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7 LONG TITLE
8 General Description:
9 This bill addresses court-ordered treatment.
10 Highlighted Provisions:
11 This bill:
12 ▸ requires the Utah Substance Use and Mental Health Advisory Council to study
13 issues relating to civil commitment;
14 ▸ provides a sunset date for the reporting requirement;
15 ▸ requires a local mental health authority to notify a peace officer or mental health
16 officer when certain individuals are released from temporary involuntary
17 commitment;
18 ▸ amends the amount of time an individual may be held under a temporary
19 commitment;
20 ▸ amends the criteria under which a court shall order the involuntary commitment of
21 an individual with a mental illness;
22 ▸ amends the criteria and procedure for court-ordered assisted outpatient treatment;
23 ▸ amends the criteria under which a court may order the involuntary commitment of
24 an individual with an intellectual disability;
25 ▸ describes information that must be provided to an individual when the individual is
26 discharged from involuntary commitment; and
27 ▸ makes technical and conforming changes.
28 Money Appropriated in this Bill:
29 None
30 Other Special Clauses:
31 This bill provides a special effective date.
32 This bill provides a coordination clause.
33 Utah Code Sections Affected:
34 AMENDS:
35 17-43-301, as last amended by Laws of Utah 2023, Chapters 15, 327
36 26B-5-331 (Superseded 07/01/24), as renumbered and amended by Laws of Utah
37 2023, Chapter 308
38 26B-5-331 (Effective 07/01/24), as last amended by Laws of Utah 2023, Chapter 310
39 and renumbered and amended by Laws of Utah 2023, Chapter 308
40 26B-5-332, as renumbered and amended by Laws of Utah 2023, Chapter 308
41 26B-5-351, as renumbered and amended by Laws of Utah 2023, Chapter 308
42 26B-6-607, as renumbered and amended by Laws of Utah 2023, Chapter 308
43 26B-6-608, as renumbered and amended by Laws of Utah 2023, Chapter 308
44 63I-2-226 (Superseded 07/01/24), as last amended by Laws of Utah 2023, Chapters 33,
45 139, 249, 295, and 465 and repealed and reenacted by Laws of Utah 2023, Chapter
46 329
47 63I-2-226 (Effective 07/01/24), as last amended by Laws of Utah 2023, Chapters 33,
48 139, 249, 295, 310, and 465 and repealed and reenacted by Laws of Utah 2023,
49 Chapter 329 and last amended by Coordination Clause, Laws of Utah 2023, Chapter
50 329
51 ENACTS:
52 26B-5-302.5, Utah Code Annotated 1953
53 REPEALS:
54 26B-5-350, as renumbered and amended by Laws of Utah 2023, Chapter 308
55 Utah Code Sections Affected By Coordination Clause:
56 26B-5-332, as renumbered and amended by Laws of Utah 2023, Chapter 308
57
58 Be it enacted by the Legislature of the state of Utah:
59 Section 1. Section 17-43-301 is amended to read:
60 17-43-301. Local mental health authorities -- Responsibilities.
61 (1) As used in this section:
62 (a) "Assisted outpatient treatment" means the same as that term is defined in Section
63 26B-5-301.
64 (b) "Crisis worker" means the same as that term is defined in Section 26B-5-610.
65 (c) "Local mental health crisis line" means the same as that term is defined in Section
66 26B-5-610.
67 (d) "Mental health therapist" means the same as that term is defined in Section
68 58-60-102.
69 (e) "Public funds" means the same as that term is defined in Section 17-43-303.
70 (f) "Statewide mental health crisis line" means the same as that term is defined in
71 Section 26B-5-610.
72 (2) (a) (i) In each county operating under a county executive-council form of
73 government under Section 17-52a-203, the county legislative body is the local mental health
74 authority, provided however that any contract for plan services shall be administered by the
75 county executive.
76 (ii) In each county operating under a council-manager form of government under
77 Section 17-52a-204, the county manager is the local mental health authority.
78 (iii) In each county other than a county described in Subsection (2)(a)(i) or (ii), the
79 county legislative body is the local mental health authority.
80 (b) Within legislative appropriations and county matching funds required by this
81 section, under the direction of the division, each local mental health authority shall:
82 (i) provide mental health services to individuals within the county; and
83 (ii) cooperate with efforts of the division to promote integrated programs that address
84 an individual's substance use, mental health, and physical healthcare needs, as described in
85 Section 26B-5-102.
86 (c) Within legislative appropriations and county matching funds required by this
87 section, each local mental health authority shall cooperate with the efforts of the department to
88 promote a system of care, as defined in Section 26B-1-102, for minors with or at risk for
89 complex emotional and behavioral needs, as described in Section 26B-1-202.
90 (3) (a) By executing an interlocal agreement under Title 11, Chapter 13, Interlocal
91 Cooperation Act, two or more counties may join to:
92 (i) provide mental health prevention and treatment services; or
93 (ii) create a united local health department that combines substance use treatment
94 services, mental health services, and local health department services in accordance with
95 Subsection (4).
96 (b) The legislative bodies of counties joining to provide services may establish
97 acceptable ways of apportioning the cost of mental health services.
98 (c) Each agreement for joint mental health services shall:
99 (i) (A) designate the treasurer of one of the participating counties or another person as
100 the treasurer for the combined mental health authorities and as the custodian of money
101 available for the joint services; and
102 (B) provide that the designated treasurer, or other disbursing officer authorized by the
103 treasurer, may make payments from the money available for the joint services upon audit of the
104 appropriate auditing officer or officers representing the participating counties;
105 (ii) provide for the appointment of an independent auditor or a county auditor of one of
106 the participating counties as the designated auditing officer for the combined mental health
107 authorities;
108 (iii) (A) provide for the appointment of the county or district attorney of one of the
109 participating counties as the designated legal officer for the combined mental health
110 authorities; and
111 (B) authorize the designated legal officer to request and receive the assistance of the
112 county or district attorneys of the other participating counties in defending or prosecuting
113 actions within their counties relating to the combined mental health authorities; and
114 (iv) provide for the adoption of management, clinical, financial, procurement,
115 personnel, and administrative policies as already established by one of the participating
116 counties or as approved by the legislative body of each participating county or interlocal board.
117 (d) An agreement for joint mental health services may provide for:
118 (i) joint operation of services and facilities or for operation of services and facilities
119 under contract by one participating local mental health authority for other participating local
120 mental health authorities; and
121 (ii) allocation of appointments of members of the mental health advisory council
122 between or among participating counties.
123 (4) A county governing body may elect to combine the local mental health authority
124 with the local substance abuse authority created in Part 2, Local Substance Abuse Authorities,
125 and the local health department created in Title 26A, Chapter 1, Part 1, Local Health
126 Department Act, to create a united local health department under Section 26A-1-105.5. A local
127 mental health authority that joins with a united local health department shall comply with this
128 part.
129 (5) (a) Each local mental health authority is accountable to the department and the state
130 with regard to the use of state and federal funds received from those departments for mental
131 health services, regardless of whether the services are provided by a private contract provider.
132 (b) Each local mental health authority shall comply, and require compliance by its
133 contract provider, with all directives issued by the department regarding the use and
134 expenditure of state and federal funds received from those departments for the purpose of
135 providing mental health programs and services. The department shall ensure that those
136 directives are not duplicative or conflicting, and shall consult and coordinate with local mental
137 health authorities with regard to programs and services.
138 (6) (a) Each local mental health authority shall:
139 (i) review and evaluate mental health needs and services, including mental health needs
140 and services for:
141 (A) an individual incarcerated in a county jail or other county correctional facility; and
142 (B) an individual who is a resident of the county and who is court ordered to receive
143 assisted outpatient treatment under Section 26B-5-351;
144 (ii) in accordance with Subsection (6)(b), annually prepare and submit to the division a
145 plan approved by the county legislative body for mental health funding and service delivery,
146 either directly by the local mental health authority or by contract;
147 (iii) establish and maintain, either directly or by contract, programs licensed under Title
148 26B, Chapter 2, Part 1, Human Services Programs and Facilities;
149 (iv) appoint, directly or by contract, a full-time or part-time director for mental health
150 programs and prescribe the director's duties;
151 (v) provide input and comment on new and revised rules established by the division;
152 (vi) establish and require contract providers to establish administrative, clinical,
153 personnel, financial, procurement, and management policies regarding mental health services
154 and facilities, in accordance with the rules of the division, and state and federal law;
155 (vii) establish mechanisms allowing for direct citizen input;
156 (viii) annually contract with the division to provide mental health programs and
157 services in accordance with the provisions of Title 26B, Chapter 5, Health Care - Substance
158 Use and Mental Health;
159 (ix) comply with all applicable state and federal statutes, policies, audit requirements,
160 contract requirements, and any directives resulting from those audits and contract requirements;
161 (x) provide funding equal to at least 20% of the state funds that it receives to fund
162 services described in the plan;
163 (xi) comply with the requirements and procedures of Title 11, Chapter 13, Interlocal
164 Cooperation Act, Title 17B, Chapter 1, Part 6, Fiscal Procedures for Special Districts, and Title
165 51, Chapter 2a, Accounting Reports from Political Subdivisions, Interlocal Organizations, and
166 Other Local Entities Act; and
167 (xii) take and retain physical custody of minors committed to the physical custody of
168 local mental health authorities by a judicial proceeding under Title 26B, Chapter 5, Part 4,
169 Commitment of Persons Under Age 18.
170 (b) Each plan under Subsection (6)(a)(ii) shall include services for adults, youth, and
171 children, which shall include:
172 (i) inpatient care and services;
173 (ii) residential care and services;
174 (iii) outpatient care and services;
175 (iv) 24-hour crisis care and services;
176 (v) psychotropic medication management;
177 (vi) psychosocial rehabilitation, including vocational training and skills development;
178 (vii) case management;
179 (viii) community supports, including in-home services, housing, family support
180 services, and respite services;
181 (ix) consultation and education services, including case consultation, collaboration
182 with other county service agencies, public education, and public information; and
183 (x) services to persons incarcerated in a county jail or other county correctional facility.
