1     
ASSISTED OUTPATIENT TREATMENT FOR MENTAL

2     
ILLNESS

3     
2019 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Lincoln Fillmore

6     
House Sponsor: Steve Eliason

7     

8     LONG TITLE
9     Committee Note:
10          The Health and Human Services Interim Committee recommended this bill.
11     General Description:
12          This bill creates a process for the provision of assisted outpatient treatment for an
13     individual with mental illness.
14     Highlighted Provisions:
15          This bill:
16          ▸     defines "assisted outpatient treatment";
17          ▸     describes the services provided to an individual receiving assisted outpatient
18     treatment;
19          ▸     describes the process whereby an individual is court ordered to receive assisted
20     outpatient treatment;
21          ▸     requires a designated examiner to consider assisted outpatient treatment when
22     evaluating a proposed patient for civil commitment; and
23          ▸     makes technical changes.
24     Money Appropriated in this Bill:
25          None
26     Other Special Clauses:
27          None

28     Utah Code Sections Affected:
29     AMENDS:
30          17-43-301, as last amended by Laws of Utah 2018, Chapters 68 and 407
31          62A-15-602, as last amended by Laws of Utah 2018, Chapter 322
32          62A-15-618, as renumbered and amended by Laws of Utah 2002, Fifth Special Session,
33     Chapter 8
34          62A-15-631, as last amended by Laws of Utah 2018, Chapter 322
35          62A-15-703, as last amended by Laws of Utah 2018, Chapter 322
36     ENACTS:
37          31A-22-650, Utah Code Annotated 1953
38          62A-15-630.4, Utah Code Annotated 1953
39          62A-15-630.5, Utah Code Annotated 1953
40     

41     Be it enacted by the Legislature of the state of Utah:
42          Section 1. Section 17-43-301 is amended to read:
43          17-43-301. Local mental health authorities -- Responsibilities.
44          (1) As used in this section:
45          (a) "Assisted outpatient treatment" means the same as that term is defined in Section
46     62A-15-602.
47          [(a)] (b) "Crisis worker" means the same as that term is defined in Section
48     62A-15-1301.
49          [(b)] (c) "Local mental health crisis line" means the same as that term is defined in
50     Section 63C-18-102.
51          [(c)] (d) "Mental health therapist" means the same as that term is defined in Section
52     58-60-102.
53          [(d)] (e) "Public funds" means the same as that term is defined in Section 17-43-303.
54          [(e)] (f) "Statewide mental health crisis line" means the same as that term is defined in
55     Section 63C-18-102.
56          (2) (a) (i) In each county operating under a county executive-council form of
57     government under Section 17-52a-203, the county legislative body is the local mental health
58     authority, provided however that any contract for plan services shall be administered by the

59     county executive.
60          (ii) In each county operating under a council-manager form of government under
61     Section 17-52a-204, the county manager is the local mental health authority.
62          (iii) In each county other than a county described in Subsection (2)(a)(i) or (ii), the
63     county legislative body is the local mental health authority.
64          (b) Within legislative appropriations and county matching funds required by this
65     section, under the direction of the division, each local mental health authority shall:
66          (i) provide mental health services to [persons] individuals within the county; and
67          (ii) cooperate with efforts of the Division of Substance Abuse and Mental Health to
68     promote integrated programs that address an individual's substance abuse, mental health, and
69     physical healthcare needs, as described in Section 62A-15-103.
70          (c) Within legislative appropriations and county matching funds required by this
71     section, each local mental health authority shall cooperate with the efforts of the Department of
72     Human Services to promote a system of care, as defined in Section 62A-1-104, for minors with
73     or at risk for complex emotional and behavioral needs, as described in Section 62A-1-111.
74          (3) (a) By executing an interlocal agreement under Title 11, Chapter 13, Interlocal
75     Cooperation Act, two or more counties may join to:
76          (i) provide mental health prevention and treatment services; or
77          (ii) create a united local health department that combines substance abuse treatment
78     services, mental health services, and local health department services in accordance with
79     Subsection (4).
80          (b) The legislative bodies of counties joining to provide services may establish
81     acceptable ways of apportioning the cost of mental health services.
82          (c) Each agreement for joint mental health services shall:
83          (i) (A) designate the treasurer of one of the participating counties or another person as
84     the treasurer for the combined mental health authorities and as the custodian of money
85     available for the joint services; and
86          (B) provide that the designated treasurer, or other disbursing officer authorized by the
87     treasurer, may make payments from the money available for the joint services upon audit of the
88     appropriate auditing officer or officers representing the participating counties;
89          (ii) provide for the appointment of an independent auditor or a county auditor of one of

90     the participating counties as the designated auditing officer for the combined mental health
91     authorities;
92          (iii) (A) provide for the appointment of the county or district attorney of one of the
93     participating counties as the designated legal officer for the combined mental health
94     authorities; and
95          (B) authorize the designated legal officer to request and receive the assistance of the
96     county or district attorneys of the other participating counties in defending or prosecuting
97     actions within their counties relating to the combined mental health authorities; and
98          (iv) provide for the adoption of management, clinical, financial, procurement,
99     personnel, and administrative policies as already established by one of the participating
100     counties or as approved by the legislative body of each participating county or interlocal board.
101          (d) An agreement for joint mental health services may provide for:
102          (i) joint operation of services and facilities or for operation of services and facilities
103     under contract by one participating local mental health authority for other participating local
104     mental health authorities; and
105          (ii) allocation of appointments of members of the mental health advisory council
106     between or among participating counties.
107          (4) A county governing body may elect to combine the local mental health authority
108     with the local substance abuse authority created in Part 2, Local Substance Abuse Authorities,
109     and the local health department created in Title 26A, Chapter 1, Part 1, Local Health
110     Department Act, to create a united local health department under Section 26A-1-105.5. A local
111     mental health authority that joins with a united local health department shall comply with this
112     part.
113          (5) (a) Each local mental health authority is accountable to the department, the
114     Department of Health, and the state with regard to the use of state and federal funds received
115     from those departments for mental health services, regardless of whether the services are
116     provided by a private contract provider.
117          (b) Each local mental health authority shall comply, and require compliance by its
118     contract provider, with all directives issued by the department and the Department of Health
119     regarding the use and expenditure of state and federal funds received from those departments
120     for the purpose of providing mental health programs and services. The department and

