract, programs licensed under Title
132 62A, Chapter 2, Licensure of Programs and Facilities;
133 (iv) appoint, directly or by contract, a full-time or part-time director for mental health
134 programs and prescribe the director's duties;
135 (v) provide input and comment on new and revised rules established by the division;
136 (vi) establish and require contract providers to establish administrative, clinical,
137 personnel, financial, procurement, and management policies regarding mental health services
138 and facilities, in accordance with the rules of the division, and state and federal law;
139 (vii) establish mechanisms allowing for direct citizen input;
140 (viii) annually contract with the division to provide mental health programs and
141 services in accordance with the provisions of Title 62A, Chapter 15, Substance Abuse and
142 Mental Health Act;
143 (ix) comply with all applicable state and federal statutes, policies, audit requirements,
144 contract requirements, and any directives resulting from those audits and contract requirements;
145 (x) provide funding equal to at least 20% of the state funds that it receives to fund
146 services described in the plan;
147 (xi) comply with the requirements and procedures of Title 11, Chapter 13, Interlocal
148 Cooperation Act, Title 17B, Chapter 1, Part 6, Fiscal Procedures for Local Districts, and Title
149 51, Chapter 2a, Accounting Reports from Political Subdivisions, Interlocal Organizations, and
150 Other Local Entities Act; and
151 (xii) take and retain physical custody of minors committed to the physical custody of
152 local mental health authorities by a judicial proceeding under Title 62A, Chapter 15, Part 7,
153 Commitment of Persons Under Age 18 to Division of Substance Abuse and Mental Health.
154 (b) Each plan under Subsection (6)(a)(ii) shall include services for adults, youth, and
155 children, which shall include:
156 (i) inpatient care and services;
157 (ii) residential care and services;
158 (iii) outpatient care and services;
159 (iv) 24-hour crisis care and services;
160 (v) psychotropic medication management;
161 (vi) psychosocial rehabilitation, including vocational training and skills development;
162 (vii) case management;
163 (viii) community supports, including in-home services, housing, family support
164 services, and respite services;
165 (ix) consultation and education services, including case consultation, collaboration
166 with other county service agencies, public education, and public information; and
167 (x) services to persons incarcerated in a county jail or other county correctional facility.
168 (7) (a) If a local mental health authority provides for a local mental health crisis line
169 under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the local
170 mental health authority shall:
171 (i) collaborate with the statewide mental health crisis line described in Section
172 62A-15-1302;
173 (ii) ensure that each individual who answers calls to the local mental health crisis line:
174 (A) is a mental health therapist or a crisis worker; and
175 (B) meets the standards of care and practice established by the Division of Substance
176 Abuse and Mental Health, in accordance with Section 62A-15-1302; and
177 (iii) ensure that when necessary, based on the local mental health crisis line's capacity,
178 calls are immediately routed to the statewide mental health crisis line to ensure that when an
179 individual calls the local mental health crisis line, regardless of the time, date, or number of
180 individuals trying to simultaneously access the local mental health crisis line, a mental health
181 therapist or a crisis worker answers the call without the caller first:
182 (A) waiting on hold; or
183 (B) being screened by an individual other than a mental health therapist or crisis
184 worker.
185 (b) If a local mental health authority does not provide for a local mental health crisis
186 line under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the
187 local mental health authority shall use the statewide mental health crisis line as a local crisis
188 line resource.
189 (8) Before disbursing any public funds, each local mental health authority shall require
190 that each entity that receives any public funds from a local mental health authority agrees in
191 writing that:
192 (a) the entity's financial records and other records relevant to the entity's performance
193 of the services provided to the mental health authority shall be subject to examination by:
194 (i) the division;
195 (ii) the local mental health authority director;
196 (iii) (A) the county treasurer and county or district attorney; or
197 (B) if two or more counties jointly provide mental health services under an agreement
198 under Subsection (3), the designated treasurer and the designated legal officer;
199 (iv) the county legislative body; and
200 (v) in a county with a county executive that is separate from the county legislative
201 body, the county executive;
202 (b) the county auditor may examine and audit the entity's financial and other records
203 relevant to the entity's performance of the services provided to the local mental health
204 authority; and
205 (c) the entity will comply with the provisions of Subsection (5)(b).
206 (9) A local mental health authority may receive property, grants, gifts, supplies,
207 materials, contributions, and any benefit derived therefrom, for mental health services. If those
208 gifts are conditioned upon their use for a specified service or program, they shall be so used.
209 (10) Public funds received for the provision of services pursuant to the local mental
210 health plan may not be used for any other purpose except those authorized in the contract
211 between the local mental health authority and the provider for the provision of plan services.
212 (11) A local mental health authority shall provide assisted outpatient treatment
213 services, as described in Section 62A-15-630.4, to a resident of the county who has been
214 ordered under Section 62A-15-630.5 to receive assisted outpatient treatment.
215 Section 2. Section 31A-22-650 is enacted to read:
216 31A-22-650. Insurance coverage for assisted outpatient treatment.
217 (1) As used in this section, "assisted outpatient treatment" means the same as that term
218 is defined in Section 62A-15-602.
219 (2) A health insurance provider may not deny an insured the benefits of the insured's
220 policy solely because the health care that the insured receives is provided under a court order
221 for assisted outpatient treatment, as provided in Section 62A-15-630.5.