184 (7) (a) If a local mental health authority provides for a local mental health crisis line
185 under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the local
186 mental health authority shall:
187 (i) collaborate with the statewide mental health crisis line described in Section
188 26B-5-610;
189 (ii) ensure that each individual who answers calls to the local mental health crisis line:
190 (A) is a mental health therapist or a crisis worker; and
191 (B) meets the standards of care and practice established by the Division of Integrated
192 Healthcare, in accordance with Section 26B-5-610; and
193 (iii) ensure that when necessary, based on the local mental health crisis line's capacity,
194 calls are immediately routed to the statewide mental health crisis line to ensure that when an
195 individual calls the local mental health crisis line, regardless of the time, date, or number of
196 individuals trying to simultaneously access the local mental health crisis line, a mental health
197 therapist or a crisis worker answers the call without the caller first:
198 (A) waiting on hold; or
199 (B) being screened by an individual other than a mental health therapist or crisis
200 worker.
201 (b) If a local mental health authority does not provide for a local mental health crisis
202 line under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the
203 local mental health authority shall use the statewide mental health crisis line as a local crisis
204 line resource.
205 (8) Before disbursing any public funds, each local mental health authority shall require
206 that each entity that receives any public funds from a local mental health authority agrees in
207 writing that:
208 (a) the entity's financial records and other records relevant to the entity's performance
209 of the services provided to the mental health authority shall be subject to examination by:
210 (i) the division;
211 (ii) the local mental health authority director;
212 (iii) (A) the county treasurer and county or district attorney; or
213 (B) if two or more counties jointly provide mental health services under an agreement
214 under Subsection (3), the designated treasurer and the designated legal officer;
215 (iv) the county legislative body; and
216 (v) in a county with a county executive that is separate from the county legislative
217 body, the county executive;
218 (b) the county auditor may examine and audit the entity's financial and other records
219 relevant to the entity's performance of the services provided to the local mental health
220 authority; and
221 (c) the entity will comply with the provisions of Subsection (5)(b).
222 (9) A local mental health authority may receive property, grants, gifts, supplies,
223 materials, contributions, and any benefit derived therefrom, for mental health services. If those
224 gifts are conditioned upon their use for a specified service or program, they shall be so used.
225 (10) Public funds received for the provision of services pursuant to the local mental
226 health plan may not be used for any other purpose except those authorized in the contract
227 between the local mental health authority and the provider for the provision of plan services.
228 (11) A local mental health authority shall provide assisted outpatient treatment
229 services[
230 under Section 26B-5-351 to receive assisted outpatient treatment.
231 Section 2. Section 26B-5-302.5 is enacted to read:
232 26B-5-302.5. Study concerning civil commitment and the Utah State Hospital.
233 (1) (a) The Utah Substance Use and Mental Health Advisory Council shall study and
234 make recommendations concerning the need for expanded civil commitment capacity in the
235 state, including an analysis of the anticipated impact that any changes to civil commitment
236 standards made during the 2024 General Session will have on the number of individuals
237 subject to civil commitment.
238 (b) The study and recommendations described in Subsection (1)(a) shall also address
239 the role of the Utah State Hospital in serving patients who are subject to court-ordered
240 treatment, including civil commitment.
241 (c) The study and recommendations described in Subsection (1)(a) shall also address
242 any additional resources or services needed to decrease the likelihood that individuals who are
243 subject to court-ordered treatment, including civil commitment, will enter or reenter the Utah
244 State Hospital or another inpatient facility.
245 (2) The Utah Substance Use and Mental Health Advisory Council shall provide a
246 report on the study and recommendations described in Subsection (1) to the Judiciary Interim
247 Committee at or before the committee's October 2024 interim meeting.
248 Section 3. Section 26B-5-331 (Superseded 07/01/24) is amended to read:
249 26B-5-331 (Superseded 07/01/24). Temporary commitment -- Requirements and
250 procedures -- Rights.
251 (1) An adult shall be temporarily, involuntarily committed to a local mental health
252 authority upon:
253 (a) a written application that:
254 (i) is completed by a responsible individual who has reason to know, stating a belief
255 that the adult, due to mental illness, is likely to pose substantial danger to self or others if not
256 restrained and stating the personal knowledge of the adult's condition or circumstances that
257 lead to the individual's belief; and
258 (ii) includes a certification by a licensed physician, licensed physician assistant,
259 licensed nurse practitioner, or designated examiner stating that the physician, physician
260 assistant, nurse practitioner, or designated examiner has examined the adult within a three-day
261 period immediately preceding the certification, and that the physician, physician assistant,
262 nurse practitioner, or designated examiner is of the opinion that, due to mental illness, the adult
263 poses a substantial danger to self or others; or
264 (b) a peace officer or a mental health officer:
265 (i) observing an adult's conduct that gives the peace officer or mental health officer
266 probable cause to believe that:
267 (A) the adult has a mental illness; and
268 (B) because of the adult's mental illness and conduct, the adult poses a substantial
269 danger to self or others; and
270 (ii) completing a temporary commitment application that:
271 (A) is on a form prescribed by the division;
272 (B) states the peace officer's or mental health officer's belief that the adult poses a
273 substantial danger to self or others;
274 (C) states the specific nature of the danger;
275 (D) provides a summary of the observations upon which the statement of danger is
276 based; and
277 (E) provides a statement of the facts that called the adult to the peace officer's or
278 mental health officer's attention.
279 (2) If at any time a patient committed under this section no longer meets the
280 commitment criteria described in Subsection (1), the local mental health authority or the local
281 mental health authority's designee shall:
282 (a) document the change and release the patient[
283 (b) if the patient was admitted under Subsection (1)(b), notify the peace officer or
284 mental health officer of the patient's release.
285 (3) [
286 hours after commitment, excluding Saturdays, Sundays, and legal holidays, unless:
287 [
288 is commenced, which may be accompanied by an order of detention described in Subsection
289 26B-5-332(4); or
290 [
291 [
292
293
294 [
295 [
296
297 [
298
299 [
300
301
302 [
303 (4) Upon a written application described in Subsection (1)(a) or the observation and
304 belief described in Subsection (1)(b)(i), the adult shall be:
305 (a) taken into a peace officer's protective custody, by reasonable means, if necessary for
306 public safety; and
307 (b) transported for temporary commitment to a facility designated by the local mental
308 health authority, by means of:
309 (i) an ambulance, if the adult meets any of the criteria described in Section 26B-4-119;
310 (ii) an ambulance, if a peace officer is not necessary for public safety, and
311 transportation arrangements are made by a physician, physician assistant, nurse practitioner,
312 designated examiner, or mental health officer;
313 (iii) the city, town, or municipal law enforcement authority with jurisdiction over the
314 location where the adult is present, if the adult is not transported by ambulance;
315 (iv) the county sheriff, if the designated facility is outside of the jurisdiction of the law
316 enforcement authority described in Subsection (4)(b)(iii) and the adult is not transported by
317 ambulance; or
318 (v) nonemergency secured behavioral health transport as that term is defined in Section
319 26B-4-101.
320 (5) Notwithstanding Subsection (4):
321 (a) an individual shall be transported by ambulance to an appropriate medical facility
322 for treatment if the individual requires physical medical attention;
323 (b) if an officer has probable cause to believe, based on the officer's experience and
324 de-escalation training that taking an individual into protective custody or transporting an
325 individual for temporary commitment would increase the risk of substantial danger to the
326 individual or others, a peace officer may exercise discretion to not take the individual into
327 custody or transport the individual, as permitted by policies and procedures established by the
328 officer's law enforcement agency and any applicable federal or state statute, or case law; and
329 (c) if an officer exercises discretion under Subsection (4)(b) to not take an individual
330 into protective custody or transport an individual, the officer shall document in the officer's
331 report the details and circumstances that led to the officer's decision.
332 (6) (a) The local mental health authority shall inform an adult patient committed under
333 this section of the reason for commitment.
334 (b) An adult patient committed under this section has the right to:
335 (i) within three hours after arrival at the local mental health authority, make a
336 telephone call, at the expense of the local mental health authority, to an individual of the
337 patient's choice; and
338 (ii) see and communicate with an attorney.
339 (7) (a) Title 63G, Chapter 7, Governmental Immunity Act of Utah, applies to this
340 section.
341 (b) This section does not create a special duty of care.
342 (8) (a) A local mental health authority shall provide discharge instructions to each
343 individual committed under this section at or before the time the individual is discharged from
344 the local mental health authority's custody, regardless of whether the individual is discharged
345 by being released, taken into a peace officer's protective custody, transported to a medical
346 facility or other facility, or other circumstances.