121     Department of Health shall ensure that those directives are not duplicative or conflicting, and
122     shall consult and coordinate with local mental health authorities with regard to programs and
123     services.
124          (6) (a) Each local mental health authority shall:
125          (i) review and evaluate mental health needs and services, including mental health needs
126     and services for [persons]:
127          (A) an individual incarcerated in a county jail or other county correctional facility; and
128          (B) an individual who is a resident of the county and who is court ordered to receive
129     assisted outpatient treatment under Section 62A-15-630.5;
130          (ii) in accordance with Subsection (6)(b), annually prepare and submit to the division a
131     plan approved by the county legislative body for mental health funding and service delivery,
132     either directly by the local mental health authority or by contract;
133          (iii) establish and maintain, either directly or by contract, programs licensed under Title
134     62A, Chapter 2, Licensure of Programs and Facilities;
135          (iv) appoint, directly or by contract, a full-time or part-time director for mental health
136     programs and prescribe the director's duties;
137          (v) provide input and comment on new and revised rules established by the division;
138          (vi) establish and require contract providers to establish administrative, clinical,
139     personnel, financial, procurement, and management policies regarding mental health services
140     and facilities, in accordance with the rules of the division, and state and federal law;
141          (vii) establish mechanisms allowing for direct citizen input;
142          (viii) annually contract with the division to provide mental health programs and
143     services in accordance with the provisions of Title 62A, Chapter 15, Substance Abuse and
144     Mental Health Act;
145          (ix) comply with all applicable state and federal statutes, policies, audit requirements,
146     contract requirements, and any directives resulting from those audits and contract requirements;
147          (x) provide funding equal to at least 20% of the state funds that it receives to fund
148     services described in the plan;
149          (xi) comply with the requirements and procedures of Title 11, Chapter 13, Interlocal
150     Cooperation Act, Title 17B, Chapter 1, Part 6, Fiscal Procedures for Local Districts, and Title
151     51, Chapter 2a, Accounting Reports from Political Subdivisions, Interlocal Organizations, and

152     Other Local Entities Act; and
153          (xii) take and retain physical custody of minors committed to the physical custody of
154     local mental health authorities by a judicial proceeding under Title 62A, Chapter 15, Part 7,
155     Commitment of Persons Under Age 18 to Division of Substance Abuse and Mental Health.
156          (b) Each plan under Subsection (6)(a)(ii) shall include services for adults, youth, and
157     children, which shall include:
158          (i) inpatient care and services;
159          (ii) residential care and services;
160          (iii) outpatient care and services;
161          (iv) 24-hour crisis care and services;
162          (v) psychotropic medication management;
163          (vi) psychosocial rehabilitation, including vocational training and skills development;
164          (vii) case management;
165          (viii) community supports, including in-home services, housing, family support
166     services, and respite services;
167          (ix) consultation and education services, including case consultation, collaboration
168     with other county service agencies, public education, and public information; and
169          (x) services to persons incarcerated in a county jail or other county correctional facility.
170          (7) (a) If a local mental health authority provides for a local mental health crisis line
171     under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the local
172     mental health authority shall:
173          (i) collaborate with the statewide mental health crisis line described in Section
174     62A-15-1302;
175          (ii) ensure that each individual who answers calls to the local mental health crisis line:
176          (A) is a mental health therapist or a crisis worker; and
177          (B) meets the standards of care and practice established by the Division of Substance
178     Abuse and Mental Health, in accordance with Section 62A-15-1302; and
179          (iii) ensure that when necessary, based on the local mental health crisis line's capacity,
180     calls are immediately routed to the statewide mental health crisis line to ensure that when an
181     individual calls the local mental health crisis line, regardless of the time, date, or number of
182     individuals trying to simultaneously access the local mental health crisis line, a mental health

183     therapist or a crisis worker answers the call without the caller first:
184          (A) waiting on hold; or
185          (B) being screened by an individual other than a mental health therapist or crisis
186     worker.
187          (b) If a local mental health authority does not provide for a local mental health crisis
188     line under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the
189     local mental health authority shall use the statewide mental health crisis line as a local crisis
190     line resource.
191          (8) Before disbursing any public funds, each local mental health authority shall require
192     that each entity that receives any public funds from a local mental health authority agrees in
193     writing that:
194          (a) the entity's financial records and other records relevant to the entity's performance
195     of the services provided to the mental health authority shall be subject to examination by:
196          (i) the division;
197          (ii) the local mental health authority director;
198          (iii) (A) the county treasurer and county or district attorney; or
199          (B) if two or more counties jointly provide mental health services under an agreement
200     under Subsection (3), the designated treasurer and the designated legal officer;
201          (iv) the county legislative body; and
202          (v) in a county with a county executive that is separate from the county legislative
203     body, the county executive;
204          (b) the county auditor may examine and audit the entity's financial and other records
205     relevant to the entity's performance of the services provided to the local mental health
206     authority; and
207          (c) the entity will comply with the provisions of Subsection (5)(b).
208          (9) A local mental health authority may receive property, grants, gifts, supplies,
209     materials, contributions, and any benefit derived therefrom, for mental health services. If those
210     gifts are conditioned upon their use for a specified service or program, they shall be so used.
211          (10) Public funds received for the provision of services pursuant to the local mental
212     health plan may not be used for any other purpose except those authorized in the contract
213     between the local mental health authority and the provider for the provision of plan services.