222 Section 3. Section 62A-15-602 is amended to read:
223 62A-15-602. Definitions.
224 As used in this part, Part 7, Commitment of Persons Under Age 18 to Division of
225 Substance Abuse and Mental Health, Part 8, Interstate Compact on Mental Health, Part 9, Utah
226 Forensic Mental Health Facility, Part 10, Declaration for Mental Health Treatment, and Part
227 12, Essential Treatment and Intervention Act:
228 (1) "Adult" means an individual 18 years of age or older.
229 (2) "Approved treatment facility or program" means a treatment provider that meets the
230 standards described in Subsection 62A-15-103(2)(a)(v).
231 (3) "Assisted outpatient treatment" means involuntary outpatient mental health
232 treatment ordered under Section 62A-15-630.5.
233 [
234 adult is committed to the custody of the local mental health authority that governs the mental
235 health catchment area where the adult resides or is found.
236 [
237 and services to a resident of a designated geographical area, that operates by or under contract
238 with a local mental health authority, and that complies with state standards for community
239 mental health centers.
240 [
241 (a) a licensed physician, preferably a psychiatrist, who is designated by the division as
242 specially qualified by training or experience in the diagnosis of mental or related illness; or
243 (b) a licensed mental health professional designated by the division as specially
244 qualified by training and who has at least five years' continual experience in the treatment of
245 mental illness.
246 [
247 including admission and discharge, an employee of a local mental health authority, or an
248 employee of a person that has contracted with a local mental health authority to provide mental
249 health services under Section 17-43-304.
250 [
251 court-ordered treatment at a local substance abuse authority or an approved treatment facility or
252 program for the treatment of an adult's substance use disorder.
253 [
254 without the individual's consent, including the nonconsensual circumstances described in
255 Subsections 76-5-406(1) through (12):
256 (a) sexual intercourse;
257 (b) penetration, however slight, of the genital or anal opening of the individual;
258 (c) any sexual act involving the genitals or anus of the actor or the individual and the
259 mouth or anus of either individual, regardless of the gender of either participant; or
260 (d) any sexual act causing substantial emotional injury or bodily pain.
261 [
262 26-21-8.
263 [
264 Section 62A-15-102 and described in Section 17-43-201.
265 [
266 provides mental health services under contract with the division, a local mental health
267 authority, a person that contracts with a local mental health authority, or a person that provides
268 acute inpatient psychiatric services to a patient.
269 [
270 mental health authority as qualified by training and experience in the recognition and
271 identification of mental illness, to:
272 (a) apply for and provide certification for a temporary commitment; or
273 (b) assist in the arrangement of transportation to a designated mental health facility.
274 [
275 (a) a psychiatric disorder that substantially impairs an individual's mental, emotional,
276 behavioral, or related functioning; or
277 (b) the same as that term is defined in:
278 (i) the current edition of the Diagnostic and Statistical Manual of Mental Disorders
279 published by the American Psychiatric Association; or
280 (ii) the current edition of the International Statistical Classification of Diseases and
281 Related Health Problems.
282 [
283 (a) under commitment to the custody or to the treatment services of a local mental
284 health authority; or
285 (b) undergoing essential treatment and intervention.
286 [
287 (a) licensed as a physician under Title 58, Chapter 67, Utah Medical Practice Act; or
288 (b) licensed as a physician under Title 58, Chapter 68, Utah Osteopathic Medical
289 Practice Act.
290 [
291 of death, unconsciousness, extreme physical pain, protracted and obvious disfigurement, or
292 protracted loss or impairment of the function of a bodily member, organ, or mental faculty.
293 [
294 serious risk of:
295 (a) suicide;
296 (b) serious bodily self-injury;
297 (c) serious bodily injury because the individual is incapable of providing the basic
298 necessities of life, including food, clothing, or shelter;
299 (d) causing or attempting to cause serious bodily injury to another individual; or
300 (e) engaging in harmful sexual conduct.
301 [
302 of psychotropic medication, or other medical treatments that are generally accepted medical or
303 psychosocial interventions for the purpose of restoring the patient to an optimal level of
304 functioning in the least restrictive environment.
305 Section 4. Section 62A-15-618 is amended to read:
306 62A-15-618. Designated examiners.
307 (1) A designated examiner, when evaluating a proposed patient for civil commitment,
308 shall consider whether:
309 (a) a proposed patient has been under a court order for assisted outpatient treatment;
310 (b) the proposed patient complied with the terms of the assisted outpatient treatment
311 order, if any; and
312 (c) whether assisted outpatient treatment is sufficient to meet the proposed patient's
313 needs.
314 (2) Designated examiners shall be allowed a reasonable fee by the county legislative
315 body of the county in which the proposed patient resides or is found, unless they are otherwise
316 paid.
317 Section 5. Section 62A-15-630.4 is enacted to read:
318 62A-15-630.4. Assisted outpatient treatment services.
319 (1) The local mental health authority or its designee shall provide assisted outpatient
320 treatment, which shall include:
321 (a) case management; and
322 (b) an individualized treatment plan, created with input from the proposed patient
323 when possible.
324 (2) A court order for assisted outpatient treatment does not create independent
325 authority to forcibly medicate a patient.
326 Section 6. Section 62A-15-630.5 is enacted to read:
327 62A-15-630.5. Assisted outpatient treatment proceedings.
