Transcript Everything You Should Know about Title 33

EVERYTHING YOU SHOULD
KNOW ABOUT TITLE 33
provided by:
Tennessee Department of
Mental Health and Substance Abuse Services
Division of Mental Health Services
Content guided by Title 33
and TDMHSAS Rule 0940-3-8
OBJECTIVES
• Participants will verbalize an increased knowledge
of the laws that relate to the emergency
involuntary hospitalization process
• Participants will demonstrate an increased
understanding of how an individuals rights might
be impacted in an emergency situation
• Participants will learn about resources available to
individuals experiencing a behavioral health crisis
WHAT IS TITLE 33?
Title 33 is the section of
Tennessee Code Annotated
that pertains to the laws and
codes that govern mental
health care here in Tennessee.
YOUR RIGHTS
No person shall be deprived of liberty on the
grounds that the person has or is believed to
have a mental illness, a serious emotional
disturbance, a developmental disability, or is
in need of service for such a condition except
in accordance with the provisions of this title.
TCA §33-3-101
YOUR RIGHTS
Individuals with mental illness, serious
emotional disturbance, or
developmental disability have the same
rights as all others except to the extent
that an individual’s rights are curtailed in
accordance with Title 33 or other law.
TCA §33-3-101
YOUR RIGHTS
Individuals with mental illness, serious
emotional disturbance, or
developmental disability shall be
provided services or supports, to the
extent that facilities, equipment and
personnel are available, in accordance
with community standards.
TCA §33-3-101
YOUR RIGHTS
• No individual shall be denied the right to dispose
of property, execute instruments, make
purchases, enter into contractual relationships,
give informed consent to treatment, and vote,
unless the individual is unable to make decisions
or state or federal law allows denial. TCA §33-3-102
• Providers under this title may not discourage or
prevent an individual from exercising their right
to religious expression. TCA §33-3-126
ACCESS TO YOUR RECORDS
• If you are sixteen (16) years of age or older, you may
request that your service provider tell you what
records are being maintained and how you can access
to them. Upon your written request, a service
provider shall permit you, within a reasonable time, to
review your record.
• There are certain exceptions to this disclosure which
your provider must adhere to.
TCA §33-3-112
RIGHT TO FILE FOR WRIT
OF HABEAS CORPUS
This is a request made to a court by an individual who
believes they have been unjustly detained or taken
into custody asking that a legal review of the
custodial authority occur.
If a court determines an individual has been unjustly
taken into custody, the court may order the
individual be released immediately.
TCA §33-3-801
CONFIDENTIALITY
Your service records shall be kept confidential
and shall not be disclosed by any person
except in compliance with this part.
In order for your family, friends or advocates
to get information about your care or
treatment you must sign a release form
authorizing the service provider to disclose the
information to which you have consented.
T.C.A. §33-3-103
Processes
VOLUNTARY
HOSPITALIZATION
You or your conservator/guardian may request admission to
a hospital or treatment resource for diagnosis, observation
and treatment and if an examination by an admitting
physician determines that there is a need for
hospitalization you may be admitted.
TCA §33-6-201 and TCA § 33-6-202
You may request release from the inpatient facility at any
time during your stay but if professionals determine you
present a risk of harm to yourself or others they may
initiate the involuntary process. TCA §33-6-206
WHEN SOMEONE IS EXPERIENCING A
BEHAVIORAL HEALTH CRISIS
• You or someone you know may be
involved in a community based screening
process completed by a physician,
psychologist or Mandatory Pre-screening
Agent (all crisis teams have MPAs).
• This may be done at an individuals’
home, an emergency department, jail or
other community location.
TENNESSEE’S CRISIS DELIVERY SYSTEM
WHAT IS A MANDATORY PRESCREENING AGENT?
• A qualified mental health professional (QMHP)
• Licensed to practice in TN
• Who has satisfactorily completed the required
TDMHSAS training and designated by the
Commissioner
T.C.A. § 33-6-427
WHAT IS A QMHP?
• Psychiatrist
• Physician with expertise
in psychiatry
• Psychologist with health
service provider
designation
• Licensed psychological
examiner
• Licensed senior
psychological examiner
T.C.A. § 33-1-101 (20)
•
•
•
•
•
Licensed master’s social worker
with two years of mental
health experience
Licensed clinical social worker
Licensed or certified martial
and family therapist
Licensed professional counselor
Licensed nurse with a master’s
degree in nursing who
functions as a psychiatric nurse
AN INDIVIDUAL MAY BE DETAINED FOR THE
PURPOSE OF A MENTAL HEALTH EVALUATION
If an individual is experiencing signs and/or
symptoms of a mental illness or serious
emotional disturbance that present a risk of
harm to the individual experiencing the
symptoms or to others they may be detained
without a court order for an unlimited amount
of time pending completion of a behavioral
health evaluation.
TCA §33-6-401
DEFINITIONS
Mental illness:
A psychiatric disorder, alcohol
dependence, or drug dependence, but
does not include Intellectual Disability or
other developmental disabilities.