347 (b) Discharge instructions provided under Subsection (8)(a) shall include:
348 (i) a summary of why the individual was committed to the local mental health
349 authority;
350 (ii) detailed information about why the individual is being discharged from the local
351 mental health authority's custody;
352 (iii) a safety plan for the individual based on the individual's mental illness or mental or
353 emotional state;
354 (iv) notification to the individual's primary care provider, if applicable;
355 (v) if the individual is discharged without food, housing, or economic security, a
356 referral to appropriate services, if such services exist in the individual's community;
357 (vi) the phone number to call or text for a crisis services hotline, and information about
358 the availability of peer support services;
359 (vii) a copy of any psychiatric advance directive presented to the local mental health
360 authority, if applicable;
361 (viii) information about how to establish a psychiatric advance directive if one was not
362 presented to the local mental health authority;
363 (ix) as applicable, information about medications that were changed or discontinued
364 during the commitment;
365 (x) a list of any screening or diagnostic tests conducted during the commitment;
366 (xi) a summary of therapeutic treatments provided during the commitment;
367 (xii) any laboratory work, including blood samples or imaging, that was completed or
368 attempted during the commitment; and
369 (xiii) information about how to contact the local mental health authority if needed.
370 (c) If an individual's medications were changed, or if an individual was prescribed new
371 medications while committed under this section, discharge instructions provided under
372 Subsection (8)(a) shall include a clinically appropriate supply of medications, as determined by
373 a licensed health care provider, to allow the individual time to access another health care
374 provider or follow-up appointment.
375 (d) If an individual refuses to accept discharge instructions, the local mental health
376 authority shall document the refusal in the individual's medical record.
377 (e) If an individual's discharge instructions include referrals to services under
378 Subsection (8)(b)(v), the local mental health authority shall document those referrals in the
379 individual's medical record.
380 (f) The local mental health authority shall attempt to follow up with a discharged
381 individual at least 48 hours after discharge, and may use peer support professionals when
382 performing follow-up care or developing a continuing care plan.
383 Section 4. Section 26B-5-331 (Effective 07/01/24) is amended to read:
384 26B-5-331 (Effective 07/01/24). Temporary commitment -- Requirements and
385 procedures -- Rights.
386 (1) An adult shall be temporarily, involuntarily committed to a local mental health
387 authority upon:
388 (a) a written application that:
389 (i) is completed by a responsible individual who has reason to know, stating a belief
390 that the adult, due to mental illness, is likely to pose substantial danger to self or others if not
391 restrained and stating the personal knowledge of the adult's condition or circumstances that
392 lead to the individual's belief; and
393 (ii) includes a certification by a licensed physician, licensed physician assistant,
394 licensed nurse practitioner, or designated examiner stating that the physician, physician
395 assistant, nurse practitioner, or designated examiner has examined the adult within a three-day
396 period immediately preceding the certification, and that the physician, physician assistant,
397 nurse practitioner, or designated examiner is of the opinion that, due to mental illness, the adult
398 poses a substantial danger to self or others; or
399 (b) a peace officer or a mental health officer:
400 (i) observing an adult's conduct that gives the peace officer or mental health officer
401 probable cause to believe that:
402 (A) the adult has a mental illness; and
403 (B) because of the adult's mental illness and conduct, the adult poses a substantial
404 danger to self or others; and
405 (ii) completing a temporary commitment application that:
406 (A) is on a form prescribed by the division;
407 (B) states the peace officer's or mental health officer's belief that the adult poses a
408 substantial danger to self or others;
409 (C) states the specific nature of the danger;
410 (D) provides a summary of the observations upon which the statement of danger is
411 based; and
412 (E) provides a statement of the facts that called the adult to the peace officer's or
413 mental health officer's attention.
414 (2) If at any time a patient committed under this section no longer meets the
415 commitment criteria described in Subsection (1), the local mental health authority or the local
416 mental health authority's designee shall:
417 (a) document the change and release the patient[
418 (b) if the patient was admitted under Subsection (1)(b), notify the peace officer or
419 mental health officer of the patient's release.
420 (3) [
421 hours after commitment, excluding Saturdays, Sundays, and legal holidays, unless:
422 [
423 is commenced, which may be accompanied by an order of detention described in Subsection
424 26B-5-332(4); or
425 [
426 [
427
428
429 [
430 [
431
432 [
433
434 [
435
436
437 [
438 (4) Upon a written application described in Subsection (1)(a) or the observation and
439 belief described in Subsection (1)(b)(i), the adult shall be:
440 (a) taken into a peace officer's protective custody, by reasonable means, if necessary for
441 public safety; and
442 (b) transported for temporary commitment to a facility designated by the local mental
443 health authority, by means of:
444 (i) an ambulance, if the adult meets any of the criteria described in Section 26B-4-119;
445 (ii) an ambulance, if a peace officer is not necessary for public safety, and
446 transportation arrangements are made by a physician, physician assistant, nurse practitioner,
447 designated examiner, or mental health officer;
448 (iii) the city, town, or municipal law enforcement authority with jurisdiction over the
449 location where the adult is present, if the adult is not transported by ambulance;
450 (iv) the county sheriff, if the designated facility is outside of the jurisdiction of the law
451 enforcement authority described in Subsection (4)(b)(iii) and the adult is not transported by
452 ambulance; or
453 (v) nonemergency secured behavioral health transport as that term is defined in Section
454 53-2d-101.
455 (5) Notwithstanding Subsection (4):
456 (a) an individual shall be transported by ambulance to an appropriate medical facility
457 for treatment if the individual requires physical medical attention;
458 (b) if an officer has probable cause to believe, based on the officer's experience and
459 de-escalation training that taking an individual into protective custody or transporting an
460 individual for temporary commitment would increase the risk of substantial danger to the
461 individual or others, a peace officer may exercise discretion to not take the individual into
462 custody or transport the individual, as permitted by policies and procedures established by the
463 officer's law enforcement agency and any applicable federal or state statute, or case law; and
464 (c) if an officer exercises discretion under Subsection (4)(b) to not take an individual
465 into protective custody or transport an individual, the officer shall document in the officer's
466 report the details and circumstances that led to the officer's decision.
467 (6) (a) The local mental health authority shall inform an adult patient committed under
468 this section of the reason for commitment.
469 (b) An adult patient committed under this section has the right to:
470 (i) within three hours after arrival at the local mental health authority, make a
471 telephone call, at the expense of the local mental health authority, to an individual of the
472 patient's choice; and
473 (ii) see and communicate with an attorney.
474 (7) (a) Title 63G, Chapter 7, Governmental Immunity Act of Utah, applies to this
475 section.
476 (b) This section does not create a special duty of care.
477 (8) (a) A local mental health authority shall provide discharge instructions to each
478 individual committed under this section at or before the time the individual is discharged from
479 the local mental health authority's custody, regardless of whether the individual is discharged
480 by being released, taken into a peace officer's protective custody, transported to a medical
481 facility or other facility, or other circumstances.
482 (b) Discharge instructions provided under Subsection (8)(a) shall include:
483 (i) a summary of why the individual was committed to the local mental health
484 authority;
485 (ii) detailed information about why the individual is being discharged from the local
486 mental health authority's custody;
487 (iii) a safety plan for the individual based on the individual's mental illness or mental or
488 emotional state;
489 (iv) notification to the individual's primary care provider, if applicable;
490 (v) if the individual is discharged without food, housing, or economic security, a
491 referral to appropriate services, if such services exist in the individual's community;
492 (vi) the phone number to call or text for a crisis services hotline, and information about
493 the availability of peer support services;
494 (vii) a copy of any psychiatric advance directive presented to the local mental health
495 authority, if applicable;
496 (viii) information about how to establish a psychiatric advance directive if one was not
497 presented to the local mental health authority;
498 (ix) as applicable, information about medications that were changed or discontinued
499 during the commitment;
500 (x) a list of any screening or diagnostic tests conducted during the commitment;
501 (xi) a summary of therapeutic treatments provided during the commitment;
502 (xii) any laboratory work, including blood samples or imaging, that was completed or
503 attempted during the commitment; and
504 (xiii) information about how to contact the local mental health authority if needed.
505 (c) If an individual's medications were changed, or if an individual was prescribed new
506 medications while committed under this section, discharge instructions provided under
507 Subsection (8)(a) shall include a clinically appropriate supply of medications, as determined by
508 a licensed health care provider, to allow the individual time to access another health care
509 provider or follow-up appointment.
510 (d) If an individual refuses to accept discharge instructions, the local mental health
511 authority shall document the refusal in the individual's medical record.
512 (e) If an individual's discharge instructions include referrals to services under
513 Subsection (8)(b)(v), the local mental health authority shall document those referrals in the
514 individual's medical record.
515 (f) The local mental health authority shall attempt to follow up with a discharged
516 individual at least 48 hours after discharge, and may use peer support professionals when
517 performing follow-up care or developing a continuing care plan.
518 The following section is affected by a coordination clause at the end of this bill.
519 Section 5. Section 26B-5-332 is amended to read:
520 26B-5-332. Involuntary commitment under court order -- Examination --
521 Hearing -- Power of court -- Findings required -- Costs.
522 (1) A responsible individual who has credible knowledge of an adult's mental illness
523 and the condition or circumstances that have led to the adult's need to be involuntarily
524 committed may initiate an involuntary commitment court proceeding by filing, in the court in
525 the county where the proposed patient resides or is found, a written application that includes:
526 (a) unless the court finds that the information is not reasonably available, the proposed
527 patient's:
528 (i) name;
529 (ii) date of birth; and
530 (iii) social security number;
531 (b) (i) a certificate of a licensed physician or a designated examiner stating that within
532 the seven-day period immediately preceding the certification, the physician or designated
533 examiner examined the proposed patient and is of the opinion that the proposed patient has a
534 mental illness and should be involuntarily committed; or
535 (ii) a written statement by the applicant that:
536 (A) the proposed patient has been requested to, but has refused to, submit to an
537 examination of mental condition by a licensed physician or designated examiner;
538 (B) is sworn to under oath; and
539 (C) states the facts upon which the application is based; and
540 (c) a statement whether the proposed patient has previously been under an assisted
541 outpatient treatment order, if known by the applicant.