214          (11) A local mental health authority shall provide assisted outpatient treatment
215     services, as described in Section 62A-15-630.4, to a resident of the county who has been
216     ordered under Section 62A-15-630.5 to receive assisted outpatient treatment.
217          Section 2. Section 31A-22-650 is enacted to read:
218          31A-22-650. Insurance coverage for assisted outpatient treatment.
219          (1) As used in this section, "assisted outpatient treatment" means the same as that term
220     is defined in Section 62A-15-602.
221          (2) A health insurance provider may not deny an insured the benefits of the insured's
222     policy solely because the health care that the insured receives is provided under a court order
223     for assisted outpatient treatment, as provided in Section 62A-15-630.5.     
224          Section 3. Section 62A-15-602 is amended to read:
225          62A-15-602. Definitions.
226          As used in this part, Part 7, Commitment of Persons Under Age 18 to Division of
227     Substance Abuse and Mental Health, Part 8, Interstate Compact on Mental Health, Part 9, Utah
228     Forensic Mental Health Facility, Part 10, Declaration for Mental Health Treatment, and Part
229     12, Essential Treatment and Intervention Act:
230          (1) "Adult" means an individual 18 years of age or older.
231          (2) "Approved treatment facility or program" means a treatment provider that meets the
232     standards described in Subsection 62A-15-103(2)(a)(v).
233          (3) "Assisted outpatient treatment" means involuntary outpatient mental health
234     treatment ordered under Section 62A-15-630.5.
235          [(3)] (4) "Commitment to the custody of a local mental health authority" means that an
236     adult is committed to the custody of the local mental health authority that governs the mental
237     health catchment area where the adult resides or is found.
238          [(4)] (5) "Community mental health center" means an entity that provides treatment
239     and services to a resident of a designated geographical area, that operates by or under contract
240     with a local mental health authority, and that complies with state standards for community
241     mental health centers.
242          [(5)] (6) "Designated examiner" means:
243          (a) a licensed physician, preferably a psychiatrist, who is designated by the division as
244     specially qualified by training or experience in the diagnosis of mental or related illness; or

245          (b) a licensed mental health professional designated by the division as specially
246     qualified by training and who has at least five years' continual experience in the treatment of
247     mental illness.
248          [(6)] (7) "Designee" means a physician who has responsibility for medical functions
249     including admission and discharge, an employee of a local mental health authority, or an
250     employee of a person that has contracted with a local mental health authority to provide mental
251     health services under Section 17-43-304.
252          [(7)] (8) "Essential treatment" and "essential treatment and intervention" mean
253     court-ordered treatment at a local substance abuse authority or an approved treatment facility or
254     program for the treatment of an adult's substance use disorder.
255          [(8)] (9) "Harmful sexual conduct" means the following conduct upon an individual
256     without the individual's consent, including the nonconsensual circumstances described in
257     Subsections 76-5-406(1) through (12):
258          (a) sexual intercourse;
259          (b) penetration, however slight, of the genital or anal opening of the individual;
260          (c) any sexual act involving the genitals or anus of the actor or the individual and the
261     mouth or anus of either individual, regardless of the gender of either participant; or
262          (d) any sexual act causing substantial emotional injury or bodily pain.
263          [(9)] (10) "Institution" means a hospital or a health facility licensed under Section
264     26-21-8.
265          [(10)] (11) "Local substance abuse authority" means the same as that term is defined in
266     Section 62A-15-102 and described in Section 17-43-201.
267          [(11)] (12) "Mental health facility" means the Utah State Hospital or other facility that
268     provides mental health services under contract with the division, a local mental health
269     authority, a person that contracts with a local mental health authority, or a person that provides
270     acute inpatient psychiatric services to a patient.
271          [(12)] (13) "Mental health officer" means an individual who is designated by a local
272     mental health authority as qualified by training and experience in the recognition and
273     identification of mental illness, to:
274          (a) apply for and provide certification for a temporary commitment; or
275          (b) assist in the arrangement of transportation to a designated mental health facility.

276          [(13)] (14) "Mental illness" means:
277          (a) a psychiatric disorder that substantially impairs an individual's mental, emotional,
278     behavioral, or related functioning; or
279          (b) the same as that term is defined in:
280          (i) the current edition of the Diagnostic and Statistical Manual of Mental Disorders
281     published by the American Psychiatric Association; or
282          (ii) the current edition of the International Statistical Classification of Diseases and
283     Related Health Problems.
284          [(14)] (15) "Patient" means an individual who is:
285          (a) under commitment to the custody or to the treatment services of a local mental
286     health authority; or
287          (b) undergoing essential treatment and intervention.
288          [(15)] (16) "Physician" means an individual who is:
289          (a) licensed as a physician under Title 58, Chapter 67, Utah Medical Practice Act; or
290          (b) licensed as a physician under Title 58, Chapter 68, Utah Osteopathic Medical
291     Practice Act.
292          [(16)] (17) "Serious bodily injury" means bodily injury that involves a substantial risk
293     of death, unconsciousness, extreme physical pain, protracted and obvious disfigurement, or
294     protracted loss or impairment of the function of a bodily member, organ, or mental faculty.
295          [(17)] (18) "Substantial danger" means that due to mental illness, an individual is at
296     serious risk of:
297          (a) suicide;
298          (b) serious bodily self-injury;
299          (c) serious bodily injury because the individual is incapable of providing the basic
300     necessities of life, including food, clothing, or shelter;
301          (d) causing or attempting to cause serious bodily injury to another individual; or
302          (e) engaging in harmful sexual conduct.
303          [(18)] (19) "Treatment" means psychotherapy, medication, including the administration
304     of psychotropic medication, or other medical treatments that are generally accepted medical or
305     psychosocial interventions for the purpose of restoring the patient to an optimal level of
306     functioning in the least restrictive environment.

307          Section 4. Section 62A-15-618 is amended to read:
308          62A-15-618. Designated examiners.
309          (1) A designated examiner, when evaluating a proposed patient for civil commitment,
310     shall consider whether:
311          (a) a proposed patient has been under a court order for assisted outpatient treatment;
312          (b) the proposed patient complied with the terms of the assisted outpatient treatment
313     order, if any; and
314          (c) whether assisted outpatient treatment is sufficient to meet the proposed patient's
315     needs.
316          (2) Designated examiners shall be allowed a reasonable fee by the county legislative
317     body of the county in which the proposed patient resides or is found, unless they are otherwise
318     paid.
319          Section 5. Section 62A-15-630.4 is enacted to read:
320          62A-15-630.4. Assisted outpatient treatment services.
321          (1) The local mental health authority or its designee shall provide assisted outpatient
322     treatment, which shall include:
323          (a) case management; and
324          (b) an individualized treatment plan, created with input from the proposed patient
325     when possible.
326          (2) A court order for assisted outpatient treatment does not create independent
327     authority to forcibly medicate a patient.
328          Section 6. Section 62A-15-630.5 is enacted to read:
329          62A-15-630.5. Assisted outpatient treatment proceedings.
330          (1) A responsible individual who has credible knowledge of an adult's mental illness
331     and the condition or circumstances that have led to the adult's need for assisted outpatient
332     treatment may file, in the district court in the county where the proposed patient resides or is
333     found, a written application that includes:
334          (a) unless the court finds that the information is not reasonably available, the proposed
335     patient's:
336          (i) name;
337          (ii) date of birth; and