T.C.A. § 33-1-101(18)
DEFINITIONS
Serious Emotional Disturbance:
A condition in a child who currently or at any time during the
past year has had a diagnosable mental, behavioral, or emotional
disorder of sufficient duration to meet psychiatric diagnostic
criteria, that results in functional impairment which substantially
interferes with or limits the child’s role or functioning in family,
school, or community activities and includes any mental disorder,
regardless of whether it is of biological etiology.
T.C.A. § 33-1-101(22)
DETAINING FOR EXAMINATION
Professionals who have the authority to
detain for examination include:
• law enforcement,
• physician,
• psychologist or
• a Mandatory Prescreening Agent
T.C.A. § 33-6-402
DETAINING FOR EXAMINATION
A person cannot be deprived of liberty on the grounds that
the person is believed to have:
a mental illness,
serious emotional disturbance,
developmental disability, or
is in need of service for such a condition
except in accordance with Title 33.
T.C.A. § 33-3-101
The Process for
Emergency Involuntary
Psychiatric
Hospitalization
THE SCREENING PROCESS MAY
DETERMINE THE NEED OF EMERGENCY
HOSPITALIZATION
An individual may be admitted and
detained by a hospital or treatment
resource for emergency diagnosis,
evaluation, and treatment IF AND
ONLY IF:
T.C.A. § 33-6-403
TO QUALIFY FOR EMERGENCY
INVOLUNTARY ADMISSION
An individual:
• Has a mental illness or serious emotional disturbance,
• Poses an immediate substantial likelihood of serious
harm because of the mental illness or serious
emotional disturbance,
• Needs care, training, or treatment because of the
mental illness or emotional disturbance, AND
• All available less drastic alternatives to placement in a
hospital or treatment resource are unsuitable to meet
their needs.
HOW IS SUBSTANTIAL LIKELIHOOD OF
SERIOUS HARM DEFINED?
IF an individual has:
 Threatened or attempted suicide or to inflict serious bodily harm
on him/herself OR
 Threatened or attempted homicide or other violent behavior OR
 Has placed others in reasonable fear of violent behavior and
serious physical harm to them OR
 Is unable to avoid severe impairment or injury from specific risks
AND there is a substantial likelihood that such harm will occur
unless the person is placed under involuntary treatment
THEN the criteria for “substantial likelihood of serious harm” can
be met.
T.C.A. § 33-6-501
WHAT IS A CERTIFICATE OF NEED?
A Certificate of Need (CON) is a legal
document which is required by the court for
an individual who is admitted to an
inpatient behavioral health treatment
resource without the consent of the
individual receiving services.
To be admitted involuntarily there must be
two Certificates of Need completed and
approved by the court.
ABOUT THE PROCESS
A Mandatory Pre-screening Agent (MPA) must
complete one of the two required CONs for a
person with mental illness or serious
emotional disturbance to be admitted to a
Regional Mental Health Institute (RMHI) or
private psychiatric hospital.
MPAs are a part of every state crisis service
providers crisis delivery system so if you call
crisis you will likely be seen by a MPA.
T.C.A. § 33-6-105
IF A MANDATORY PRE-SCREENING AGENT IS
NOT AVAILABLE
If a MPA is not available within two hours, then a
licensed physician or a licensed psychologist with a
health service provider designation may complete
the CON.
The physician or psychologist must consult with a
crisis team member regarding less restrictive
alternatives.
T.C.A. § 33-6-105
REQUIREMENT FOR
DISINTERESTED PROFESSIONAL
• If a person is to be admitted to a private facility, at
least one (1) of the CONs shall be from a professional
who is not an employee of the private facility.
• Employment as a faculty member by a school of
medicine at a university or college associated with a
hospital is not considered employment by the
hospital
T.C.A. § 33-4-107
MEDICAL CONSIDERATIONS
If an individual has a physical disorder that
requires immediate care, the individual may
be taken to the emergency department for
medical treatment before being transported
to the psychiatric inpatient facility.
T.C.A. §33-4-104
AVAILABLE, SUITABLE
ACCOMMODATIONS (ASA)
REQUIRED
What does this mean?
This means that the hospital accepting the person for
care and treatment must have enough staff and enough
space to adequately meet the needs of the individual
being hospitalized.
This also means that there may be times that someone in
need of emergency involuntary hospitalization is either
sent to the next closest state hospital that has an empty
bed or has to wait for a period of time for a bed to
become available at the nearest state hospital.
TCA §33-6-108
TRANSPORTATION TO THE INPATIENT
PSYCHIATRIC HOSPITAL
The Sheriff is obligated by Title 33 to provide
transportation if a Certificate of Need for
Emergency Involuntary Hospitalization has
been completed and a confirmation number for
an available bed has been provided
The Sheriff may designate a secondary
transportation agent(s) for the county such as
an ambulance service
T.C.A. §33-6-406
T.C.A. §33-6-901
TRANSPORTATION TO THE HOSPITAL
If it is determined during the screening process that
the person does not require physical restraint or
vehicle security, these people may transport the
individual to the hospital at the transporter’s
expense:
– one or more friends
– neighbors
– mental health professionals
familiar with the person
– relatives of the person
– member of the clergy
T.C.A. § 33-6-901
TRANSPORTATION
The person or persons providing
transportation must provide
proof of current automobile
insurance to the sheriff before
transportation can occur.