542 (2) Before issuing a judicial order, the court:
543 (a) shall require the applicant to consult with the appropriate local mental health
544 authority at or before the hearing; and
545 (b) may direct a mental health professional from the local mental health authority to
546 interview the applicant and the proposed patient to determine the existing facts and report the
547 existing facts to the court.
548 (3) The court may issue an order, directed to a mental health officer or peace officer, to
549 immediately place a proposed patient in the custody of a local mental health authority or in a
550 temporary emergency facility, as described in Section 26B-5-334, to be detained for the
551 purpose of examination if:
552 (a) the court finds from the application, any other statements under oath, or any reports
553 from a mental health professional that there is a reasonable basis to believe that the proposed
554 patient has a mental illness that poses a danger to self or others and requires involuntary
555 commitment pending examination and hearing; or
556 (b) the proposed patient refuses to submit to an interview with a mental health
557 professional as directed by the court or to go to a treatment facility voluntarily.
558 (4) (a) The court shall provide notice of commencement of proceedings for involuntary
559 commitment, setting forth the allegations of the application and any reported facts, together
560 with a copy of any official order of detention, to a proposed patient before, or upon, placement
561 of the proposed patient in the custody of a local mental health authority or, with respect to any
562 proposed patient presently in the custody of a local mental health authority whose status is
563 being changed from voluntary to involuntary, upon the filing of an application for that purpose
564 with the court.
565 (b) The place of detention shall maintain a copy of the order of detention.
566 (5) (a) The court shall provide notice of commencement of proceedings for involuntary
567 commitment as soon as practicable to the applicant, any legal guardian, any immediate adult
568 family members, legal counsel for the parties involved, the local mental health authority or the
569 local mental health authority's designee, and any other persons whom the proposed patient or
570 the court designates.
571 (b) Except as provided in Subsection (5)(c), the notice under Subsection (5)(a) shall
572 advise the persons that a hearing may be held within the time provided by law.
573 (c) If the proposed patient refuses to permit release of information necessary for
574 provisions of notice under this subsection, the court shall determine the extent of notice.
575 (6) Proceedings for commitment of an individual under 18 years old to a local mental
576 health authority may be commenced in accordance with Part 4, Commitment of Persons Under
577 Age 18.
578 (7) (a) The court may, in the court's discretion, transfer the case to any other district
579 court within this state, if the transfer will not be adverse to the interest of the proposed patient.
580 (b) If a case is transferred under Subsection (7)(a), the parties to the case may be
581 transferred and the local mental health authority may be substituted in accordance with Utah
582 Rules of Civil Procedure, Rule 25.
583 (8) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
584 of a judicial order, or after commitment of a proposed patient to a local mental health authority
585 or the local mental health authority's designee under court order for detention or examination,
586 the court shall appoint two designated examiners:
587 (a) who did not sign the civil commitment application nor the civil commitment
588 certification under Subsection (1);
589 (b) one of whom is a licensed physician; and
590 (c) one of whom may be designated by the proposed patient or the proposed patient's
591 counsel, if that designated examiner is reasonably available.
592 (9) The court shall schedule a hearing to be held within 10 calendar days after the day
593 on which the designated examiners are appointed.
594 (10) (a) The designated examiners shall:
595 (i) conduct the examinations separately;
596 (ii) conduct the examinations at the home of the proposed patient, at a hospital or other
597 medical facility, or at any other suitable place, including through telehealth, that is not likely to
598 have a harmful effect on the proposed patient's health;
599 (iii) inform the proposed patient, if not represented by an attorney:
600 (A) that the proposed patient does not have to say anything;
601 (B) of the nature and reasons for the examination;
602 (C) that the examination was ordered by the court;
603 (D) that any information volunteered could form part of the basis for the proposed
604 patient's involuntary commitment;
605 (E) that findings resulting from the examination will be made available to the court;
606 and
607 (F) that the designated examiner may, under court order, obtain the proposed patient's
608 mental health records; and
609 (iv) within 24 hours of examining the proposed patient, report to the court, orally or in
610 writing, whether the proposed patient is mentally ill, has agreed to voluntary commitment, as
611 described in Section 26B-5-360, or has acceptable programs available to the proposed patient
612 without court proceedings.
613 (b) If a designated examiner reports orally under Subsection (10)(a), the designated
614 examiner shall immediately send a written report to the clerk of the court.
615 (11) If a designated examiner is unable to complete an examination on the first attempt
616 because the proposed patient refuses to submit to the examination, the court shall fix a
617 reasonable compensation to be paid to the examiner.
618 (12) If the local mental health authority, the local mental health authority's designee, or
619 a medical examiner determines before the court hearing that the conditions justifying the
620 findings leading to a commitment hearing no longer exist, the local mental health authority, the
621 local mental health authority's designee, or the medical examiner shall immediately report the
622 determination to the court.
623 (13) The court may terminate the proceedings and dismiss the application at any time,
624 including before the hearing, if the designated examiners or the local mental health authority or
625 the local mental health authority's designee informs the court that the proposed patient:
626 (a) does not meet the criteria in Subsection (16);
627 (b) has agreed to voluntary commitment, as described in Section 26B-5-360;
628 (c) has acceptable options for treatment programs that are available without court
629 proceedings; or
630 (d) meets the criteria for assisted outpatient treatment described in Section 26B-5-351.
631 (14) (a) Before the hearing, the court shall provide the proposed patient an opportunity
632 to be represented by counsel, and if neither the proposed patient nor others provide counsel, the
633 court shall appoint counsel and allow counsel sufficient time to consult with the proposed
634 patient before the hearing.
635 (b) In the case of an indigent proposed patient, the county in which the proposed
636 patient resides or is found shall make payment of reasonable attorney fees for counsel, as
637 determined by the court.
638 (15) (a) (i) The court shall afford the proposed patient, the applicant, and any other
639 person to whom notice is required to be given an opportunity to appear at the hearing, to
640 testify, and to present and cross-examine witnesses.
641 (ii) The court may, in the court's discretion, receive the testimony of any other person.
642 (iii) The court may allow a waiver of the proposed patient's right to appear for good
643 cause, which cause shall be set forth in the record, or an informed waiver by the patient, which
644 shall be included in the record.
645 (b) The court is authorized to exclude any person not necessary for the conduct of the
646 proceedings and may, upon motion of counsel, require the testimony of each designated
647 examiner to be given out of the presence of any other designated examiners.
648 (c) The court shall conduct the hearing in as informal a manner as may be consistent
649 with orderly procedure, and in a physical setting that is not likely to have a harmful effect on
650 the mental health of the proposed patient, while preserving the due process rights of the
651 proposed patient.
652 (d) The court shall consider any relevant historical and material information that is
653 offered, subject to the rules of evidence, including reliable hearsay under Utah Rules of
654 Evidence, Rule 1102.
655 (e) (i) A local mental health authority or the local mental health authority's designee or
656 the physician in charge of the proposed patient's care shall, at the time of the hearing, provide
657 the court with the following information:
658 (A) the detention order;
659 (B) admission notes;
660 (C) the diagnosis;
661 (D) any doctors' orders;
662 (E) progress notes;
663 (F) nursing notes;
664 (G) medication records pertaining to the current commitment; and
665 (H) whether the proposed patient has previously been civilly committed or under an
666 order for assisted outpatient treatment.
667 (ii) The information described in Subsection (15)(e)(i) shall also be supplied to the
668 proposed patient's counsel at the time of the hearing, and at any time prior to the hearing upon
669 request.
670 (16) (a) The court shall order commitment of an adult proposed patient to a local
671 mental health authority if, upon completion of the hearing and consideration of the information
672 presented, the court finds by clear and convincing evidence that:
673 (i) [
674 recent actions, omissions, or behaviors, the proposed patient:[
675 (A) poses a substantial danger to self or others; or
676 (B) lacks the ability to engage in a rational decision-making process regarding the
677 acceptance of mental treatment as demonstrated by evidence of inability to weigh the possible
678 risks of accepting or rejecting treatment;
679 [
680
681 [
682
683
684 [
685 commitment; and
686 [
687 treatment that is adequate and appropriate to the proposed patient's conditions and needs.
688 (b) (i) If, at the hearing, the court determines that the proposed patient has a mental
689 illness but does not meet the other criteria described in Subsection (16)(a), the court may
690 consider whether the proposed patient meets the criteria for assisted outpatient treatment under
691 Section 26B-5-351.
692 (ii) The court may order the proposed patient to receive assisted outpatient treatment in
693 accordance with Section 26B-5-351 if, at the hearing, the court finds the proposed patient
694 meets the criteria for assisted outpatient treatment under Section 26B-5-351.
695 (iii) If the court determines that neither the criteria for commitment under Subsection
696 (16)(a) nor the criteria for assisted outpatient treatment under Section 26B-5-351 are met, the
697 court shall dismiss the proceedings after the hearing.
698 (c) The court shall maintain a list of patients proposed for civil commitment who
699 qualify for civil commitment under Subsections (16)(a)(i) and (ii), but for whom the local
700 mental health authority is unable to provide treatment as described in Subsection (16)(a)(iii).
701 (17) (a) (i) The order of commitment shall designate the period for which the patient
702 shall be treated.
703 (ii) If the patient is not under an order of commitment at the time of the hearing, the
704 patient's treatment period may not exceed six months without a review hearing.
705 (iii) Upon a review hearing, to be commenced before the expiration of the previous
706 order of commitment, an order for commitment may be for an indeterminate period, if the court
707 finds by clear and convincing evidence that the criteria described in Subsection (16) will last
708 for an indeterminate period.