328 (1) A responsible individual who has credible knowledge of an adult's mental illness
329 and the condition or circumstances that have led to the adult's need for assisted outpatient
330 treatment may file, in the district court in the county where the proposed patient resides or is
331 found, a written application that includes:
332 (a) unless the court finds that the information is not reasonably available, the proposed
333 patient's:
334 (i) name;
335 (ii) date of birth; and
336 (iii) social security number; and
337 (b) (i) a certificate of a licensed physician or a designated examiner stating that within
338 the seven-day period immediately preceding the certification, the physician or designated
339 examiner examined the proposed patient and is of the opinion that the proposed patient has a
340 mental illness and should be involuntarily committed; or
341 (ii) a written statement by the applicant that:
342 (A) the proposed patient has been requested to, but has refused to, submit to an
343 examination of mental condition by a licensed physician or designated examiner;
344 (B) is sworn to under oath; and
345 (C) states the facts upon which the application is based.
346 (2) (a) Subject to Subsection (2)(b), before issuing a judicial order, the court may
347 require the applicant to consult with the appropriate local mental health authority, and the court
348 may direct a mental health professional from that local mental health authority to interview the
349 applicant and the proposed patient to determine the existing facts and report them to the court.
350 (b) The consultation described in Subsection (2)(a):
351 (i) may take place at or before the hearing; and
352 (ii) is required if the local mental health authority appears at the hearing.
353 (3) If the proposed patient refuses to submit to an interview described in Subsection
354 (2)(a) or an examination described in Subsection (8), the court may issue an order, directed to a
355 mental health officer or peace officer, to immediately place the proposed patient into the
356 custody of a local mental health authority or in a temporary emergency facility, as provided in
357 Section 62A-15-634, to be detained for the purpose of examination.
358 (4) Notice of commencement of proceedings for assisted outpatient treatment, setting
359 forth the allegations of the application and any reported facts, together with a copy of any
360 official order of detention, shall:
361 (a) be provided by the court to a proposed patient before, or upon, placement into the
362 custody of a local mental health authority or, with respect to any proposed patient presently in
363 the custody of a local mental health authority;
364 (b) be maintained at the proposed patient's place of detention, if any;
365 (c) be provided by the court as soon as practicable to the applicant, any legal guardian,
366 any immediate adult family members, legal counsel for the parties involved, the local mental
367 health authority or its designee, and any other person whom the proposed patient or the court
368 shall designate; and
369 (d) advise that a hearing may be held within the time provided by law.
370 (5) The district court may, in its discretion, transfer the case to any other district court
371 within this state, provided that the transfer will not be adverse to the interest of the proposed
372 patient.
373 (6) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
374 of a judicial order, or after commitment of a proposed patient to a local mental health authority
375 or its designee under court order for detention in order to complete an examination, the court
376 shall appoint two designated examiners:
377 (a) who did not sign the assisted outpatient treatment application nor the certification
378 described in Subsection (1);
379 (b) one of whom is a licensed physician; and
380 (c) one of whom may be designated by the proposed patient or the proposed patient's
381 counsel, if that designated examiner is reasonably available.
382 (7) The court shall schedule a hearing to be held within 10 calendar days of the day on
383 which the designated examiners are appointed.
384 (8) The designated examiners shall:
385 (a) conduct their examinations separately;
386 (b) conduct the examinations at the home of the proposed patient, at a hospital or other
387 medical facility, or at any other suitable place that is not likely to have a harmful effect on the
388 proposed patient's health;
389 (c) inform the proposed patient, if not represented by an attorney:
390 (i) that the proposed patient does not have to say anything;
391 (ii) of the nature and reasons for the examination;
392 (iii) that the examination was ordered by the court;
393 (iv) that any information volunteered could form part of the basis for the proposed
394 patient to be ordered to receive assisted outpatient treatment; and
395 (v) that findings resulting from the examination will be made available to the court;
396 and
397 (d) within 24 hours of examining the proposed patient, report to the court, orally or in
398 writing, whether the proposed patient is mentally ill. If the designated examiner reports orally,
399 the designated examiner shall immediately send a written report to the clerk of the court.
400 (9) If a designated examiner is unable to complete an examination on the first attempt
401 because the proposed patient refuses to submit to the examination, the court shall fix a
402 reasonable compensation to be paid to the examiner.
403 (10) If the local mental health authority, its designee, or a medical examiner determines
404 before the court hearing that the conditions justifying the findings leading to an assisted
405 outpatient treatment hearing no longer exist, the local mental health authority, its designee, or
406 the medical examiner shall immediately report that determination to the court.
407 (11) The court may terminate the proceedings and dismiss the application at any time,
408 including prior to the hearing, if the designated examiners or the local mental health authority
409 or its designee informs the court that the proposed patient is not mentally ill.
410 (12) Before the hearing, an opportunity to be represented by counsel shall be afforded
411 to the proposed patient, and if neither the proposed patient nor others provide counsel, the court
412 shall appoint counsel and allow counsel sufficient time to consult with the proposed patient
413 before the hearing. In the case of an indigent proposed patient, the payment of reasonable
414 attorney fees for counsel, as determined by the court, shall be made by the county in which the
415 proposed patient resides or is found.
