Relates to involuntary in-patient mental health treatment where care and treatment in a hospital is essential to a person's welfare if, in the absence of such care and treatment, the person's mental illness is likely to result in serious harm.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A812
SPONSOR: Braunstein
 
TITLE OF BILL:
An act to amend the mental hygiene law, in relation to clarifying the
standards for involuntary in-patient care and treatment
 
PURPOSE:
To provide an alternative means for mental health intervention by
providing for court ordered in patient medical treatment.
 
SUMMARY OF PROVISIONS:
§ 1 - adds a short title to be known as the New York State Mental Health
Reform Act.
§ 2 - details a legislative finding that, although the state's public
policy to encourage mental health treatment and services through volun-
tary outpatient and mandated outpatient treatment protocols is still
encouraged. There are multiplying instances where patients have either
refused treatment or become incapable of following treatment protocols,
which has resulted in a large degree of homelessness, criminal behavior,
drug use, and severe alcoholism of our most vulnerable population. All
too often, behavioral transgressions as the result of mental illness
forces families, the public and anyone with a negative interaction with
this vulnerable population, to invoke police involvement with tragic
outcomes. More often than not, the question always arises as to why
earlier intervention was not provided through our state's mental health
system. Simply put, the current legal definitions encompassed in the law
do not allow for sufficient judicial determination that a patient's care
and treatment is so essential that mandated in-patient treatment is
warranted. This legislation provides a clearer definition from which
judicial determinations may be more focused to provide the attention and
care of the patient.
§ 3 - amends subdivision 1 of section 9 of the mental hygiene law, to
add, "Care and treatment in a hospital shall be considered essential to
a person's welfare if, in the absence of such care and treatment, the
person's illness is likely to result in serious harm". The addition of
this language allows for more consistent judicial determinations that
allows the court to consider the best type of treatment so that longterm
positive outcomes prevent the revolving door of sporadic, inconsequen-
tial short-term treatment.
§ 4 - amends subdivision 1 of section 9 of the mental hygiene law, to
add a clearer definition of "likely to result in serious harm" to allow
the court to determine if the person's mental state results in a
substantial interference with the person's ability to meet the person's
needs for food, clothing, shelter or medical care." All too often, an
ill person cannot make reasoned decisions to provide for their own
survival, let alone care. Government programs offer basic sustenance
such as food and shelter but often go unutilized by the person who
cannot rationally recognize the aid offered due to their mental illness
which results in starvation, adverse health outcomes or death.
§ 5 - amends subdivision 1 to section 9 of the mental hygiene law, to
add a clearer definition of "need for retention" by allowing for mental
health professionals to seek additional time of retention for a "further
period" of involuntary care and treatment in a hospital, to include
"consideration of the person's preparedness, with appropriate and avail-
able support, to adhere to essential outpatient treatment". In order to
allow for more consistent treatment, this amendment allows medical
professionals to consider the overall effect of discharging a person
before appropriate treatment is established by allowing for additional
time for retention of the person to ensure a positive treatment outcome.
 
EXISTING LAW:
None.
 
JUSTIFICATION:
Our state's current Mental Hygiene Law contains needless barriers to
treatment for people with severe mental illness. This new legislation
expands the definitions of "care and treatment of a person in a hospi-
tal" and "likelihood that the person's actions may commit serious harm."
Numerous medical experts affirm that earlier intervention in treatment
of mental illness results in more successful and positive outcomes to
treatment, yet our current laws do not afford a means to earlier inter-
vention since the current law only provides for emergency holds of up to
seventy-two hours. This insufficient time-period acts as an arbitrary
barrier to provide sufficient medical and/or psychiatric treatment thus
resulting in "streeting", the abominable practice of discharge without
care because a person is simply "timed out" of their opportunity for
intervention. For many, this can mean violence, arrest, trauma and
further victimization. This new legislation to the Mental Hygiene Law
enhances the opportunity for successful mental health intervention by
reducing exposure to police intervention, thus reducing the likelihood
of drastic outcomes for people in need of mental health assistance.
 