T.C.A. §33-6-901
COURT PROCESS UPON
ADMISSION
• Immediate notice is provided to the court upon
admission.
• Probable cause hearing within (5) five working days.
• With court approval, continued stay for up to 15 more
days.
• Court may approve indefinite stay after that time.
T.C.A. Section 33-6-421(-423)
LIMITS OF CONFIDENTIALITY
Information may be disclosed without the consent of
the individual receiving services if it is:
• Necessary to carry out duties under this title
• Necessary to assure service/care in least drastic means
that are suitable to the service recipient’s liberty and
interests
• A service recipient moves from one service provider to
another and exchange of information is necessary for
continuity of service
T.C.A. § 33-3-105
IF THE MPA DOES NOT RECOMMEND
INPATIENT CARE
The MPA or the MPA’s designee will:
Assess the availability of alternative services and
offer referral, if appropriate and
Follow-up with the individual within 12 hours of the
assessment
T.C.A. §33-6-106
MPS Rule Chapter 0940-3-8-.05(9)
IF HOSPITALIZATION IS NEEDED BUT
DOESN’T OCCUR- WHAT CAN I DO?
• Work with your regular mental health provider to
get an expedited appointment.
• Work with the crisis service provider to establish a
crisis management plan.
• Call your Managed Care Organization for guidance.
• Ensure support systems are available as much as
possible.
• If concerns persist, ask for a re-evaluation by crisis
and the inpatient provider to determine whether a
change in status now results in hospitalization.
IF HOSPITALIZATION IS NEEDED BUT DOESN’T
OCCUR- WHAT CAN I DO?
If you or your loved one does not meet
emergency hospitalization criteria you may
still be able to seek non-emergency admission
under Part 5 by filing a complaint with the
court clerk.
This requires that the person be examined by
two physicians or one physician and one
psychologist who both agree that the person
needs.
TCA §33-6-504
IF HOSPITALIZATION IS NEEDED BUT
DOESN’T OCCUR- WHAT CAN I DO?
• If you are concerned that your loved one might
be unable to make sound decisions for
themselves due to the symptoms of a mental
illness or serious emotional disturbance you
may seek a conservator to help the individual
with their treatment decisions.
• Conservators/ guardians with power of
attorney for health care decisions have the
authority to sign someone in for care and
treatment if clinically indicated.
Title 34
Mental Health Declaration for Treatment
TCA §33-6-1001
http://www.state.tn.us/mental/t33/DHMT_FORM.pdf
WHAT IS A MENTAL HEALTH
DECLARATION FOR TREATMENT?
The DMHT is a legal document where individuals can write
down their wishes in case of a mental health crisis which
may include:
• The mental health treatments and medications that are
okay with them and any that are not okay.
• What it looks like when the individual is in a mental health
crisis and need help.
• Which hospitals and which mental health agencies are
preferred.
TCA §33-6-1001
DECLARATION FOR MENTAL
HEALTH TREATMENT
Even though mental health professionals will
attempt to conform to the wishes of the
individual as outlined in the DMHT, those
wishes may be overridden if emergency
involuntary psychiatric hospitalization is
required or the individuals life or health is at
risk .
TCA §33-6-1006
DMHT FACTS
• Generally, the physician or other service provider
will follow the Declaration only when you lack
capacity to make informed mental health
treatment decisions. TCA §33-6-1002
• A Declaration is not related to payment for services
and cannot require hospitalization in the absence of
medical necessity. When completing a Declaration,
you should consider the limitations of your
insurance benefits.
TCA §33-6-1012
DMHT FACTS
A declaration for mental health treatment is
good for two (2) years, for a lesser period if so
stated, or until revoked, whichever is sooner.
TCA §33-6-1003
A declaration is effective only if it is signed by
the individual creating the declaration and
two (2) competent adult witnesses and is not
signed on the premises of a mental health
service provider. TCA §33-6-1004
DMHT FACTS CONTINUED
• If the physician or other provider is unwilling at any
time to comply with the declaration for mental health
treatment, the physician or provider may withdraw
from providing treatment. TCA § 33-6-1005
• The declaration for mental health treatment shall
remain in effect and shall be superior to the powers
and duties of an appointed conservator with the
authority to make mental health treatment decisions.
TCA § 33-6-1007
If Crisis Services are needed
Statewide Toll free Crisis Number
1-855-CRISIS1 (1-855-274-7471)
National Suicide Prevention Lifeline
1-800-273-TALK(8255)
Always call 911 if life or death emergency
PRESENTERS
Sejal West, MA – Assistant Commissioner,
Division of Mental Health Services
Melissa Sparks, RN, MSN – TDMHSAS Director
of Crisis Services and Suicide Prevention