416 (13) (a) All persons to whom notice is required to be given shall be afforded an
417 opportunity to appear at the hearing, to testify, and to present and cross-examine witnesses. The
418 court may, in its discretion, receive the testimony of any other individual. The court may allow
419 a waiver of the proposed patient's right to appear only for good cause shown, and that cause
420 shall be made a matter of court record.
421 (b) The court is authorized to exclude all individuals not necessary for the conduct of
422 the proceedings and may, upon motion of counsel, require the testimony of each examiner to be
423 given out of the presence of any other examiners.
424 (c) The hearing shall be conducted in as informal a manner as may be consistent with
425 orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
426 mental health of the proposed patient.
427 (d) The court shall consider all relevant historical and material information that is
428 offered, subject to the rules of evidence, including reliable hearsay under Rule 1102, Utah
429 Rules of Evidence.
430 (e) (i) A local mental health authority or its designee, or the physician in charge of the
431 proposed patient's care shall, at the time of the hearing, provide the court with the following
432 information:
433 (A) the detention order, if any;
434 (B) admission notes, if any;
435 (C) the diagnosis, if any;
436 (D) doctor's orders, if any;
437 (E) progress notes, if any;
438 (F) nursing notes, if any; and
439 (G) medication records, if any.
440 (ii) The information described in Subsection (13)(e)(i) shall also be provided to the
441 proposed patient's counsel:
442 (A) at the time of the hearing; and
443 (B) at any time prior to the hearing, upon request.
444 (14) The court shall order a proposed patient to assisted outpatient treatment if, upon
445 completion of the hearing and consideration of the information presented, the court finds by
446 clear and convincing evidence that:
447 (a) the proposed patient has a mental illness;
448 (b) there is no appropriate less-restrictive alternative to a court order for assisted
449 outpatient treatment; and
450 (c) (i) the proposed patient lacks the ability to engage in a rational decision-making
451 process regarding the acceptance of mental health treatment, as demonstrated by evidence of
452 inability to weigh the possible risks of accepting or rejecting treatment; or
453 (ii) the proposed patient needs assisted outpatient treatment in order to prevent relapse
454 or deterioration that is likely to result in the proposed patient posing a substantial danger to self
455 or others.
456 (15) The court may order the applicant or a close relative of the patient to be the
457 patient's personal representative, as described in 45 C.F.R. Sec. 164.502(g), for purposes of the
458 patient's mental health treatment.
459 (16) In the absence of the findings described in Subsection (14), the court, after the
460 hearing, shall dismiss the proceedings.
461 (17) (a) The assisted outpatient treatment order shall designate the period for which the
462 patient shall be treated, which may not exceed six months without a review hearing.
463 (b) An individual identified under Subsection (4) may request a review hearing at any
464 time while the assisted outpatient treatment order is in effect.
465 (c) At a review hearing, the court may extend the duration of an assisted outpatient
466 treatment order by up to six months, if:
467 (i) the court finds by clear and convincing evidence that the patient meets the
468 conditions described in Subsection (14); or
469 (ii) (A) the patient does not appear at the review hearing; and
470 (B) notice of the review hearing was provided to the patient's last known address by the
471 applicant described in Subsection (1) or by a local mental health authority.
472 (d) The court shall maintain a current list of all patients under its order of assisted
473 outpatient treatment.
474 (e) At least two weeks prior to the expiration of the designated period of any assisted
475 outpatient treatment order still in effect, the court that entered the original order shall inform
476 the appropriate local mental health authority or its designee.
477 (18) Costs of all proceedings under this section shall be paid by the county in which the
478 proposed patient resides or is found.
479 (19) A court may not hold an individual in contempt for failure to comply with an
480 assisted outpatient treatment order.
481 (20) As provided in Section 31A-22-650, a health insurance provider may not deny an
482 insured the benefits of the insured's policy solely because the health care that the insured
483 receives is provided under a court order for assisted outpatient treatment.
484 Section 7. Section 62A-15-631 is amended to read:
485 62A-15-631. Involuntary commitment under court order -- Examination --
486 Hearing -- Power of court -- Findings required -- Costs.
487 (1) A responsible [
488 an adult's mental illness and the condition or circumstances that have led to the adult's need to
489 be involuntarily committed may initiate an involuntary commitment court proceeding by filing,
490 in the district court in the county where the proposed patient resides or is found, a written
491 application that includes:
492 (a) unless the court finds that the information is not reasonably available, the proposed
493 patient's:
494 (i) name;
495 (ii) date of birth; and
496 (iii) social security number; [
497 (b) (i) a certificate of a licensed physician or a designated examiner stating that within
498 the seven-day period immediately preceding the certification, the physician or designated
499 examiner examined the proposed patient and is of the opinion that the proposed patient has a
500 mental illness and should be involuntarily committed; or
501 (ii) a written statement by the applicant that:
502 (A) the proposed patient has been requested to, but has refused to, submit to an
503 examination of mental condition by a licensed physician or designated examiner;
504 (B) is sworn to under oath; and
505 (C) states the facts upon which the application is based[
506 (c) a statement whether the proposed patient has previously been under an assisted
507 outpatient treatment order, if known by the applicant.
508 (2) (a) Subject to Subsection (2)(b), before issuing a judicial order, the court may
509 require the applicant to consult with the appropriate local mental health authority, and the court
510 may direct a mental health professional from that local mental health authority to interview the
511 applicant and the proposed patient to determine the existing facts and report them to the court.