338          (iii) social security number; and
339          (b) (i) a certificate of a licensed physician or a designated examiner stating that within
340     the seven-day period immediately preceding the certification, the physician or designated
341     examiner examined the proposed patient and is of the opinion that the proposed patient has a
342     mental illness and should be involuntarily committed; or
343          (ii) a written statement by the applicant that:
344          (A) the proposed patient has been requested to, but has refused to, submit to an
345     examination of mental condition by a licensed physician or designated examiner;
346          (B) is sworn to under oath; and
347          (C) states the facts upon which the application is based.
348          (2) (a) Subject to Subsection (2)(b), before issuing a judicial order, the court may
349     require the applicant to consult with the appropriate local mental health authority, and the court
350     may direct a mental health professional from that local mental health authority to interview the
351     applicant and the proposed patient to determine the existing facts and report them to the court.
352          (b) The consultation described in Subsection (2)(a):
353          (i) may take place at or before the hearing; and
354          (ii) is required if the local mental health authority appears at the hearing.
355          (3) If the proposed patient refuses to submit to an interview described in Subsection
356     (2)(a) or an examination described in Subsection (8), the court may issue an order, directed to a
357     mental health officer or peace officer, to immediately place the proposed patient into the
358     custody of a local mental health authority or in a temporary emergency facility, as provided in
359     Section 62A-15-634, to be detained for the purpose of examination.
360          (4) Notice of commencement of proceedings for assisted outpatient treatment, setting
361     forth the allegations of the application and any reported facts, together with a copy of any
362     official order of detention, shall:
363          (a) be provided by the court to a proposed patient before, or upon, placement into the
364     custody of a local mental health authority or, with respect to any proposed patient presently in
365     the custody of a local mental health authority;
366          (b) be maintained at the proposed patient's place of detention, if any;
367          (c) be provided by the court as soon as practicable to the applicant, any legal guardian,
368     any immediate adult family members, legal counsel for the parties involved, the local mental

369     health authority or its designee, and any other person whom the proposed patient or the court
370     shall designate; and
371          (d) advise that a hearing may be held within the time provided by law.
372          (5) The district court may, in its discretion, transfer the case to any other district court
373     within this state, provided that the transfer will not be adverse to the interest of the proposed
374     patient.
375          (6) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
376     of a judicial order, or after commitment of a proposed patient to a local mental health authority
377     or its designee under court order for detention in order to complete an examination, the court
378     shall appoint two designated examiners:
379          (a) who did not sign the assisted outpatient treatment application nor the certification
380     described in Subsection (1);
381          (b) one of whom is a licensed physician; and
382          (c) one of whom may be designated by the proposed patient or the proposed patient's
383     counsel, if that designated examiner is reasonably available.
384          (7) The court shall schedule a hearing to be held within 10 calendar days of the day on
385     which the designated examiners are appointed.
386          (8) The designated examiners shall:
387          (a) conduct their examinations separately;
388          (b) conduct the examinations at the home of the proposed patient, at a hospital or other
389     medical facility, or at any other suitable place that is not likely to have a harmful effect on the
390     proposed patient's health;
391          (c) inform the proposed patient, if not represented by an attorney:
392          (i) that the proposed patient does not have to say anything;
393          (ii) of the nature and reasons for the examination;
394          (iii) that the examination was ordered by the court;
395          (iv) that any information volunteered could form part of the basis for the proposed
396     patient to be ordered to receive assisted outpatient treatment; and
397          (v) that findings resulting from the examination will be made available to the court;
398     and
399          (d) within 24 hours of examining the proposed patient, report to the court, orally or in

400     writing, whether the proposed patient is mentally ill. If the designated examiner reports orally,
401     the designated examiner shall immediately send a written report to the clerk of the court.
402          (9) If a designated examiner is unable to complete an examination on the first attempt
403     because the proposed patient refuses to submit to the examination, the court shall fix a
404     reasonable compensation to be paid to the examiner.
405          (10) If the local mental health authority, its designee, or a medical examiner determines
406     before the court hearing that the conditions justifying the findings leading to an assisted
407     outpatient treatment hearing no longer exist, the local mental health authority, its designee, or
408     the medical examiner shall immediately report that determination to the court.
409          (11) The court may terminate the proceedings and dismiss the application at any time,
410     including prior to the hearing, if the designated examiners or the local mental health authority
411     or its designee informs the court that the proposed patient is not mentally ill.
412          (12) Before the hearing, an opportunity to be represented by counsel shall be afforded
413     to the proposed patient, and if neither the proposed patient nor others provide counsel, the court
414     shall appoint counsel and allow counsel sufficient time to consult with the proposed patient
415     before the hearing. In the case of an indigent proposed patient, the payment of reasonable
416     attorney fees for counsel, as determined by the court, shall be made by the county in which the
417     proposed patient resides or is found.
418          (13) (a) All persons to whom notice is required to be given shall be afforded an
419     opportunity to appear at the hearing, to testify, and to present and cross-examine witnesses. The
420     court may, in its discretion, receive the testimony of any other individual. The court may allow
421     a waiver of the proposed patient's right to appear only for good cause shown, and that cause
422     shall be made a matter of court record.
423          (b) The court is authorized to exclude all individuals not necessary for the conduct of
424     the proceedings and may, upon motion of counsel, require the testimony of each examiner to be
425     given out of the presence of any other examiners.
426          (c) The hearing shall be conducted in as informal a manner as may be consistent with
427     orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
428     mental health of the proposed patient.
429          (d) The court shall consider all relevant historical and material information that is
430     offered, subject to the rules of evidence, including reliable hearsay under Rule 1102, Utah

