Denton County Sheriff`s Office Mental Health Investigative Unit

Transcription

Emergency
Psychiatric
Issues
The System for Access in
Denton County
Introduction
Denton County Sheriff’s Office
Mental Health Investigative Unit (MHIU)
–
Gillis Hammett, Lieutenant MHIU
2
Learning Objectives
Definitions (Legal, General and Medical)
Mental Illness Signs & Symptoms
Duties of the MHIU
Emergency Apprehension and
Detention
Applications for Temporary and
Extended Mental Health Services (Court
Ordered)
3
Learning Objectives
(continued)
Admission
Continuity of Care and Court Hearings
Discharge
Recidivism
Transportation ~ Civil and Criminal
Aftercare
Paperwork and Examples
The Laws (incorporated throughout the
presentation)
4
Definitions
Mental Illness
– Legal: illness, disease or condition, other than epilepsy,
senility, alcoholism or mental deficiency, that: (A)
substantially impairs a person’s thought, perception of
reality, emotional process or judgment; or (B) grossly
impairs behavior as demonstrated by recent disturbed
behavior (Texas Health and Safety Code Section 571.003
(14))
– General: any of various conditions characterized by
impairment of an individual's normal cognitive, emotional,
or behavioral functioning, and caused by social,
psychological, biochemical, genetic, or other factors, such
as infection or head trauma (American Heritage
Dictionary)
– Medical: Any disorder that affects the mind or behavior
(Taber’s Cyclopedic Medical Dictionary)
5
Definitions
(continued)
Mental retardation
– Diagnosis occurs before the age of 18
– Legal: significantly subaverage general intellectual
functioning that is concurrent with deficits in adaptive
behavior and originates during the developmental period
(Texas Health and Safety Code Section 591.003 (13))
– General: subnormal intellectual development as a result
of congenital causes, brain injury, or disease and
characterized by any of various cognitive deficiencies,
including impaired learning, social, and vocational ability.
Also called mental deficiency. (American Heritage
Dictionary)
– Medical: Below-normal intellectual function that has its
cause or onset during the developmental period and
usually in the first years after birth (Taber’s Cyclopedic
Medical Dictionary)
6
Mental Illness
Signs and Symptoms
The following areas are assessed when determining
mental status:
– Physical State: general appearance and behavior,
posture, hygiene, mannerisms
– Emotional State: mood, affect, speech, thought flow,
stability of affect
– Flow Disturbances: preservation, flight of ideas,
neologism (making up words)
– Word Salad: clanging, clarity of thought
– Suicidal/Homicidal: ideation, hallucination
– Obsessions, Compulsions, Delusions, Phobias
– Perceptual Disturbances: illusion, hallucination
– Cognitive Functions: orientation, performance, social
judgment, memory, insight into illness
handout
Titled: Mental Status Assessment
7
Mental Health Investigators
In addition to being
commissioned peace
officers, Mental Health
Investigators attend
additional training to
obtain Mental Health
Officer Proficiency
Certification.
Mental Health training
includes, but is not
limited to:
–
–
–
–
–
–
–
Abnormal Behaviors
Personality Disorders
Depression and Suicide
Patient Assessment
Substance Abuse
Psychopharmacology
Mental Retardation vs
Mental Illness
– Mental Health Legal Issues
– Officer Safety and
Awareness
8
Duties of the MHIU
Protect and serve the citizens of Denton
County by enforcing the laws of the State of
Texas.
Investigate all cases concerning emotionally
disturbed persons in Denton County through
the collection of evidence and witness
statements in addition to courtroom
testimony.
Form a belief whether an emotionally disturbed
person is suffering from a mental illness.
Transportation of emotionally disturbed
persons.
9
Primary Role of
Responding Officer(s)
What are my duties as a peace officer in the State of
Texas?
– As a commissioned peace officer in the State of Texas
you are to PREVENT INJURY
– Code of Criminal Procedure Chapter 6, Art. 6.06.
Peace Officer to Prevent Injury
Whenever, in the presence of a peace officer, or within his view,
one person is about to commit an offense against the person or
property of another, including the person or property of his spouse,
or injure himself, it is his duty to prevent it; and, for this purpose
the peace officer may summon any number of the citizens of his
county to his aid. The peace officer must use the amount of force
necessary to prevent the commission of the offense, and no
greater.