512 (b) The consultation described in Subsection (2)(a):
513 (i) may take place at or before the hearing; and
514 (ii) is required if the local mental health authority appears at the hearing.
515 (3) If the court finds from the application, from any other statements under oath, or
516 from any reports from a mental health professional that there is a reasonable basis to believe
517 that the proposed patient has a mental illness that poses a substantial danger to self or others
518 requiring involuntary commitment pending examination and hearing; or, if the proposed patient
519 has refused to submit to an interview with a mental health professional as directed by the court
520 or to go to a treatment facility voluntarily, the court may issue an order, directed to a mental
521 health officer or peace officer, to immediately place the proposed patient in the custody of a
522 local mental health authority or in a temporary emergency facility as provided in Section
523 62A-15-634 to be detained for the purpose of examination.
524 (4) Notice of commencement of proceedings for involuntary commitment, setting forth
525 the allegations of the application and any reported facts, together with a copy of any official
526 order of detention, shall be provided by the court to a proposed patient before, or upon,
527 placement in the custody of a local mental health authority or, with respect to any proposed
528 patient presently in the custody of a local mental health authority whose status is being changed
529 from voluntary to involuntary, upon the filing of an application for that purpose with the court.
530 A copy of that order of detention shall be maintained at the place of detention.
531 (5) Notice of commencement of those proceedings shall be provided by the court as
532 soon as practicable to the applicant, any legal guardian, any immediate adult family members,
533 legal counsel for the parties involved, the local mental health authority or its designee, and any
534 other persons whom the proposed patient or the court shall designate. That notice shall advise
535 those persons that a hearing may be held within the time provided by law. If the proposed
536 patient has refused to permit release of information necessary for provisions of notice under
537 this subsection, the extent of notice shall be determined by the court.
538 (6) Proceedings for commitment of an individual under the age of 18 years to a local
539 mental health authority may be commenced in accordance with Part 7, Commitment of Persons
540 Under Age 18 to Division of Substance Abuse and Mental Health.
541 (7) The district court may, in its discretion, transfer the case to any other district court
542 within this state, provided that the transfer will not be adverse to the interest of the proposed
543 patient.
544 (8) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
545 of a judicial order, or after commitment of a proposed patient to a local mental health authority
546 or its designee under court order for detention or examination, the court shall appoint two
547 designated examiners:
548 (a) who did not sign the civil commitment application nor the civil commitment
549 certification under Subsection (1);
550 (b) one of whom is a licensed physician; and
551 (c) one of whom may be designated by the proposed patient or the proposed patient's
552 counsel, if that designated examiner is reasonably available.
553 (9) The court shall schedule a hearing to be held within 10 calendar days of the day on
554 which the designated examiners are appointed.
555 (10) The designated examiners shall:
556 (a) conduct their examinations separately;
557 (b) conduct the examinations at the home of the proposed patient, at a hospital or other
558 medical facility, or at any other suitable place that is not likely to have a harmful effect on the
559 proposed patient's health;
560 (c) inform the proposed patient, if not represented by an attorney:
561 (i) that the proposed patient does not have to say anything;
562 (ii) of the nature and reasons for the examination;
563 (iii) that the examination was ordered by the court;
564 (iv) that any information volunteered could form part of the basis for the proposed
565 patient's involuntary commitment; and
566 (v) that findings resulting from the examination will be made available to the court;
567 and
568 (d) within 24 hours of examining the proposed patient, report to the court, orally or in
569 writing, whether the proposed patient is mentally ill, has agreed to voluntary commitment, as
570 described in Section 62A-15-625, or has acceptable programs available to the proposed patient
571 without court proceedings. If the designated examiner reports orally, the designated examiner
572 shall immediately send a written report to the clerk of the court.
573 (11) If a designated examiner is unable to complete an examination on the first attempt
574 because the proposed patient refuses to submit to the examination, the court shall fix a
575 reasonable compensation to be paid to the examiner.
576 (12) If the local mental health authority, its designee, or a medical examiner determines
577 before the court hearing that the conditions justifying the findings leading to a commitment
578 hearing no longer exist, the local mental health authority, its designee, or the medical examiner
579 shall immediately report that determination to the court.
580 (13) The court may terminate the proceedings and dismiss the application at any time,
581 including prior to the hearing, if the designated examiners or the local mental health authority
582 or its designee informs the court that the proposed patient:
583 (a) is not mentally ill;
584 (b) has agreed to voluntary commitment, as described in Section 62A-15-625; or
585 (c) has acceptable options for treatment programs that are available without court
586 proceedings.
587 (14) Before the hearing, an opportunity to be represented by counsel shall be afforded
588 to [
589 the court shall appoint counsel and allow counsel sufficient time to consult with the proposed
590 patient before the hearing. In the case of an indigent proposed patient, the payment of
591 reasonable attorney fees for counsel, as determined by the court, shall be made by the county in
592 which the proposed patient resides or is found.
593 (15) (a) The proposed patient, the applicant, and all other persons to whom notice is
594 required to be given shall be afforded an opportunity to appear at the hearing, to testify, and to
595 present and cross-examine witnesses. The court may, in its discretion, receive the testimony of
596 any other person. The court may allow a waiver of the proposed patient's right to appear only
597 for good cause shown, and that cause shall be made a matter of court record.