431     Rules of Evidence.
432          (e) (i) A local mental health authority or its designee, or the physician in charge of the
433     proposed patient's care shall, at the time of the hearing, provide the court with the following
434     information:
435          (A) the detention order, if any;
436          (B) admission notes, if any;
437          (C) the diagnosis, if any;
438          (D) doctor's orders, if any;
439          (E) progress notes, if any;
440          (F) nursing notes, if any; and
441          (G) medication records, if any.
442          (ii) The information described in Subsection (13)(e)(i) shall also be provided to the
443     proposed patient's counsel:
444          (A) at the time of the hearing; and
445          (B) at any time prior to the hearing, upon request.
446          (14) The court shall order a proposed patient to assisted outpatient treatment if, upon
447     completion of the hearing and consideration of the information presented, the court finds by
448     clear and convincing evidence that:
449          (a) the proposed patient has a mental illness;
450          (b) there is no appropriate less-restrictive alternative to a court order for assisted
451     outpatient treatment; and
452          (c) (i) the proposed patient lacks the ability to engage in a rational decision-making
453     process regarding the acceptance of mental health treatment, as demonstrated by evidence of
454     inability to weigh the possible risks of accepting or rejecting treatment; or
455          (ii) the proposed patient needs assisted outpatient treatment in order to prevent relapse
456     or deterioration that is likely to result in the proposed patient posing a substantial danger to self
457     or others.
458          (15) The court may order the applicant or a close relative of the patient to be the
459     patient's personal representative, as described in 45 C.F.R. Sec. 164.502(g), for purposes of the
460     patient's mental health treatment.
461          (16) In the absence of the findings described in Subsection (14), the court, after the

462     hearing, shall dismiss the proceedings.
463          (17) (a) The assisted outpatient treatment order shall designate the period for which the
464     patient shall be treated, which may not exceed six months without a review hearing.
465          (b) An individual identified under Subsection (4) may request a review hearing at any
466     time while the assisted outpatient treatment order is in effect.
467          (c) At a review hearing, the court may extend the duration of an assisted outpatient
468     treatment order by up to six months, if:
469          (i) the court finds by clear and convincing evidence that the patient meets the
470     conditions described in Subsection (14); or
471          (ii) (A) the patient does not appear at the review hearing; and
472          (B) notice of the review hearing was provided to the patient's last known address by the
473     applicant described in Subsection (1) or by a local mental health authority.
474          (d) The court shall maintain a current list of all patients under its order of assisted
475     outpatient treatment.
476          (e) At least two weeks prior to the expiration of the designated period of any assisted
477     outpatient treatment order still in effect, the court that entered the original order shall inform
478     the appropriate local mental health authority or its designee.
479          (18) Costs of all proceedings under this section shall be paid by the county in which the
480     proposed patient resides or is found.
481          (19) A court may not hold an individual in contempt for failure to comply with an
482     assisted outpatient treatment order.
483          (20) As provided in Section 31A-22-650, a health insurance provider may not deny an
484     insured the benefits of the insured's policy solely because the health care that the insured
485     receives is provided under a court order for assisted outpatient treatment.
486          Section 7. Section 62A-15-631 is amended to read:
487          62A-15-631. Involuntary commitment under court order -- Examination --
488     Hearing -- Power of court -- Findings required -- Costs.
489          (1) A responsible [person] individual who has [reason to know] credible knowledge of
490     an adult's mental illness and the condition or circumstances that have led to the adult's need to
491     be involuntarily committed may initiate an involuntary commitment court proceeding by filing,
492     in the district court in the county where the proposed patient resides or is found, a written

493     application that includes:
494          (a) unless the court finds that the information is not reasonably available, the proposed
495     patient's:
496          (i) name;
497          (ii) date of birth; and
498          (iii) social security number; [and]
499          (b) (i) a certificate of a licensed physician or a designated examiner stating that within
500     the seven-day period immediately preceding the certification, the physician or designated
501     examiner examined the proposed patient and is of the opinion that the proposed patient has a
502     mental illness and should be involuntarily committed; or
503          (ii) a written statement by the applicant that:
504          (A) the proposed patient has been requested to, but has refused to, submit to an
505     examination of mental condition by a licensed physician or designated examiner;
506          (B) is sworn to under oath; and
507          (C) states the facts upon which the application is based[.]; and
508          (c) a statement whether the proposed patient has previously been under an assisted
509     outpatient treatment order, if known by the applicant.
510          (2) (a) Subject to Subsection (2)(b), before issuing a judicial order, the court may
511     require the applicant to consult with the appropriate local mental health authority, and the court
512     may direct a mental health professional from that local mental health authority to interview the
513     applicant and the proposed patient to determine the existing facts and report them to the court.
514          (b) The consultation described in Subsection (2)(a):
515          (i) may take place at or before the hearing; and
516          (ii) is required if the local mental health authority appears at the hearing.
517          (3) If the court finds from the application, from any other statements under oath, or
518     from any reports from a mental health professional that there is a reasonable basis to believe
519     that the proposed patient has a mental illness that poses a substantial danger to self or others
520     requiring involuntary commitment pending examination and hearing; or, if the proposed patient
521     has refused to submit to an interview with a mental health professional as directed by the court
522     or to go to a treatment facility voluntarily, the court may issue an order, directed to a mental
523     health officer or peace officer, to immediately place the proposed patient in the custody of a

524     local mental health authority or in a temporary emergency facility as provided in Section
525     62A-15-634 to be detained for the purpose of examination.
526          (4) Notice of commencement of proceedings for involuntary commitment, setting forth
527     the allegations of the application and any reported facts, together with a copy of any official
528     order of detention, shall be provided by the court to a proposed patient before, or upon,
529     placement in the custody of a local mental health authority or, with respect to any proposed
530     patient presently in the custody of a local mental health authority whose status is being changed
531     from voluntary to involuntary, upon the filing of an application for that purpose with the court.
532     A copy of that order of detention shall be maintained at the place of detention.
533          (5) Notice of commencement of those proceedings shall be provided by the court as
534     soon as practicable to the applicant, any legal guardian, any immediate adult family members,
535     legal counsel for the parties involved, the local mental health authority or its designee, and any
536     other persons whom the proposed patient or the court shall designate. That notice shall advise
537     those persons that a hearing may be held within the time provided by law. If the proposed
538     patient has refused to permit release of information necessary for provisions of notice under
539     this subsection, the extent of notice shall be determined by the court.
540          (6) Proceedings for commitment of an individual under the age of 18 years to a local
541     mental health authority may be commenced in accordance with Part 7, Commitment of Persons
542     Under Age 18 to Division of Substance Abuse and Mental Health.
543          (7) The district court may, in its discretion, transfer the case to any other district court
544     within this state, provided that the transfer will not be adverse to the interest of the proposed
545     patient.
546          (8) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
547     of a judicial order, or after commitment of a proposed patient to a local mental health authority
548     or its designee under court order for detention or examination, the court shall appoint two
549     designated examiners:
550          (a) who did not sign the civil commitment application nor the civil commitment
551     certification under Subsection (1);
552          (b) one of whom is a licensed physician; and
553          (c) one of whom may be designated by the proposed patient or the proposed patient's
554     counsel, if that designated examiner is reasonably available.