709 (b) (i) The court shall maintain a current list of all patients under the court's order of
710 commitment and review the list to determine those patients who have been under an order of
711 commitment for the court designated period.
712 (ii) At least two weeks before the expiration of the designated period of any order of
713 commitment still in effect, the court that entered the original order of commitment shall inform
714 the appropriate local mental health authority or the local mental health authority's designee of
715 the expiration.
716 (iii) Upon receipt of the information described in Subsection (17)(b)(ii), the local
717 mental health authority or the local mental health authority's designee shall immediately
718 reexamine the reasons upon which the order of commitment was based.
719 (iv) If, after reexamination under Subsection (17)(b)(iii), the local mental health
720 authority or the local mental health authority's designee determines that the conditions
721 justifying commitment no longer exist, the local mental health authority or the local mental
722 health authority's designee shall discharge the patient from involuntary commitment and
723 immediately report the discharge to the court.
724 (v) If, after reexamination under Subsection (17)(b)(iii), the local mental health
725 authority or the local mental health authority's designee determines that the conditions
726 justifying commitment continue to exist, the court shall immediately appoint two designated
727 examiners and proceed under Subsections (8) through (14).
728 (c) (i) The local mental health authority or the local mental health authority's designee
729 responsible for the care of a patient under an order of commitment for an indeterminate period
730 shall, at six-month intervals, reexamine the reasons upon which the order of indeterminate
731 commitment was based.
732 (ii) If the local mental health authority or the local mental health authority's designee
733 determines that the conditions justifying commitment no longer exist, the local mental health
734 authority or the local mental health authority's designee shall discharge the patient from the
735 local mental health authority's or the local mental health authority designee's custody and
736 immediately report the discharge to the court.
737 (iii) If the local mental health authority or the local mental health authority's designee
738 determines that the conditions justifying commitment continue to exist, the local mental health
739 authority or the local mental health authority's designee shall send a written report of the
740 findings to the court.
741 (iv) A patient and the patient's counsel of record shall be notified in writing that the
742 involuntary commitment will be continued under Subsection (17)(c)(iii), the reasons for the
743 decision to continue, and that the patient has the right to a review hearing by making a request
744 to the court.
745 (v) Upon receiving a request under Subsection (17)(c)(iv), the court shall immediately
746 appoint two designated examiners and proceed under Subsections (8) through (14).
747 (18) (a) Any patient committed as a result of an original hearing or a patient's legally
748 designated representative who is aggrieved by the findings, conclusions, and order of the court
749 entered in the original hearing has the right to a new hearing upon a petition filed with the court
750 within 30 days after the day on which the court order is entered.
751 (b) The petition shall allege error or mistake in the findings, in which case the court
752 shall appoint three impartial designated examiners previously unrelated to the case to conduct
753 an additional examination of the patient.
754 (c) Except as provided in Subsection (18)(b), the court shall, in all other respects,
755 conduct the new hearing in the manner otherwise permitted.
756 (19) The county in which the proposed patient resides or is found shall pay the costs of
757 all proceedings under this section.
758 (20) (a) A local mental health authority shall provide discharge instructions to each
759 individual committed under this section at or before the time the individual is discharged from
760 the local mental health authority's custody, regardless of the circumstances under which the
761 individual is discharged.
762 (b) Discharge instructions provided under Subsection (20)(a) shall include:
763 (i) a summary of why the individual was committed to the local mental health
764 authority;
765 (ii) detailed information about why the individual is being discharged from the local
766 mental health authority's custody;
767 (iii) a safety plan for the individual based on the individual's mental illness or mental or
768 emotional state;
769 (iv) notification to the individual's primary care provider, if applicable;
770 (v) if the individual is discharged without food, housing, or economic security, a
771 referral to appropriate services, if such services exist in the individual's community;
772 (vi) the phone number to call or text for a crisis services hotline, and information about
773 the availability of peer support services;
774 (vii) a copy of any psychiatric advance directive presented to the local mental health
775 authority, if applicable;
776 (viii) information about how to establish a psychiatric advance directive if one was not
777 presented to the local mental health authority;
778 (ix) as applicable, information about medications that were changed or discontinued
779 during the commitment;
780 (x) a list of any screening or diagnostic tests conducted during the commitment;
781 (xi) a summary of therapeutic treatments provided during the commitment;
782 (xii) any laboratory work, including blood samples or imaging, that was completed or
783 attempted during the commitment; and
784 (xiii) information about how to contact the local mental health authority if needed.
785 (c) If an individual's medications were changed, or if an individual was prescribed new
786 medications while committed under this section, discharge instructions provided under
787 Subsection (20)(a) shall include a clinically appropriate supply of medications, as determined
788 by a licensed health care provider, to allow the individual time to access another health care
789 provider or follow-up appointment.
790 (d) If an individual refuses to accept discharge instructions, the local mental health
791 authority shall document the refusal in the individual's medical record.
792 (e) If an individual's discharge instructions include referrals to services under
793 Subsection (20)(b)(v), the local mental health authority shall document those referrals in the
794 individual's medical record.
795 (f) The local mental health authority shall attempt to follow up with a discharged
796 individual at least 48 hours after discharge, and may use peer support professionals when
797 performing follow-up care or developing a continuing care plan.
798 Section 6. Section 26B-5-351 is amended to read:
799 26B-5-351. Assisted outpatient treatment proceedings.
800 (1) A responsible individual who has credible knowledge of an adult's mental illness
801 and the condition or circumstances that have led to the adult's need for assisted outpatient
802 treatment may file, in the court in the county where the proposed patient resides or is found, a
803 written application that includes:
804 (a) unless the court finds that the information is not reasonably available, the proposed
805 patient's:
806 (i) name;
807 (ii) date of birth; and
808 (iii) social security number; and
809 (b) (i) a certificate of a licensed physician or a designated examiner stating that within
810 the seven-day period immediately preceding the certification, the physician or designated
811 examiner examined the proposed patient and is of the opinion that the proposed patient has a
812 mental illness and should be involuntarily committed; or
813 (ii) a written statement by the applicant that:
814 (A) the proposed patient has been requested to, but has refused to, submit to an
815 examination of mental condition by a licensed physician or designated examiner;
816 (B) is sworn to under oath; and
817 (C) states the facts upon which the application is based.
818 (2) (a) Subject to Subsection (2)(b), before issuing a judicial order, the court may
819 require the applicant to consult with the appropriate local mental health authority, and the court
820 may direct a mental health professional from that local mental health authority to interview the
821 applicant and the proposed patient to determine the existing facts and report them to the court.
822 (b) The consultation described in Subsection (2)(a):
823 (i) may take place at or before the hearing; and
824 (ii) is required if the local mental health authority appears at the hearing.
825 (3) If the proposed patient refuses to submit to an interview described in Subsection
826 (2)(a) or an examination described in Subsection (8), the court may issue an order, directed to a
827 mental health officer or peace officer, to immediately place the proposed patient into the
828 custody of a local mental health authority or in a temporary emergency facility, as provided in
829 Section 26B-5-334, to be detained for the purpose of examination.
830 (4) Notice of commencement of proceedings for assisted outpatient treatment, setting
831 forth the allegations of the application and any reported facts, together with a copy of any
832 official order of detention, shall:
833 (a) be provided by the court to a proposed patient before, or upon, placement into the
834 custody of a local mental health authority or, with respect to any proposed patient presently in
835 the custody of a local mental health authority;
836 (b) be maintained at the proposed patient's place of detention, if any;
837 (c) be provided by the court as soon as practicable to the applicant, any legal guardian,
838 any immediate adult family members, legal counsel for the parties involved, the local mental
839 health authority or its designee, and any other person whom the proposed patient or the court
840 shall designate; and
841 (d) advise that a hearing may be held within the time provided by law.
842 (5) The court may, in its discretion, transfer the case to any other court within this state,
843 provided that the transfer will not be adverse to the interest of the proposed patient.
844 (6) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
845 of a judicial order, or after commitment of a proposed patient to a local mental health authority
846 or its designee under court order for detention in order to complete an examination, the court
847 shall appoint two designated examiners:
848 (a) who did not sign the assisted outpatient treatment application nor the certification
849 described in Subsection (1);
850 (b) one of whom is a licensed physician; and
851 (c) one of whom may be designated by the proposed patient or the proposed patient's
852 counsel, if that designated examiner is reasonably available.
853 (7) The court shall schedule a hearing to be held within 10 calendar days of the day on
854 which the designated examiners are appointed.
855 (8) The designated examiners shall:
856 (a) conduct their examinations separately;
857 (b) conduct the examinations at the home of the proposed patient, at a hospital or other
858 medical facility, or at any other suitable place that is not likely to have a harmful effect on the
859 proposed patient's health;
860 (c) inform the proposed patient, if not represented by an attorney:
861 (i) that the proposed patient does not have to say anything;
862 (ii) of the nature and reasons for the examination;
863 (iii) that the examination was ordered by the court;
864 (iv) that any information volunteered could form part of the basis for the proposed
865 patient to be ordered to receive assisted outpatient treatment; and
866 (v) that findings resulting from the examination will be made available to the court;
867 and
868 (d) within 24 hours of examining the proposed patient, report to the court, orally or in
869 writing, whether the proposed patient is mentally ill. If the designated examiner reports orally,
870 the designated examiner shall immediately send a written report to the clerk of the court.
871 (9) If a designated examiner is unable to complete an examination on the first attempt
872 because the proposed patient refuses to submit to the examination, the court shall fix a
873 reasonable compensation to be paid to the examiner.