598 (b) The court is authorized to exclude all persons not necessary for the conduct of the
599 proceedings and may, upon motion of counsel, require the testimony of each examiner to be
600 given out of the presence of any other examiners.
601 (c) The hearing shall be conducted in as informal a manner as may be consistent with
602 orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
603 mental health of the proposed patient.
604 (d) The court shall consider all relevant historical and material information that is
605 offered, subject to the rules of evidence, including reliable hearsay under Rule 1102, Utah
606 Rules of Evidence.
607 (e) (i) A local mental health authority or its designee, or the physician in charge of the
608 proposed patient's care shall, at the time of the hearing, provide the court with the following
609 information:
610 (A) the detention order;
611 (B) admission notes;
612 (C) the diagnosis;
613 (D) any doctors' orders;
614 (E) progress notes;
615 (F) nursing notes; [
616 (G) medication records pertaining to the current commitment[
617 (H) whether the proposed patient has previously been civilly committed or under an
618 order for assisted outpatient treatment.
619 (ii) That information shall also be supplied to the proposed patient's counsel at the time
620 of the hearing, and at any time prior to the hearing upon request.
621 (16) The court shall order commitment of a proposed patient who is 18 years of age or
622 older to a local mental health authority if, upon completion of the hearing and consideration of
623 the information presented in accordance with Subsection (15)(d), the court finds by clear and
624 convincing evidence that:
625 (a) the proposed patient has a mental illness;
626 (b) because of the proposed patient's mental illness the proposed patient poses a
627 substantial danger to self or others;
628 (c) the proposed patient lacks the ability to engage in a rational decision-making
629 process regarding the acceptance of mental treatment as demonstrated by evidence of inability
630 to weigh the possible risks of accepting or rejecting treatment;
631 (d) there is no appropriate less-restrictive alternative to a court order of commitment;
632 and
633 (e) the local mental health authority can provide the proposed patient with treatment
634 that is adequate and appropriate to the proposed patient's conditions and needs. In the absence
635 of the required findings of the court after the hearing, the court shall dismiss the proceedings.
636 (17) (a) The order of commitment shall designate the period for which the patient shall
637 be treated. When the patient is not under an order of commitment at the time of the hearing,
638 that period may not exceed six months without benefit of a review hearing. Upon such a
639 review hearing, to be commenced prior to the expiration of the previous order, an order for
640 commitment may be for an indeterminate period, if the court finds by clear and convincing
641 evidence that the required conditions in Subsection (16) will last for an indeterminate period.
642 (b) The court shall maintain a current list of all patients under its order of commitment.
643 That list shall be reviewed to determine those patients who have been under an order of
644 commitment for the designated period. At least two weeks prior to the expiration of the
645 designated period of any order of commitment still in effect, the court that entered the original
646 order shall inform the appropriate local mental health authority or its designee. The local
647 mental health authority or its designee shall immediately reexamine the reasons upon which the
648 order of commitment was based. If the local mental health authority or its designee determines
649 that the conditions justifying that commitment no longer exist, it shall discharge the patient
650 from involuntary commitment and immediately report the discharge to the court. Otherwise,
651 the court shall immediately appoint two designated examiners and proceed under Subsections
652 (8) through (14).
653 (c) The local mental health authority or its designee responsible for the care of a patient
654 under an order of commitment for an indeterminate period shall, at six-month intervals,
655 reexamine the reasons upon which the order of indeterminate commitment was based. If the
656 local mental health authority or its designee determines that the conditions justifying that
657 commitment no longer exist, that local mental health authority or its designee shall discharge
658 the patient from its custody and immediately report the discharge to the court. If the local
659 mental health authority or its designee determines that the conditions justifying that
660 commitment continue to exist, the local mental health authority or its designee shall send a
661 written report of those findings to the court. The patient and the patient's counsel of record
662 shall be notified in writing that the involuntary commitment will be continued, the reasons for
663 that decision, and that the patient has the right to a review hearing by making a request to the
664 court. Upon receiving the request, the court shall immediately appoint two designated
665 examiners and proceed under Subsections (8) through (14).
666 (18) Any patient committed as a result of an original hearing or a patient's legally
667 designated representative who is aggrieved by the findings, conclusions, and order of the court
668 entered in the original hearing has the right to a new hearing upon a petition filed with the court
669 within 30 days of the entry of the court order. The petition must allege error or mistake in the
670 findings, in which case the court shall appoint three impartial designated examiners previously
671 unrelated to the case to conduct an additional examination of the patient. The new hearing
672 shall, in all other respects, be conducted in the manner otherwise permitted.
673 (19) Costs of all proceedings under this section shall be paid by the county in which the
674 proposed patient resides or is found.
675 Section 8. Section 62A-15-703 is amended to read:
676 62A-15-703. Residential and inpatient settings -- Commitment proceeding --
677 Child in physical custody of local mental health authority.
678 (1) A child may receive services from a local mental health authority in an inpatient or
679 residential setting only after a commitment proceeding, for the purpose of transferring physical
680 custody, has been conducted in accordance with the requirements of this section.