10
Emergency Apprehension
and Detention Questions
What is an Emergency Apprehension and
Detention (A&D)?
An Emergency A&D occurs when:
an emotionally disturbed individual is unable to make
treatment decisions regarding their mental health,
no safe alternatives are available for the individual,
and
the individual has done something that tends to
confirm the likelihood of serious harm to themselves or
others.
11
(continued)
Who can detain an individual for an emergency
apprehension and detention (A&D)?
Any peace officer in the State of Texas
Why does the DCSO have a specialized unit if any
peace officer may A&D an individual?
– Money ~ the cost of inpatient psychiatric care typically
cannot be absorbed by municipal police departments
– Transportation ~ the majority of municipal police agencies
in Denton County do not have the man power to transport
individuals to the state hospitals as well as back and forth
to court
12
(continued)
Why is the Denton County process so different
from the surrounding agencies such as Dallas
and Tarrant County?
– Counties to our south have public hospital systems
which absorb the costs of inpatient hospitalization
– The public hospital system provides a safe
environment to monitor and treat emotionally
disturbed individuals pending a court hearing
– Denton County does not have a public hospital
system; such as Parkland or JPS
13
(continued)
Without a public hospital system where do Denton
County patients go?
– Currently MHMR and DCSO contract with four private
facilities so that patients can receive crisis stabilization if it
is determined that a patient meets criteria for emergency
inpatient psychiatric care.
The facilities are:
Millwood (Arlington, TX) ~ a contract was signed with Millwood when
Denton County had no alternatives for inpatient psychiatric care other
than North Texas State Hospital in Wichita Falls
University Behavioral Health (UBH) (Denton, TX) ~ a contract was
signed with this facility shortly after it opened in 2006
Mayhill (Denton, TX)
Wise Regional (Decatur, TX)
– Patients with insurance or the ability to finance their own
psychiatric care may choose to seek treatment at any
private facility that takes their specific insurance including
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the ones listed above.
(continued)
What are the necessary steps that have to occur
before a Mental Health Investigator will respond?
– The emotionally disturbed person must be located in a
safe environment (hospital or jail) OR have police present
at the scene.
– The MHMR hotline is contacted and a triage is conducted.
– *If appropriate, the MHMR crisis clinician on-call responds
to the scene to evaluate the emotionally disturbed person
to determine if there are alternatives available.
– The Mental Health Investigator is notified by the *MHMR
crisis clinician to respond due to no alternatives being
available to ensure the persons safety.
15
(continued)
Are all these steps necessary?
Yes, each and every step is utilized to provide the individual
with the best treatment option legally available.
Why?
– The MHMR crisis clinician is not a peace officer; therefore,
they only respond to safe environments to conduct their
screenings.
– In order for a patient to be accepted by the state hospital
system the Local Mental Health Authority (which is MHMR
in Denton County) must provide them with a current
evaluation prior to their admission.
16
(continued)
Why does the process take so long?
– The MHMR crisis line is manned by Tarrant County
MHMR who may be assisting another individual in
crisis. Calls are triaged and returned on a priority
basis.
– (MHMR has a new system in place) and one on-call
Investigator for the entire county which consists of
950+ square miles.
– The interview and evidence gathering process takes
time for both the MHMR clinician and the Investigator.
– Additionally, some hospitals contract with a
psychiatric facility which evaluates the individual prior
to MHMR’s evaluation.
17
and Detention Process
When a Mental Health Investigator receives a call from a
MHMR Clinician that is recommending inpatient
hospitalization what happens next?
– The Investigator obtains preliminary information from the clinician
regarding the patient and the location they need to respond to.
– Upon arrival or while en route the Investigator will determine whether
the patient has active warrants. (Warrant status is necessary
because the state hospital will not accept patients who have charges
pending for violent offenses.)
– A review of the clinicians screening (AKA pink sheet) is conducted
as well as a review of any pertinent documentation or evidence.
(i.e., hospital, jail and/or police officer records, physical evidence
such as a knife, rope or gun and witness/family member statements)
– An interview with the patient typically yields additional information for
the Investigator to determine whether the patient meets criteria under
the law for an emergency apprehension and detention (A&D).
18
(continued)
– If it is determined that the least restrictive environment for the patient
is inpatient hospitalization AND the patient is unable to facilitate the
treatment financially or by signing themselves into the facility then the
Investigator take them into custody for an emergency A&D.