874 (10) If the local mental health authority, its designee, or a medical examiner determines
875 before the court hearing that the conditions justifying the findings leading to an assisted
876 outpatient treatment hearing no longer exist, the local mental health authority, its designee, or
877 the medical examiner shall immediately report that determination to the court.
878 (11) The court may terminate the proceedings and dismiss the application at any time,
879 including prior to the hearing, if the designated examiners or the local mental health authority
880 or its designee informs the court that the proposed patient does not meet the criteria in
881 Subsection (14).
882 (12) Before the hearing, an opportunity to be represented by counsel shall be afforded
883 to the proposed patient, and if neither the proposed patient nor others provide counsel, the court
884 shall appoint counsel and allow counsel sufficient time to consult with the proposed patient
885 before the hearing. In the case of an indigent proposed patient, the payment of reasonable
886 attorney fees for counsel, as determined by the court, shall be made by the county in which the
887 proposed patient resides or is found.
888 (13) (a) All persons to whom notice is required to be given shall be afforded an
889 opportunity to appear at the hearing, to testify, and to present and cross-examine witnesses. The
890 court may, in its discretion, receive the testimony of any other individual. The court may allow
891 a waiver of the proposed patient's right to appear for good cause, which cause shall be set forth
892 in the record, or an informed waiver by the patient, which shall be included in the record.
893 (b) The court is authorized to exclude all individuals not necessary for the conduct of
894 the proceedings and may, upon motion of counsel, require the testimony of each examiner to be
895 given out of the presence of any other examiners.
896 (c) The hearing shall be conducted in as informal a manner as may be consistent with
897 orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
898 mental health of the proposed patient.
899 (d) The court shall consider all relevant historical and material information that is
900 offered, subject to the rules of evidence, including reliable hearsay under Rule 1102, Utah
901 Rules of Evidence.
902 (e) (i) A local mental health authority or its designee, or the physician in charge of the
903 proposed patient's care shall, at the time of the hearing, provide the court with the following
904 information:
905 (A) the detention order, if any;
906 (B) admission notes, if any;
907 (C) the diagnosis, if any;
908 (D) doctor's orders, if any;
909 (E) progress notes, if any;
910 (F) nursing notes, if any; and
911 (G) medication records, if any.
912 (ii) The information described in Subsection (13)(e)(i) shall also be provided to the
913 proposed patient's counsel:
914 (A) at the time of the hearing; and
915 (B) at any time prior to the hearing, upon request.
916 (14) The court shall order a proposed patient to assisted outpatient treatment if, upon
917 completion of the hearing and consideration of the information presented, the court finds by
918 clear and convincing evidence that:
919 (a) [
920 omissions, or behaviors, the proposed patient:
921 (i) lacks the ability to engage in a rational decision-making process regarding the
922 acceptance of mental health treatment, as demonstrated by evidence of inability to weigh the
923 possible risks of accepting or rejecting treatment; or
924 (ii) needs assisted outpatient treatment in order to prevent relapse or deterioration that
925 is likely to result in the proposed patient posing a substantial danger to self or others; and
926 (b) there is no appropriate less-restrictive alternative to a court order for assisted
927 outpatient treatment[
928 [
929
930
931 [
932
933
934 (15) A court order for assisted outpatient treatment does not create an independent
935 authority to forcibly medicate a patient.
936 (16) The court may order the applicant or a close relative of the patient to be the
937 patient's personal representative, as described in 45 C.F.R. Sec. 164.502(g), for purposes of the
938 patient's mental health treatment.
939 [
940 the hearing, shall dismiss the proceedings.
941 [
942 which the patient shall be treated, which may not exceed 12 months without a review hearing.
943 (b) At a review hearing, the court may extend the duration of an assisted outpatient
944 treatment order by up to 12 months, if:
945 (i) the court finds by clear and convincing evidence that the patient meets the
946 conditions described in Subsection (14); or
947 (ii) (A) the patient does not appear at the review hearing;
948 (B) notice of the review hearing was provided to the patient's last known address by the
949 applicant described in Subsection (1) or by a local mental health authority; and
950 (C) the patient has appeared in court or signed an informed waiver within the previous
951 18 months.
952 (c) The court shall maintain a current list of all patients under its order of assisted
953 outpatient treatment.
954 (d) At least two weeks prior to the expiration of the designated period of any assisted
955 outpatient treatment order still in effect, the court that entered the original order shall inform
956 the appropriate local mental health authority or its designee.
957 [
958 which the proposed patient resides or is found.
959 [
960 an assisted outpatient treatment order.
961 [
962 deny an insured the benefits of the insured's policy solely because the health care that the
963 insured receives is provided under a court order for assisted outpatient treatment.
964 Section 7. Section 26B-6-607 is amended to read:
965 26B-6-607. Temporary emergency commitment -- Observation and evaluation.
966 (1) The director of the division or his designee may temporarily commit an individual
967 to the division and therefore, as a matter of course, to an intermediate care facility for people
968 with an intellectual disability for observation and evaluation upon:
969 (a) written application by a responsible person who has reason to know that the
970 individual is in need of commitment, stating:
971 (i) a belief that the individual has an intellectual disability and is likely to cause serious
972 injury to self or others if not immediately committed;
973 (ii) personal knowledge of the individual's condition; and
974 (iii) the circumstances supporting that belief; or
975 (b) certification by a licensed physician or designated intellectual disability
976 professional stating that the physician or designated intellectual disability professional:
977 (i) has examined the individual within a three-day period immediately preceding the
978 certification; and
979 (ii) is of the opinion that the individual has an intellectual disability, and that because
980 of the individual's intellectual disability is likely to injure self or others if not immediately
981 committed.
982 (2) If the individual in need of commitment is not placed in the custody of the director
983 or the director's designee by the person submitting the application, the director's or the
984 director's designee may certify, either in writing or orally that the individual is in need of
985 immediate commitment to prevent injury to self or others.
986 (3) Upon receipt of the application required by Subsection (1)(a) and the certifications
987 required by Subsections (1)(b) and (2), a peace officer may take the individual named in the
988 application and certificates into custody, and may transport the individual to a designated
989 intermediate care facility for people with an intellectual disability.
990 (4) (a) An individual committed under this section may be held for a maximum of [
991 72 hours, excluding Saturdays, Sundays, and legal holidays. At the expiration of that time, the
992 individual shall be released unless proceedings for involuntary commitment have been
993 commenced under Section 26B-6-608.
994 (b) After proceedings for involuntary commitment have been commenced the
995 individual shall be released unless an order of detention is issued in accordance with Section
996 26B-6-608.
997 (5) If an individual is committed to the division under this section on the application of
998 any person other than the individual's legal guardian, spouse, parent, or next of kin, the director
999 or his designee shall immediately give notice of the commitment to the individual's legal
1000 guardian, spouse, parent, or next of kin, if known.
1001 (6) (a) The division or an intermediate care facility shall provide discharge instructions
1002 to each individual committed under this section at or before the time the individual is
1003 discharged from the custody of the division or intermediate care facility, regardless of whether
1004 the individual is discharged by being released or under other circumstances.
1005 (b) Discharge instructions provided under Subsection (6)(a) shall include:
1006 (i) a summary of why the individual was committed;
1007 (ii) detailed information about why the individual is being discharged;
1008 (iii) a safety plan for the individual based on the individual's intellectual disability and
1009 condition;
1010 (iv) notification to the individual's primary care provider, if applicable;
1011 (v) if the individual is discharged without food, housing, or economic security, a
1012 referral to appropriate services, if such services exist in the individual's community;
1013 (vi) the phone number to call or text for a crisis services hotline, and information about
1014 the availability of peer support services;
1015 (vii) a copy of any advance directive presented to the local mental health authority, if
1016 applicable;
1017 (viii) information about how to establish an advance directive if one was not presented
1018 to the division or intermediate care facility;
1019 (ix) as applicable, information about medications that were changed or discontinued
1020 during the commitment;
1021 (x) a list of any screening or diagnostic tests conducted during the commitment;
1022 (xi) a summary of therapeutic treatments provided during the commitment;
1023 (xii) any laboratory work, including blood samples or imaging, that was completed or
1024 attempted during the commitment; and
1025 (xiii) information about how to contact the division or intermediate care facility if
1026 needed.
1027 (c) If an individual's medications were changed, or if an individual was prescribed new
1028 medications while committed under this section, discharge instructions provided under
1029 Subsection (6)(a) shall include a clinically appropriate supply of medications, as determined by
1030 a licensed health care provider, to allow the individual time to access another health care
1031 provider or follow-up appointment.
1032 (d) If an individual refuses to accept discharge instructions, the division or intermediate
1033 care facility shall document the refusal in the individual's medical record.
1034 (e) If an individual's discharge instructions include referrals to services under
1035 Subsection (6)(b)(v), the division or intermediate care facility shall document those referrals in
1036 the individual's medical record.
1037 (f) The division shall attempt to follow up with a discharged individual at least 48
1038 hours after discharge, and may use peer support professionals when performing follow-up care
1039 or developing a continuing care plan.