681 (2) That commitment proceeding shall be initiated by a petition for commitment, and
682 shall be a careful, diagnostic inquiry, conducted by a neutral and detached fact finder, pursuant
683 to the procedures and requirements of this section. If the findings described in Subsection (4)
684 exist, the proceeding shall result in the transfer of physical custody to the appropriate local
685 mental health authority, and the child may be placed in an inpatient or residential setting.
686 (3) The neutral and detached fact finder who conducts the inquiry:
687 (a) shall be a designated examiner, as defined in Section 62A-15-602; and
688 (b) may not profit, financially or otherwise, from the commitment or physical
689 placement of the child in that setting.
690 (4) Upon determination by a fact finder that the following circumstances clearly exist,
691 the fact finder may order that the child be committed to the physical custody of a local mental
692 health authority:
693 (a) the child has a mental illness, as defined in [
694 (b) the child demonstrates a reasonable fear of the risk of substantial danger to self or
695 others;
696 (c) the child will benefit from care and treatment by the local mental health authority;
697 and
698 (d) there is no appropriate less-restrictive alternative.
699 (5) (a) The commitment proceeding before the neutral and detached fact finder shall be
700 conducted in as informal manner as possible and in a physical setting that is not likely to have a
701 harmful effect on the child.
702 (b) The child, the child's parent or legal guardian, the petitioner, and a representative of
703 the appropriate local mental health authority:
704 (i) shall receive informal notice of the date and time of the proceeding; and
705 (ii) may appear and address the petition for commitment.
706 (c) The neutral and detached fact finder may, in the fact finder's discretion, receive the
707 testimony of any other person.
708 (d) The fact finder may allow a child to waive the child's right to be present at the
709 commitment proceeding, for good cause shown. If that right is waived, the purpose of the
710 waiver shall be made a matter of record at the proceeding.
711 (e) At the time of the commitment proceeding, the appropriate local mental health
712 authority, its designee, or the psychiatrist who has been in charge of the child's care prior to the
713 commitment proceeding, shall provide the neutral and detached fact finder with the following
714 information, as it relates to the period of current admission:
715 (i) the petition for commitment;
716 (ii) the admission notes;
717 (iii) the child's diagnosis;
718 (iv) physicians' orders;
719 (v) progress notes;
720 (vi) nursing notes; and
721 (vii) medication records.
722 (f) The information described in Subsection (5)(e) shall also be provided to the child's
723 parent or legal guardian upon written request.
724 (g) (i) The neutral and detached fact finder's decision of commitment shall state the
725 duration of the commitment. Any commitment to the physical custody of a local mental health
726 authority may not exceed 180 days. Prior to expiration of the commitment, and if further
727 commitment is sought, a hearing shall be conducted in the same manner as the initial
728 commitment proceeding, in accordance with the requirements of this section.
729 (ii) At the conclusion of the hearing and subsequently in writing, when a decision for
730 commitment is made, the neutral and detached fact finder shall inform the child and the child's
731 parent or legal guardian of that decision and of the reasons for ordering commitment.
732 (iii) The neutral and detached fact finder shall state in writing the basis of the decision,
733 with specific reference to each of the criteria described in Subsection (4), as a matter of record.
734 (6) A child may be temporarily committed for a maximum of 72 hours, excluding
735 Saturdays, Sundays, and legal holidays, to the physical custody of a local mental health
736 authority in accordance with the procedures described in Section 62A-15-629 and upon
737 satisfaction of the risk factors described in Subsection (4). A child who is temporarily
738 committed shall be released at the expiration of the 72 hours unless the procedures and findings
739 required by this section for the commitment of a child are satisfied.
740 (7) A local mental health authority shall have physical custody of each child committed
741 to it under this section. The parent or legal guardian of a child committed to the physical
742 custody of a local mental health authority under this section, retains legal custody of the child,
743 unless legal custody has been otherwise modified by a court of competent jurisdiction. In cases
744 when the Division of Child and Family Services or the Division of Juvenile Justice Services
745 has legal custody of a child, that division shall retain legal custody for purposes of this part.
746 (8) The cost of caring for and maintaining a child in the physical custody of a local
747 mental health authority shall be assessed to and paid by the child's parents, according to their
748 ability to pay. For purposes of this section, the Division of Child and Family Services or the
749 Division of Juvenile Justice Services shall be financially responsible, in addition to the child's
750 parents, if the child is in the legal custody of either of those divisions at the time the child is
751 committed to the physical custody of a local mental health authority under this section, unless
752 Medicaid regulation or contract provisions specify otherwise. The Office of Recovery Services
753 shall assist those divisions in collecting the costs assessed pursuant to this section.
754 (9) Whenever application is made for commitment of a minor to a local mental health
755 authority under any provision of this section by a person other than the child's parent or
756 guardian, the local mental health authority or its designee shall notify the child's parent or
757 guardian. The parents shall be provided sufficient time to prepare and appear at any scheduled
758 proceeding.
759 (10) (a) Each child committed pursuant to this section is entitled to an appeal within 30
760 days after any order for commitment. The appeal may be brought on the child's own petition or
761 on petition of the child's parent or legal guardian, to the juvenile court in the district where the
762 child resides or is currently physically located. With regard to a child in the custody of the
763 Division of Child and Family Services or the Division of Juvenile Justice Services, the attorney
764 general's office shall handle the appeal, otherwise the appropriate county attorney's office is
765 responsible for appeals brought pursuant to this Subsection (10)(a).