LEGISLATIVE HISTORY:
2022: A.9669/S.8508A - Referred to Mental Health
STATE OF NEW YORK
________________________________________________________________________
812
2023-2024 Regular Sessions
IN ASSEMBLY
January 11, 2023
___________
Introduced by M. of A. BRAUNSTEIN -- read once and referred to the
Committee on Mental Health
AN ACT to amend the mental hygiene law, in relation to clarifying the
standards for involuntary in-patient care and treatment
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Short title. This act shall be known as the "New York
2 State Mental Health Reform Act".
3 § 2. Legislative findings. With the intent of restoring dignity and
4 transparency to our state's treatment and care of mentally ill patients,
5 the state engaged in reforming procedures and policies in implementing
6 preferred outpatient treatment through a structured outpatient treatment
7 process commonly referred to as Kendra's Law. The law was to ensure
8 those individuals requiring mental health treatment were afforded a
9 dignified process in treatment while allowing the patient's liberty to
10 be free to pursue their daily lives without stigma or negative connota-
11 tions attached to mental health.
12 Unfortunately, the practical application of the state's mental hygiene
13 laws has allowed thousands of people who require more stringent mental
14 health protocols for treatment to go without appropriate oversight to
15 ensure their treatment is pursued thus, resulting in severe behavioral
16 transgression to include a large degree of homelessness, criminal behav-
17 ior, toxic drug use and alcoholism. The severity of abhorrent outcomes
18 as the result of a failure to give medical professionals, as well as
19 judicial direction in determining certain behavioral dysfunction(s) that
20 display a need for in-patient care, has severely impacted patient's
21 health, welfare, and their ability to regularly function in society. All
22 too often, we are seeing unsuspecting citizens killed or maimed as the
23 result of violent behavior by patients who have either disregarded or
24 rejected available or mandated mental health services due to their dete-
25 riorating mental state, which compounds the deleterious outcome for the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01614-01-3
A. 812 2
1 patient as well as society. Although outpatient commitment is the
2 preferred mode of treatment for patients seeking mental health services,
3 the occasion arises where judicial intervention to seek immediate,
4 mandated treatment through court ordered in-patient treatment, in order
5 to facilitate an expedited pathway for seeking medical or psychiatric
6 help is necessary to prevent on-going negative behavioral episodes that
7 places the patient or the public at risk of physical injury or death.
8 § 3. The second, third and fourth undesignated paragraphs of section
9 9.01 of the mental hygiene law, as amended by chapter 723 of the laws of
10 1989, are amended to read as follows:
11 "in need of involuntary care and treatment" means that a person has a
12 mental illness for which care and treatment as a patient in a hospital
13 is essential to such person's welfare and [whose] which so impairs the
14 person's judgment [is so impaired that he] that the person is unable to
15 understand the need for such care and treatment. Care and treatment in a
16 hospital shall be considered essential to a person's welfare if, in the
17 absence of such care and treatment, the person's mental illness is like-
18 ly to result in serious harm.
19 ["likelihood to result in serious harm" or] "likely to result in seri-
20 ous harm" means presenting a substantial risk of: (a) [a substantial
21 risk of] physical or mental harm to the person as manifested by:
22 (i) threats of or attempts at suicide or serious bodily harm;
23 (ii) substantial interference with the person's ability to meet the
24 person's needs for food, clothing, shelter or medical care; or
25 (iii) other conduct demonstrating that the person is dangerous to
26 himself or herself, or (b) [a substantial risk of physical harm to other
27 persons as manifested by] homicidal or other violent behavior by which
28 others are placed in reasonable fear of serious physical harm. Evalu-
29 ation of the likelihood that a person's mental illness will result in
30 serious harm shall include consideration of all relevant information,
31 including credible reports of the person's recent behavior and any known
32 relevant aspects of the person's medical and behavioral history.
33 "need for retention" means [that] the need of a person who has been
34 admitted to a hospital pursuant to this article [is in need] for a
35 further period of involuntary care and treatment in a hospital [for a