1040 Section 8. Section 26B-6-608 is amended to read:
1041 26B-6-608. Involuntary commitment -- Procedures -- Necessary findings --
1042 Periodic review.
1043 (1) Any responsible person who has reason to know that an individual is in need of
1044 commitment, who has a belief that the individual has an intellectual disability, and who has
1045 personal knowledge of the conditions and circumstances supporting that belief, may commence
1046 proceedings for involuntary commitment by filing a written petition with the district court, or if
1047 the subject of the petition is less than 18 years old with the juvenile court, of the county in
1048 which the individual to be committed is physically located at the time the petition is filed. The
1049 application shall be accompanied by:
1050 (a) a certificate of a licensed physician or a designated intellectual disability
1051 professional, stating that within a seven-day period immediately preceding the certification, the
1052 physician or designated intellectual disability professional examined the individual and
1053 believes that the individual has an intellectual disability and is in need of involuntary
1054 commitment; or
1055 (b) a written statement by the petitioner that:
1056 (i) states that the individual was requested to, but refused to, submit to an examination
1057 for an intellectual disability by a licensed physician or designated intellectual disability
1058 professional, and that the individual refuses to voluntarily go to the division or an intermediate
1059 care facility for people with an intellectual disability recommended by the division for
1060 treatment;
1061 (ii) is under oath; and
1062 (iii) sets forth the facts on which the statement is based.
1063 (2) Before issuing a detention order, the court may require the petitioner to consult
1064 with personnel at the division or at an intermediate care facility for people with an intellectual
1065 disability and may direct a designated intellectual disability professional to interview the
1066 petitioner and the individual to be committed, to determine the existing facts, and to report
1067 them to the court.
1068 (3) The court may issue a detention order and may direct a peace officer to immediately
1069 take the individual to an intermediate care facility for people with an intellectual disability to
1070 be detained for purposes of an examination if the court finds from the petition, from other
1071 statements under oath, or from reports of physicians or designated intellectual disability
1072 professionals that there is a reasonable basis to believe that the individual to be committed:
1073 (a) poses an immediate danger of physical injury to self or others;
1074 (b) requires involuntary commitment pending examination and hearing;
1075 (c) the individual was requested but refused to submit to an examination by a licensed
1076 physician or designated intellectual disability professional; or
1077 (d) the individual refused to voluntarily go to the division or to an intermediate care
1078 facility for people with an intellectual disability recommended by the division.
1079 (4) (a) If the court issues a detention order based on an application that did not include
1080 a certification by a designated intellectual disability professional or physician in accordance
1081 with Subsection (1)(a), the director or his designee shall within 24 hours after issuance of the
1082 detention order, excluding Saturdays, Sundays, and legal holidays, examine the individual,
1083 report the results of the examination to the court and inform the court:
1084 (i) whether the director or his designee believes that the individual has an intellectual
1085 disability; and
1086 (ii) whether appropriate treatment programs are available and will be used by the
1087 individual without court proceedings.
1088 (b) If the report of the director or his designee is based on an oral report of the
1089 examiner, the examiner shall immediately send the results of the examination in writing to the
1090 clerk of the court.
1091 (5) Immediately after an individual is involuntarily committed under a detention order
1092 or under Section 26B-6-607, the director or his designee shall inform the individual, orally and
1093 in writing, of his right to communicate with an attorney. If an individual desires to
1094 communicate with an attorney, the director or his designee shall take immediate steps to assist
1095 the individual in contacting and communicating with an attorney.
1096 (6) (a) Immediately after commencement of proceedings for involuntary commitment,
1097 the court shall give notice of commencement of the proceedings to:
1098 (i) the individual to be committed;
1099 (ii) the applicant;
1100 (iii) any legal guardian of the individual;
1101 (iv) adult members of the individual's immediate family;
1102 (v) legal counsel of the individual to be committed, if any;
1103 (vi) the division; and
1104 (vii) any other person to whom the individual requests, or the court designates, notice
1105 to be given.
1106 (b) If an individual cannot or refuses to disclose the identity of persons to be notified,
1107 the extent of notice shall be determined by the court.
1108 (7) That notice shall:
1109 (a) set forth the allegations of the petition and all supporting facts;
1110 (b) be accompanied by a copy of any detention order issued under Subsection (3); and
1111 (c) state that a hearing will be held within the time provided by law, and give the time
1112 and place for that hearing.
1113 (8) The court may transfer the case and the custody of the individual to be committed
1114 to any other district court within the state, if:
1115 (a) there are no appropriate facilities for persons with an intellectual disability within
1116 the judicial district; and
1117 (b) the transfer will not be adverse to the interests of the individual.
1118 (9) (a) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, after any
1119 order or commitment under a detention order, the court shall appoint two designated
1120 intellectual disability professionals to examine the individual. If requested by the individual's
1121 counsel, the court shall appoint a reasonably available, qualified person designated by counsel
1122 to be one of the examining designated intellectual disability professionals. The examinations
1123 shall be conducted:
1124 (i) separately;
1125 (ii) at the home of the individual to be committed, a hospital, an intermediate care
1126 facility for people with an intellectual disability, or any other suitable place not likely to have a
1127 harmful effect on the individual; and
1128 (iii) within a reasonable period of time after appointment of the examiners by the court.
1129 (b) The court shall set a time for a hearing to be held within 10 court days of the
1130 appointment of the examiners. However, the court may immediately terminate the proceedings
1131 and dismiss the application if, prior to the hearing date, the examiners, the director, or his
1132 designee informs the court that:
1133 (i) the individual does not have an intellectual disability; or
1134 (ii) treatment programs are available and will be used by the individual without court
1135 proceedings.
1136 (10) (a) Each individual has the right to be represented by counsel at the commitment
1137 hearing and in all preliminary proceedings. If neither the individual nor others provide counsel,
1138 the court shall appoint counsel and allow sufficient time for counsel to consult with the
1139 individual prior to any hearing.
1140 (b) If the individual is indigent, the county in which the individual was physically
1141 located when taken into custody shall pay reasonable attorney fees as determined by the court.
1142 (11) The division or a designated intellectual disability professional in charge of the
1143 individual's care shall provide all documented information on the individual to be committed
1144 and to the court at the time of the hearing. The individual's attorney shall have access to all
1145 documented information on the individual at the time of and prior to the hearing.
1146 (12) (a) The court shall provide an opportunity to the individual, the petitioner, and all
1147 other persons to whom notice is required to be given to appear at the hearing, to testify, and to
1148 present and cross-examine witnesses.
1149 (b) The court may, in its discretion:
1150 (i) receive the testimony of any other person;
1151 (ii) allow a waiver of the right to appear only for good cause shown;
1152 (iii) exclude from the hearing all persons not necessary to conduct the proceedings; and
1153 (iv) upon motion of counsel, require the testimony of each examiner to be given out of
1154 the presence of any other examiner.
1155 (c) The hearing shall be conducted in as informal a manner as may be consistent with
1156 orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
1157 individual. The Utah Rules of Evidence apply, and the hearing shall be a matter of court
1158 record. A verbatim record of the proceedings shall be maintained.
1159 (13) The court may order commitment if, upon completion of the hearing and
1160 consideration of the record, it finds by clear and convincing evidence that all of the following
1161 conditions are met:
1162 (a) the individual to be committed has an intellectual disability;
1163 (b) because of the individual's intellectual disability one or more of the following
1164 conditions exist:
1165 (i) the individual poses an immediate danger of physical injury to self or others;
1166 (ii) the individual lacks the capacity to provide the basic necessities of life, such as
1167 food, clothing, or shelter; or
1168 (iii) the individual is in immediate need of habilitation, rehabilitation, care, or
1169 treatment to minimize the effects of the condition which poses a threat of serious physical or
1170 psychological injury to the individual, and the individual lacks the capacity to engage in a
1171 rational decision-making process concerning the need for habilitation, rehabilitation, care, or
1172 treatment, as evidenced by an inability to weigh the possible costs and benefits of the care or
1173 treatment and the alternatives to it;
1174 (c) there is no appropriate, less restrictive alternative reasonably available; and
1175 (d) the division or the intermediate care facility for people with an intellectual
1176 disability recommended by the division in which the individual is to be committed can provide
1177 the individual with treatment, care, habilitation, or rehabilitation that is adequate and
1178 appropriate to the individual's condition and needs.
1179 (14) In the absence of any of the required findings by the court, described in Subsection
1180 (13), the court shall dismiss the proceedings.
1181 (15) (a) The order of commitment shall designate the period for which the individual
1182 will be committed. An initial commitment may not exceed six months. Before the end of the
1183 initial commitment period, the administrator of the intermediate care facility for people with an
1184 intellectual disability shall commence a review hearing on behalf of the individual.
1185 (b) At the conclusion of the review hearing, the court may issue an order of
1186 commitment for up to a one-year period.
1187 (16) An individual committed under this part has the right to a rehearing, upon filing a
1188 petition with the court within 30 days after entry of the court's order. If the petition for
1189 rehearing alleges error or mistake in the court's findings, the court shall appoint one impartial
1190 licensed physician and two impartial designated intellectual disability professionals who have
1191 not previously been involved in the case to examine the individual. The rehearing shall, in all
1192 other respects, be conducted in accordance with this part.
1193 (17) (a) The court shall maintain a current list of all individuals under its orders of
1194 commitment. That list shall be reviewed in order to determine those patients who have been
1195 under an order of commitment for the designated period.
1196 (b) At least two weeks prior to the expiration of the designated period of any
1197 commitment order still in effect, the court that entered the original order shall inform the
1198 director of the division of the impending expiration of the designated commitment period.
1199 (c) The staff of the division shall immediately:
1200 (i) reexamine the reasons upon which the order of commitment was based and report
1201 the results of the examination to the court;
1202 (ii) discharge the resident from involuntary commitment if the conditions justifying
1203 commitment no longer exist; and
1204 (iii) immediately inform the court of any discharge.