– The Investigator will complete the necessary paperwork and gather
evidence (including witness statements) prior to leaving the scene (if
the patients demeanor does not warrant an early departure to ensure
their safety and/or the safety of those present at the scene).
– The appropriate psychiatric facility is notified and arrangements are
made for the patient to receive treatment at the designated facility.
– Transportation of the patient being committed on an involuntary status
is done by the Investigator.
– The patient is released to the care of the psychiatric hospitals staff
pending a court hearing on the following business day.
19
(continued)
Why would a MHMR clinician or Mental Health
Investigator not be able to detain an emotionally
disturbed person?
– The person is not medically stable. The contracted
psychiatric facilities do not provide extensive medical
care.
– The person will not benefit from treatment. They are
diagnosed with profound mental retardation and cannot
participate in mental health treatment.
– The person is currently in a safe environment such as a
jail, nursing home or hospital as an inpatient. This person
is not an imminent threat to themselves or others.
– Neither of the contract facilities are able to accept the
person. Each facility has a detailed list of medical
exclusionary criteria.
handout
20
Titled: Exclusionary Criteria
and Detention Criteria
When you say the patient meets criteria,
what does that mean in legal terms?
– the person evidences mental illness
– the person evidences substantial risk of serious
harm to himself or others
– a specific description of the risk of harm
– the applicant believes the risk of harm is
imminent unless the person is immediately
restrained
– the applicant beliefs are based on a specific
recent behavior, overt acts, attempts or threats
21
(continued)
When you say the patient meets criteria, what does
that mean in layman’s terms?
– The patient has committed an action that tends to lead
one to believe that they are a danger to themselves or
others and will follow through with the action if they
haven’t already done so.
– Another commonly used term is “overt act.” The patient
has committed an obvious or blatant act that will result in
a dangerous situation to themselves, others or both.
– “Criteria” is situation dependent and relies on an
investigation of the circumstances regarding the crisis.
The background and support system of the patient
typically play critical roles when determining if a patient
has met criteria for an emergency A&D.
22
(continued)
What are examples of an overt act?
(not an all inclusive list)
– Suicide attempts: intentional overdose, cutting (wrists,
arms, legs, etc.), hanging, walking in traffic
– Homicidal activities: assaultive towards an individual
typically based on a delusion or hallucination and a result
of the patients psychotic state
– Ideations (Suicidal and/or Homicidal): plans to commit
suicide or homicide with details
– Psychosis induced actions: actions by a patient who do
not understand the consequences due to their psychotic
state, typically this individual will deny homicidal and
suicidal ideations; walking in traffic, assaulting others,
over-medicating, self-injurious behavior
23
The Laws: Emergency A&D
573.001 Apprehension by Peace Officer Without Warrant
(a)
A peace officer, without a warrant, may take a person into
custody if the officer:
(1) has reason to believe and does believe that:
(A) the person is mentally ill; and
(B) because of that mental illness there is a substantial risk of serious
harm to the person or to others unless the person is immediately
restrained; and
(2) believes that there is not sufficient time to obtain a warrant before
taking the person into custody.
(b)
A substantial risk of serious harm to the person or others
under Subsection (a)(1)(B) may be demonstrated by:
(1) the person’s behavior; or
(2) evidence of severe emotional distress and deterioration in the
person’s mental condition to the extent that the person cannot
remain at liberty.
24
(continued)
573.001 Apprehension by Peace Officer Without Warrant (continued)
(c)
The peace officer may form the belief that the person meets the criteria
for apprehension:
(1)
(2)
(d)
A peace officer who takes the person into custody under Subsection (a)
shall immediately transport the apprehended person to:
(1)
(2)
(e)
(f)
from a representation of a credible person; or
on the basis of the conduct of the apprehended person or the
circumstances under which the apprehended person is found.
the nearest appropriate inpatient mental health facility; or
a mental health facility deemed suitable by the local mental health authority,
if an appropriate inpatient mental health facility is not available.
A jail or similar detention facility may not be deemed suitable except in
an extreme emergency.
A person detained in a jail or a nonmedical facility shall be kept
separate from any person who is charged with or convicted of a crime.