555          (9) The court shall schedule a hearing to be held within 10 calendar days of the day on
556     which the designated examiners are appointed.
557          (10) The designated examiners shall:
558          (a) conduct their examinations separately;
559          (b) conduct the examinations at the home of the proposed patient, at a hospital or other
560     medical facility, or at any other suitable place that is not likely to have a harmful effect on the
561     proposed patient's health;
562          (c) inform the proposed patient, if not represented by an attorney:
563          (i) that the proposed patient does not have to say anything;
564          (ii) of the nature and reasons for the examination;
565          (iii) that the examination was ordered by the court;
566          (iv) that any information volunteered could form part of the basis for the proposed
567     patient's involuntary commitment; and
568          (v) that findings resulting from the examination will be made available to the court;
569     and
570          (d) within 24 hours of examining the proposed patient, report to the court, orally or in
571     writing, whether the proposed patient is mentally ill, has agreed to voluntary commitment, as
572     described in Section 62A-15-625, or has acceptable programs available to the proposed patient
573     without court proceedings. If the designated examiner reports orally, the designated examiner
574     shall immediately send a written report to the clerk of the court.
575          (11) If a designated examiner is unable to complete an examination on the first attempt
576     because the proposed patient refuses to submit to the examination, the court shall fix a
577     reasonable compensation to be paid to the examiner.
578          (12) If the local mental health authority, its designee, or a medical examiner determines
579     before the court hearing that the conditions justifying the findings leading to a commitment
580     hearing no longer exist, the local mental health authority, its designee, or the medical examiner
581     shall immediately report that determination to the court.
582          (13) The court may terminate the proceedings and dismiss the application at any time,
583     including prior to the hearing, if the designated examiners or the local mental health authority
584     or its designee informs the court that the proposed patient:
585          (a) is not mentally ill;

586          (b) has agreed to voluntary commitment, as described in Section 62A-15-625; or
587          (c) has acceptable options for treatment programs that are available without court
588     proceedings.
589          (14) Before the hearing, an opportunity to be represented by counsel shall be afforded
590     to [every] the proposed patient, and if neither the proposed patient nor others provide counsel,
591     the court shall appoint counsel and allow counsel sufficient time to consult with the proposed
592     patient before the hearing. In the case of an indigent proposed patient, the payment of
593     reasonable attorney fees for counsel, as determined by the court, shall be made by the county in
594     which the proposed patient resides or is found.
595          (15) (a) The proposed patient, the applicant, and all other persons to whom notice is
596     required to be given shall be afforded an opportunity to appear at the hearing, to testify, and to
597     present and cross-examine witnesses. The court may, in its discretion, receive the testimony of
598     any other person. The court may allow a waiver of the proposed patient's right to appear only
599     for good cause shown, and that cause shall be made a matter of court record.
600          (b) The court is authorized to exclude all persons not necessary for the conduct of the
601     proceedings and may, upon motion of counsel, require the testimony of each examiner to be
602     given out of the presence of any other examiners.
603          (c) The hearing shall be conducted in as informal a manner as may be consistent with
604     orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
605     mental health of the proposed patient.
606          (d) The court shall consider all relevant historical and material information that is
607     offered, subject to the rules of evidence, including reliable hearsay under Rule 1102, Utah
608     Rules of Evidence.
609          (e) (i) A local mental health authority or its designee, or the physician in charge of the
610     proposed patient's care shall, at the time of the hearing, provide the court with the following
611     information:
612          (A) the detention order;
613          (B) admission notes;
614          (C) the diagnosis;
615          (D) any doctors' orders;
616          (E) progress notes;

617          (F) nursing notes; [and]
618          (G) medication records pertaining to the current commitment[.]; and
619          (H) whether the proposed patient has previously been civilly committed or under an
620     order for assisted outpatient treatment.
621          (ii) That information shall also be supplied to the proposed patient's counsel at the time
622     of the hearing, and at any time prior to the hearing upon request.
623          (16) The court shall order commitment of a proposed patient who is 18 years of age or
624     older to a local mental health authority if, upon completion of the hearing and consideration of
625     the information presented in accordance with Subsection (15)(d), the court finds by clear and
626     convincing evidence that:
627          (a) the proposed patient has a mental illness;
628          (b) because of the proposed patient's mental illness the proposed patient poses a
629     substantial danger to self or others;
630          (c) the proposed patient lacks the ability to engage in a rational decision-making
631     process regarding the acceptance of mental treatment as demonstrated by evidence of inability
632     to weigh the possible risks of accepting or rejecting treatment;
633          (d) there is no appropriate less-restrictive alternative to a court order of commitment;
634     and
635          (e) the local mental health authority can provide the proposed patient with treatment
636     that is adequate and appropriate to the proposed patient's conditions and needs. In the absence
637     of the required findings of the court after the hearing, the court shall dismiss the proceedings.
638          (17) (a) The order of commitment shall designate the period for which the patient shall
639     be treated. When the patient is not under an order of commitment at the time of the hearing,
640     that period may not exceed six months without benefit of a review hearing. Upon such a
641     review hearing, to be commenced prior to the expiration of the previous order, an order for
642     commitment may be for an indeterminate period, if the court finds by clear and convincing
643     evidence that the required conditions in Subsection (16) will last for an indeterminate period.
644          (b) The court shall maintain a current list of all patients under its order of commitment.
645     That list shall be reviewed to determine those patients who have been under an order of
646     commitment for the designated period. At least two weeks prior to the expiration of the
647     designated period of any order of commitment still in effect, the court that entered the original