766 (b) Upon receipt of the petition for appeal, the court shall appoint a designated
767 examiner previously unrelated to the case, to conduct an examination of the child in accordance
768 with the criteria described in Subsection (4), and file a written report with the court. The court
769 shall then conduct an appeal hearing to determine whether the findings described in Subsection
770 (4) exist by clear and convincing evidence.
771 (c) Prior to the time of the appeal hearing, the appropriate local mental health authority,
772 its designee, or the mental health professional who has been in charge of the child's care prior
773 to commitment, shall provide the court and the designated examiner for the appeal hearing with
774 the following information, as it relates to the period of current admission:
775 (i) the original petition for commitment;
776 (ii) admission notes;
777 (iii) diagnosis;
778 (iv) physicians' orders;
779 (v) progress notes;
780 (vi) nursing notes; and
781 (vii) medication records.
782 (d) Both the neutral and detached fact finder and the designated examiner appointed for
783 the appeal hearing shall be provided with an opportunity to review the most current
784 information described in Subsection (10)(c) prior to the appeal hearing.
785 (e) The child, the child's parent or legal guardian, the person who submitted the
786 original petition for commitment, and a representative of the appropriate local mental health
787 authority shall be notified by the court of the date and time of the appeal hearing. Those
788 persons shall be afforded an opportunity to appear at the hearing. In reaching its decision, the
789 court shall review the record and findings of the neutral and detached fact finder, the report of
790 the designated examiner appointed pursuant to Subsection (10)(b), and may, in its discretion,
791 allow or require the testimony of the neutral and detached fact finder, the designated examiner,
792 the child, the child's parent or legal guardian, the person who brought the initial petition for
793 commitment, or any other person whose testimony the court deems relevant. The court may
794 allow the child to waive the right to appear at the appeal hearing, for good cause shown. If that
795 waiver is granted, the purpose shall be made a part of the court's record.
796 (11) Each local mental health authority has an affirmative duty to conduct periodic
797 evaluations of the mental health and treatment progress of every child committed to its physical
798 custody under this section, and to release any child who has sufficiently improved so that the
799 criteria justifying commitment no longer exist.
800 (12) (a) A local mental health authority or its designee, in conjunction with the child's
801 current treating mental health professional may release an improved child to a less restrictive
802 environment, as they determine appropriate. Whenever the local mental health authority or its
803 designee, and the child's current treating mental health professional, determine that the
804 conditions justifying commitment no longer exist, the child shall be discharged and released to
805 the child's parent or legal guardian. With regard to a child who is in the physical custody of the
806 State Hospital, the treating psychiatrist or clinical director of the State Hospital shall be the
807 child's current treating mental health professional.
808 (b) A local mental health authority or its designee, in conjunction with the child's
809 current treating mental health professional, is authorized to issue a written order for the
810 immediate placement of a child not previously released from an order of commitment into a
811 more restrictive environment, if the local authority or its designee and the child's current
812 treating mental health professional has reason to believe that the less restrictive environment in
813 which the child has been placed is exacerbating the child's mental illness, or increasing the risk
814 of harm to self or others.
815 (c) The written order described in Subsection (12)(b) shall include the reasons for
816 placement in a more restrictive environment and shall authorize any peace officer to take the
817 child into physical custody and transport the child to a facility designated by the appropriate
818 local mental health authority in conjunction with the child's current treating mental health
819 professional. Prior to admission to the more restrictive environment, copies of the order shall
820 be personally delivered to the child, the child's parent or legal guardian, the administrator of the
821 more restrictive environment, or the administrator's designee, and the child's former treatment
822 provider or facility.
823 (d) If the child has been in a less restrictive environment for more than 30 days and is
824 aggrieved by the change to a more restrictive environment, the child or the child's
825 representative may request a review within 30 days of the change, by a neutral and detached
826 fact finder as described in Subsection (3). The fact finder shall determine whether:
827 (i) the less restrictive environment in which the child has been placed is exacerbating
828 the child's mental illness or increasing the risk of harm to self or others; or
829 (ii) the less restrictive environment in which the child has been placed is not
830 exacerbating the child's mental illness or increasing the risk of harm to self or others, in which
831 case the fact finder shall designate that the child remain in the less restrictive environment.
832 (e) Nothing in this section prevents a local mental health authority or its designee, in
833 conjunction with the child's current mental health professional, from discharging a child from
834 commitment or from placing a child in an environment that is less restrictive than that
835 designated by the neutral and detached fact finder.
836 (13) Each local mental health authority or its designee, in conjunction with the child's
837 current treating mental health professional shall discharge any child who, in the opinion of that
838 local authority, or its designee, and the child's current treating mental health professional, no
839 longer meets the criteria specified in Subsection (4), except as provided by Section 78A-6-120.
840 The local authority and the mental health professional shall assure that any further supportive
841 services required to meet the child's needs upon release will be provided.
842 (14) Even though a child has been committed to the physical custody of a local mental
843 health authority under this section, the child is still entitled to additional due process
844 proceedings, in accordance with Section 62A-15-704, before any treatment that may affect a
845 constitutionally protected liberty or privacy interest is administered. Those treatments include,
846 but are not limited to, antipsychotic medication, electroshock therapy, and psychosurgery.