1205 (d) If the director of the division reports to the court that the conditions justifying
1206 commitment no longer exist, and the administrator of the intermediate care facility for people
1207 with an intellectual disability does not discharge the individual at the end of the designated
1208 period, the court shall order the immediate discharge of the individual, unless involuntary
1209 commitment proceedings are again commenced in accordance with this section.
1210 (e) If the director of the division, or the director's designee reports to the court that the
1211 conditions designated in Subsection (13) still exist, the court may extend the commitment order
1212 for up to one year. At the end of any extension, the individual must be reexamined in
1213 accordance with this section, or discharged.
1214 (18) When a resident is discharged under this subsection, the division shall provide any
1215 further support services available and required to meet the resident's needs.
1216 (19) (a) The division or an intermediate care facility shall provide discharge
1217 instructions to each individual committed under this section at or before the time the individual
1218 is discharged from the custody of the division or intermediate care facility, regardless of
1219 whether the individual is discharged by being released or under other circumstances.
1220 (b) Discharge instructions provided under Subsection (19)(a) shall include:
1221 (i) a summary of why the individual was committed;
1222 (ii) detailed information about why the individual is being discharged;
1223 (iii) a safety plan for the individual based on the individual's intellectual disability and
1224 condition;
1225 (iv) notification to the individual's primary care provider, if applicable;
1226 (v) if the individual is discharged without food, housing, or economic security, a
1227 referral to appropriate services, if such services exist in the individual's community;
1228 (vi) the phone number to call or text for a crisis services hotline, and information about
1229 the availability of peer support services;
1230 (vii) a copy of any advance directive presented to the local mental health authority, if
1231 applicable;
1232 (viii) information about how to establish an advance directive if one was not presented
1233 to the division or intermediate care facility;
1234 (ix) as applicable, information about medications that were changed or discontinued
1235 during the commitment;
1236 (x) a list of any screening or diagnostic tests conducted during the commitment;
1237 (xi) a summary of therapeutic treatments provided during the commitment;
1238 (xii) any laboratory work, including blood samples or imaging, that was completed or
1239 attempted during the commitment; and
1240 (xiii) information about how to contact the division or intermediate care facility if
1241 needed.
1242 (c) If an individual's medications were changed, or if an individual was prescribed new
1243 medications while committed under this section, discharge instructions provided under
1244 Subsection (19)(a) shall include a clinically appropriate supply of medications, as determined
1245 by a licensed health care provider, to allow the individual time to access another health care
1246 provider or follow-up appointment.
1247 (d) If an individual refuses to accept discharge instructions, the division or intermediate
1248 care facility shall document the refusal in the individual's medical record.
1249 (e) If an individual's discharge instructions include referrals to services under
1250 Subsection (19)(b)(v), the division or intermediate care facility shall document those referrals
1251 in the individual's medical record.
1252 (f) The division shall attempt to follow up with a discharged individual at least 48
1253 hours after discharge, and may use peer support professionals when performing follow-up care
1254 or developing a continuing care plan.
1255 Section 9. Section 63I-2-226 (Superseded 07/01/24) is amended to read:
1256 63I-2-226 (Superseded 07/01/24). Repeal dates: Titles 26A through 26B.
1257 (1) Subsection 26B-1-204(2)(e), related to the Air Ambulance Committee, is repealed
1258 July 1, 2024.
1259 (2) Section 26B-1-241 is repealed July 1, 2024.
1260 (3) Section 26B-1-302 is repealed on July 1, 2024.
1261 (4) Section 26B-1-313 is repealed on July 1, 2024.
1262 (5) Section 26B-1-314 is repealed on July 1, 2024.
1263 (6) Section 26B-1-321 is repealed on July 1, 2024.
1264 (7) Section 26B-1-405, related to the Air Ambulance Committee, is repealed on July 1,
1265 2024.
1266 (8) Section 26B-1-419, which creates the Utah Health Care Workforce Financial
1267 Assistance Program Advisory Committee, is repealed July 1, 2027.
1268 (9) In relation to the Air Ambulance Committee, on July 1, 2024, Subsection
1269 26B-2-231(1)(a) is amended to read:
1270 "(a) provide the patient or the patient's representative with the following information
1271 before contacting an air medical transport provider:
1272 (i) which health insurers in the state the air medical transport provider contracts with;
1273 (ii) if sufficient data is available, the average charge for air medical transport services
1274 for a patient who is uninsured or out of network; and
1275 (iii) whether the air medical transport provider balance bills a patient for any charge not
1276 paid by the patient's health insurer; and".
1277 (10) Section 26B-3-142 is repealed July 1, 2024.
1278 (11) Subsection 26B-3-215(5), related to reporting on coverage for in vitro fertilization
1279 and genetic testing, is repealed July 1, 2030.
1280 (12) In relation to the Air Ambulance Committee, on July 1, 2024, Subsection
1281 26B-4-135(1)(a) is amended to read:
1282 "(a) provide the patient or the patient's representative with the following information
1283 before contacting an air medical transport provider:
1284 (i) which health insurers in the state the air medical transport provider contracts with;
1285 (ii) if sufficient data is available, the average charge for air medical transport services
1286 for a patient who is uninsured or out of network; and
1287 (iii) whether the air medical transport provider balance bills a patient for any charge not
1288 paid by the patient's health insurer; and".
1289 (13) Section 26B-4-702, related to the Utah Health Care Workforce Financial
1290 Assistance Program, is repealed July 1, 2027.
1291 (14) Section 26B-5-117, related to early childhood mental health support grant
1292 programs, is repealed January 2, 2025.
1293 (15) Section 26B-5-302.5, related to a study concerning court-ordered treatment, is
1294 repealed July 1, 2025.
1295 [
1296 exchange and education, is repealed January 1, 2027.
1297 [
1298 2025.
1299 Section 10. Section 63I-2-226 (Effective 07/01/24) is amended to read:
1300 63I-2-226 (Effective 07/01/24). Repeal dates: Titles 26A through 26B.
1301 (1) Section 26B-1-241 is repealed July 1, 2024.
1302 (2) Section 26B-1-302 is repealed on July 1, 2024.
1303 (3) Section 26B-1-313 is repealed on July 1, 2024.
1304 (4) Section 26B-1-314 is repealed on July 1, 2024.
1305 (5) Section 26B-1-321 is repealed on July 1, 2024.
1306 (6) Section 26B-1-419, which creates the Utah Health Care Workforce Financial
1307 Assistance Program Advisory Committee, is repealed July 1, 2027.
1308 (7) In relation to the Air Ambulance Committee, on July 1, 2024, Subsection
1309 26B-2-231(1)(a) is amended to read:
1310 "(a) provide the patient or the patient's representative with the following information
1311 before contacting an air medical transport provider:
1312 (i) which health insurers in the state the air medical transport provider contracts with;
1313 (ii) if sufficient data is available, the average charge for air medical transport services
1314 for a patient who is uninsured or out of network; and
1315 (iii) whether the air medical transport provider balance bills a patient for any charge not
1316 paid by the patient's health insurer; and".
1317 (8) Section 26B-3-142 is repealed July 1, 2024.
1318 (9) Subsection 26B-3-215(5), related to reporting on coverage for in vitro fertilization
1319 and genetic testing, is repealed July 1, 2030.
1320 (10) Section 26B-4-702, related to the Utah Health Care Workforce Financial
1321 Assistance Program, is repealed July 1, 2027.
1322 (11) Section 26B-5-117, related to early childhood mental health support grant
1323 programs, is repealed January 2, 2025.
1324 (12) Section 26B-5-302.5, related to a study concerning court-ordered treatment, is
1325 repealed July 1, 2025.
1326 [
1327 exchange and education, is repealed January 1, 2027.
1328 [
1329 2025.
1330 Section 11. Repealer.
1331 This bill repeals:
1332 Section 26B-5-350, Assisted outpatient treatment services.
1333 Section 12. Effective date.
1334 (1) Except as provided in Subsection (2), this bill takes effect on May 1, 2024.
1335 (2) The actions affecting Section 26B-5-331 (Effective 07/01/24) take effect on July 1,
1336 2024.
1337 Section 13. Coordinating H.B. 299 with H.B. 203.
1338 If H.B. 299, Court-Ordered Treatment Modifications, and H.B. 203, Involuntary
1339 Commitment Amendments, both pass and become law, the Legislature intends that on May 1,
1340 2024, Subsection 26B-5-332(16)(a) be amended to read:
1341 "(16)(a) The court shall order commitment of an adult proposed patient to a local
1342 mental health authority if, upon completion of the hearing and consideration of the information
1343 presented, the court finds by clear and convincing evidence that there is no appropriate,
1344 less-restrictive alternative to a court order of commitment and the local mental health authority
1345 can provide the proposed patient with treatment that is adequate and appropriate to the
1346 proposed patient's conditions and needs, and:
1347 (i) [
1348 recent actions, omissions, or behaviors, the proposed patient:
1349 (A) poses a substantial danger to self or others; or
1350 (B) lacks the ability to engage in a rational decision-making process regarding the
1351 acceptance of mental treatment as demonstrated by evidence of inability to weigh the possible
1352 risks of accepting or rejecting treatment; or
1353 (ii)(A) the proposed patient has been charged with a criminal offense;
1354 (B) with respect to the charged offense, the proposed patient is found incompetent to
1355 proceed as a result of a mental illness;
1356 (C) the proposed patient has a mental illness; and
1357 (D) the proposed patient has a persistent unawareness of their mental illness and the
1358 negative consequences of that illness, or within the preceding six months has been requested or
1359 ordered to undergo mental health treatment but has unreasonably refused to undergo that
1360 treatment.
1361 [
1362
1363 [
1364
1365
1366 [
1367
1368 [
1369