648     order shall inform the appropriate local mental health authority or its designee. The local
649     mental health authority or its designee shall immediately reexamine the reasons upon which the
650     order of commitment was based. If the local mental health authority or its designee determines
651     that the conditions justifying that commitment no longer exist, it shall discharge the patient
652     from involuntary commitment and immediately report the discharge to the court. Otherwise,
653     the court shall immediately appoint two designated examiners and proceed under Subsections
654     (8) through (14).
655          (c) The local mental health authority or its designee responsible for the care of a patient
656     under an order of commitment for an indeterminate period shall, at six-month intervals,
657     reexamine the reasons upon which the order of indeterminate commitment was based. If the
658     local mental health authority or its designee determines that the conditions justifying that
659     commitment no longer exist, that local mental health authority or its designee shall discharge
660     the patient from its custody and immediately report the discharge to the court. If the local
661     mental health authority or its designee determines that the conditions justifying that
662     commitment continue to exist, the local mental health authority or its designee shall send a
663     written report of those findings to the court. The patient and the patient's counsel of record
664     shall be notified in writing that the involuntary commitment will be continued, the reasons for
665     that decision, and that the patient has the right to a review hearing by making a request to the
666     court. Upon receiving the request, the court shall immediately appoint two designated
667     examiners and proceed under Subsections (8) through (14).
668          (18) Any patient committed as a result of an original hearing or a patient's legally
669     designated representative who is aggrieved by the findings, conclusions, and order of the court
670     entered in the original hearing has the right to a new hearing upon a petition filed with the court
671     within 30 days of the entry of the court order. The petition must allege error or mistake in the
672     findings, in which case the court shall appoint three impartial designated examiners previously
673     unrelated to the case to conduct an additional examination of the patient. The new hearing
674     shall, in all other respects, be conducted in the manner otherwise permitted.
675          (19) Costs of all proceedings under this section shall be paid by the county in which the
676     proposed patient resides or is found.
677          Section 8. Section 62A-15-703 is amended to read:
678          62A-15-703. Residential and inpatient settings -- Commitment proceeding --

679     Child in physical custody of local mental health authority.
680          (1) A child may receive services from a local mental health authority in an inpatient or
681     residential setting only after a commitment proceeding, for the purpose of transferring physical
682     custody, has been conducted in accordance with the requirements of this section.
683          (2) That commitment proceeding shall be initiated by a petition for commitment, and
684     shall be a careful, diagnostic inquiry, conducted by a neutral and detached fact finder, pursuant
685     to the procedures and requirements of this section. If the findings described in Subsection (4)
686     exist, the proceeding shall result in the transfer of physical custody to the appropriate local
687     mental health authority, and the child may be placed in an inpatient or residential setting.
688          (3) The neutral and detached fact finder who conducts the inquiry:
689          (a) shall be a designated examiner, as defined in Section 62A-15-602; and
690          (b) may not profit, financially or otherwise, from the commitment or physical
691     placement of the child in that setting.
692          (4) Upon determination by a fact finder that the following circumstances clearly exist,
693     the fact finder may order that the child be committed to the physical custody of a local mental
694     health authority:
695          (a) the child has a mental illness, as defined in [Subsection] Section 62A-15-602[(13)];
696          (b) the child demonstrates a reasonable fear of the risk of substantial danger to self or
697     others;
698          (c) the child will benefit from care and treatment by the local mental health authority;
699     and
700          (d) there is no appropriate less-restrictive alternative.
701          (5) (a) The commitment proceeding before the neutral and detached fact finder shall be
702     conducted in as informal manner as possible and in a physical setting that is not likely to have a
703     harmful effect on the child.
704          (b) The child, the child's parent or legal guardian, the petitioner, and a representative of
705     the appropriate local mental health authority:
706          (i) shall receive informal notice of the date and time of the proceeding; and
707          (ii) may appear and address the petition for commitment.
708          (c) The neutral and detached fact finder may, in the fact finder's discretion, receive the
709     testimony of any other person.

710          (d) The fact finder may allow a child to waive the child's right to be present at the
711     commitment proceeding, for good cause shown. If that right is waived, the purpose of the
712     waiver shall be made a matter of record at the proceeding.
713          (e) At the time of the commitment proceeding, the appropriate local mental health
714     authority, its designee, or the psychiatrist who has been in charge of the child's care prior to the
715     commitment proceeding, shall provide the neutral and detached fact finder with the following
716     information, as it relates to the period of current admission:
717          (i) the petition for commitment;
718          (ii) the admission notes;
719          (iii) the child's diagnosis;
720          (iv) physicians' orders;
721          (v) progress notes;
722          (vi) nursing notes; and
723          (vii) medication records.
724          (f) The information described in Subsection (5)(e) shall also be provided to the child's
725     parent or legal guardian upon written request.
726          (g) (i) The neutral and detached fact finder's decision of commitment shall state the
727     duration of the commitment. Any commitment to the physical custody of a local mental health
728     authority may not exceed 180 days. Prior to expiration of the commitment, and if further
729     commitment is sought, a hearing shall be conducted in the same manner as the initial
730     commitment proceeding, in accordance with the requirements of this section.
731          (ii) At the conclusion of the hearing and subsequently in writing, when a decision for
732     commitment is made, the neutral and detached fact finder shall inform the child and the child's
733     parent or legal guardian of that decision and of the reasons for ordering commitment.
734          (iii) The neutral and detached fact finder shall state in writing the basis of the decision,
735     with specific reference to each of the criteria described in Subsection (4), as a matter of record.
736          (6) A child may be temporarily committed for a maximum of 72 hours, excluding
737     Saturdays, Sundays, and legal holidays, to the physical custody of a local mental health
738     authority in accordance with the procedures described in Section 62A-15-629 and upon
739     satisfaction of the risk factors described in Subsection (4). A child who is temporarily
740     committed shall be released at the expiration of the 72 hours unless the procedures and findings