36 further period]. Evaluation of need for retention shall include consid-
37 eration of the person's preparedness, with appropriate and available
38 support, to adhere to essential outpatient treatment.
39 § 4. Subdivision (a) of section 9.39 of the mental hygiene law, as
40 amended by chapter 789 of the laws of 1985, is amended to read as
41 follows:
42 (a) The director of any hospital maintaining adequate staff and facil-
43 ities for the observation, examination, care, and treatment of persons
44 alleged to be mentally ill and approved by the commissioner to receive
45 and retain patients pursuant to this section may receive and retain
46 therein as a patient for a period of fifteen days any person alleged to
47 have a mental illness for which immediate observation, care, and treat-
48 ment in a hospital is appropriate and which is likely to result in seri-
49 ous harm to himself, herself or others. ["Likelihood to result in seri-
50 ous harm" as used in this article shall mean:
51 1. substantial risk of physical harm to himself as manifested by
52 threats of or attempts at suicide or serious bodily harm or other
53 conduct demonstrating that he is dangerous to himself, or
54 2. a substantial risk of physical harm to other persons as manifested
55 by homicidal or other violent behavior by which others are placed in
56 reasonable fear of serious physical harm.]
A. 812 3
1 The director shall cause to be entered upon the hospital records the
2 name of the person or persons, if any, who have brought such person to
3 the hospital and the details of the circumstances leading to the hospi-
4 talization of such person.
5 The director shall admit such person pursuant to the provisions of
6 this section only if a staff physician of the hospital upon examination
7 of such person finds that such person qualifies under the requirements
8 of this section. Such person shall not be retained for a period of more
9 than forty-eight hours unless within such period such finding is
10 confirmed after examination by another physician who shall be a member
11 of the psychiatric staff of the hospital. Such person shall be served,
12 at the time of admission, with written notice of his or her status and
13 rights as a patient under this section. Such notice shall contain the
14 patient's name. At the same time, such notice shall also be given to the
15 mental hygiene legal service and personally or by mail to such person or
16 persons, not to exceed three in number, as may be designated in writing
17 to receive such notice by the person alleged to be mentally ill. If at
18 any time after admission, the patient, any relative, friend, or the
19 mental hygiene legal service gives notice to the director in writing of
20 request for court hearing on the question of need for immediate observa-
21 tion, care, and treatment, a hearing shall be held as herein provided as
22 soon as practicable but in any event not more than five days after such
23 request is received, except that the commencement of such hearing may be
24 adjourned at the request of the patient. It shall be the duty of the
25 director upon receiving notice of such request for hearing to forward
26 forthwith a copy of such notice with a record of the patient to the
27 supreme court or county court in the county where such hospital is
28 located. A copy of such notice and record shall also be given the mental
29 hygiene legal service. The court which receives such notice shall fix
30 the date of such hearing and cause the patient or other person request-
31 ing the hearing, the director, the mental hygiene legal service and such
32 other persons as the court may determine to be advised of such date.
33 Upon such date, or upon such other date to which the proceeding may be
34 adjourned, the court shall hear testimony and examine the person alleged
35 to be mentally ill, if it be deemed advisable in or out of court, and
36 shall render a decision in writing that there is reasonable cause to
37 believe that the patient has a mental illness for which immediate inpa-
38 tient care and treatment in a hospital is appropriate and which is like-
39 ly to result in serious harm to himself, herself or others. If it be
40 determined that there is such reasonable cause, the court shall forth-
41 with issue an order authorizing the retention of such patient for any
42 such purpose or purposes in the hospital for a period not to exceed
43 fifteen days from the date of admission. Any such order entered by the
44 court shall not be deemed to be an adjudication that the patient is
45 mentally ill, but only a determination that there is reasonable cause to
46 retain the patient for the purposes of this section.
47 § 5. This act shall take effect on the sixtieth day after it shall
48 have become a law.