741     required by this section for the commitment of a child are satisfied.
742          (7) A local mental health authority shall have physical custody of each child committed
743     to it under this section. The parent or legal guardian of a child committed to the physical
744     custody of a local mental health authority under this section, retains legal custody of the child,
745     unless legal custody has been otherwise modified by a court of competent jurisdiction. In cases
746     when the Division of Child and Family Services or the Division of Juvenile Justice Services
747     has legal custody of a child, that division shall retain legal custody for purposes of this part.
748          (8) The cost of caring for and maintaining a child in the physical custody of a local
749     mental health authority shall be assessed to and paid by the child's parents, according to their
750     ability to pay. For purposes of this section, the Division of Child and Family Services or the
751     Division of Juvenile Justice Services shall be financially responsible, in addition to the child's
752     parents, if the child is in the legal custody of either of those divisions at the time the child is
753     committed to the physical custody of a local mental health authority under this section, unless
754     Medicaid regulation or contract provisions specify otherwise. The Office of Recovery Services
755     shall assist those divisions in collecting the costs assessed pursuant to this section.
756          (9) Whenever application is made for commitment of a minor to a local mental health
757     authority under any provision of this section by a person other than the child's parent or
758     guardian, the local mental health authority or its designee shall notify the child's parent or
759     guardian. The parents shall be provided sufficient time to prepare and appear at any scheduled
760     proceeding.
761          (10) (a) Each child committed pursuant to this section is entitled to an appeal within 30
762     days after any order for commitment. The appeal may be brought on the child's own petition or
763     on petition of the child's parent or legal guardian, to the juvenile court in the district where the
764     child resides or is currently physically located. With regard to a child in the custody of the
765     Division of Child and Family Services or the Division of Juvenile Justice Services, the attorney
766     general's office shall handle the appeal, otherwise the appropriate county attorney's office is
767     responsible for appeals brought pursuant to this Subsection (10)(a).
768          (b) Upon receipt of the petition for appeal, the court shall appoint a designated
769     examiner previously unrelated to the case, to conduct an examination of the child in accordance
770     with the criteria described in Subsection (4), and file a written report with the court. The court
771     shall then conduct an appeal hearing to determine whether the findings described in Subsection

772     (4) exist by clear and convincing evidence.
773          (c) Prior to the time of the appeal hearing, the appropriate local mental health authority,
774     its designee, or the mental health professional who has been in charge of the child's care prior
775     to commitment, shall provide the court and the designated examiner for the appeal hearing with
776     the following information, as it relates to the period of current admission:
777          (i) the original petition for commitment;
778          (ii) admission notes;
779          (iii) diagnosis;
780          (iv) physicians' orders;
781          (v) progress notes;
782          (vi) nursing notes; and
783          (vii) medication records.
784          (d) Both the neutral and detached fact finder and the designated examiner appointed for
785     the appeal hearing shall be provided with an opportunity to review the most current
786     information described in Subsection (10)(c) prior to the appeal hearing.
787          (e) The child, the child's parent or legal guardian, the person who submitted the
788     original petition for commitment, and a representative of the appropriate local mental health
789     authority shall be notified by the court of the date and time of the appeal hearing. Those
790     persons shall be afforded an opportunity to appear at the hearing. In reaching its decision, the
791     court shall review the record and findings of the neutral and detached fact finder, the report of
792     the designated examiner appointed pursuant to Subsection (10)(b), and may, in its discretion,
793     allow or require the testimony of the neutral and detached fact finder, the designated examiner,
794     the child, the child's parent or legal guardian, the person who brought the initial petition for
795     commitment, or any other person whose testimony the court deems relevant. The court may
796     allow the child to waive the right to appear at the appeal hearing, for good cause shown. If that
797     waiver is granted, the purpose shall be made a part of the court's record.
798          (11) Each local mental health authority has an affirmative duty to conduct periodic
799     evaluations of the mental health and treatment progress of every child committed to its physical
800     custody under this section, and to release any child who has sufficiently improved so that the
801     criteria justifying commitment no longer exist.
802          (12) (a) A local mental health authority or its designee, in conjunction with the child's

803     current treating mental health professional may release an improved child to a less restrictive
804     environment, as they determine appropriate. Whenever the local mental health authority or its
805     designee, and the child's current treating mental health professional, determine that the
806     conditions justifying commitment no longer exist, the child shall be discharged and released to
807     the child's parent or legal guardian. With regard to a child who is in the physical custody of the
808     State Hospital, the treating psychiatrist or clinical director of the State Hospital shall be the
809     child's current treating mental health professional.
810          (b) A local mental health authority or its designee, in conjunction with the child's
811     current treating mental health professional, is authorized to issue a written order for the
812     immediate placement of a child not previously released from an order of commitment into a
813     more restrictive environment, if the local authority or its designee and the child's current
814     treating mental health professional has reason to believe that the less restrictive environment in
815     which the child has been placed is exacerbating the child's mental illness, or increasing the risk
816     of harm to self or others.
817          (c) The written order described in Subsection (12)(b) shall include the reasons for
818     placement in a more restrictive environment and shall authorize any peace officer to take the
819     child into physical custody and transport the child to a facility designated by the appropriate
820     local mental health authority in conjunction with the child's current treating mental health
821     professional. Prior to admission to the more restrictive environment, copies of the order shall
822     be personally delivered to the child, the child's parent or legal guardian, the administrator of the
823     more restrictive environment, or the administrator's designee, and the child's former treatment
824     provider or facility.
825          (d) If the child has been in a less restrictive environment for more than 30 days and is
826     aggrieved by the change to a more restrictive environment, the child or the child's
827     representative may request a review within 30 days of the change, by a neutral and detached
828     fact finder as described in Subsection (3). The fact finder shall determine whether:
829          (i) the less restrictive environment in which the child has been placed is exacerbating
830     the child's mental illness or increasing the risk of harm to self or others; or
831          (ii) the less restrictive environment in which the child has been placed is not
832     exacerbating the child's mental illness or increasing the risk of harm to self or others, in which
833     case the fact finder shall designate that the child remain in the less restrictive environment.

834          (e) Nothing in this section prevents a local mental health authority or its designee, in
835     conjunction with the child's current mental health professional, from discharging a child from
836     commitment or from placing a child in an environment that is less restrictive than that
837     designated by the neutral and detached fact finder.
838          (13) Each local mental health authority or its designee, in conjunction with the child's
839     current treating mental health professional shall discharge any child who, in the opinion of that
840     local authority, or its designee, and the child's current treating mental health professional, no
841     longer meets the criteria specified in Subsection (4), except as provided by Section 78A-6-120.
842     The local authority and the mental health professional shall assure that any further supportive
843     services required to meet the child's needs upon release will be provided.
844          (14) Even though a child has been committed to the physical custody of a local mental
845     health authority under this section, the child is still entitled to additional due process
846     proceedings, in accordance with Section 62A-15-704, before any treatment that may affect a
847     constitutionally protected liberty or privacy interest is administered. Those treatments include,
848     but are not limited to, antipsychotic medication, electroshock therapy, and psychosurgery.