25
(continued)
573.002 Peace Officer’s Application for Detention
(a)
(b)
A peace officer shall immediately file an application for detention
after transporting a person to a facility under Section 573.001.
The application for detention must contain:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
a statement that the officer has reason to believe and does believe that the
person evidences mental illness;
person evidences a substantial risk of serious harm to himself or others;
a specific description of the risk of harm;
risk of harm is imminent unless the person is immediately restrained;
a statement that he officer’s beliefs are derived from specific recent
behavior, over acts, attempts or threats that were observed by or reliably
reported to the officer;
a detailed description of the specific behavior, acts, attempts or threats;
and
the name and relationship to the apprehended person of any person who
reported or observed the behavior, acts, attempts or threats.
26
(continued)
571.004 Least Restrictive Appropriate Setting
The least restrictive appropriate setting for the treatment of a
patient is the treatment setting that:
(1) is available;
(2) provides the patient with the greatest probability of
improvement or cure; and
(3) is no more restrictive of the patient’s physical or social
liberties than is necessary to provide the patient with the
most effective treatment and to protect adequately against
any danger the patient poses to himself or others.
27
(continued)
What is a Least Restrictive Environment?
–
–
Commonly referred to as “LRE”
An environment that is available with the greatest
probability of improvement and is no more restrictive of
the patients liberties than necessary to adequately
protect them from harming themselves or others.
How does the availability of a LRE affect the
outcome of an evaluation?
–
–
If a LRE is available, then the Investigator is required by
the Texas Mental Health Code to abide by the least
restrictive alternative.
If it is determined that the LRE is the most appropriate
setting (either by the MHMR Clinician or the Investigator)
then the patient is released to the setting and no
emergency A&D is conducted.
28
(continued)
What are examples that lead to a LRE being
utilized? (not an all inclusive list)
– Family or friends agree to provide adequate protection for
the individual and assist them in follow-up treatment either
at MHMR or with a private physician.
– The individuals crisis is situational and is resolved by
providing a LRE. (i.e., a homeless person is suicidal only
because it is cold/hot out and they need somewhere to
stay ~ a bed at the Salvation Army removes the suicidal
ideations)
– The individual has insurance or funding and decides to
receive voluntary treatment at a psychiatric facility.
29
Access to MH Inpatient Services
MH Investigator Called
to Scene
Released to family/friends or
other responsible party
Emergency apprehension by
investigator
Referred to voluntary services
Follow up with MHMR or
private outpatient provider
Application may be filed.
Detained until next court date
at contract hospital
Transferred to treatment
elsewhere w/ no further contact
30
Following Emergency
Apprehension
Judge finds PC and orders pt
to WFSH for 10-14 Days
Judge finds no PC and
dismisses case W/ no further
action
Judge finds PC but orders out
patient services
31
Following 10-14 day stay
Pt is returned to court
Pt is ordered returned to
WFSH for up to 90 days
With or without meds at
request of hospital.
Pt is court ordered to
outpatient services for up to 90
days with MHMR
Case is dismissed/disposed of
and no further action is taken.
32
If patient is sent to WFSH for up
to 90 days then
Pt may be released at any time
by treating physician with referral
to MHMR for outpatient services.
Typically once discharged court
order expires.
Dr. may file for extended
commitment for up to one year if
he believes pt is still substantial
risk.
33
Legal References
The majority of the laws utilized by the MHIU and
MHMR pertaining to Emergency Apprehensions
and Detentions and Applications for Temporary
Mental Health Services can be found by
referencing the following:
Part 1. Texas Health and Safety Code
Title 7. Mental Health and Mental Retardation
Subtitle C. Texas Mental Health Code
Chapters 571-615
http://tlo2.tlc.state.tx.us/statutes/statutes.html
34
The Application Process
What happens when an individual needs help but does not
meet criteria for an emergency A&D?
An application for Court-Ordered Temporary Mental Health Services
may be filed.
Who may file the application?
The application may be filed by an adult or county/district attorney.
Where do you obtain the forms from?
The probate court, MHMR and the MHIU have copies of the forms
available. When are applications typically filed?
When the individual is currently in a safe environment and is not an
immediate danger to self/others. The individual may be at a hospital,
psychiatric facility, nursing home, jail, residence, etc.
Who approves the applications?
The Assistant District Attorney (ADA) that is assigned to the mental
health court reviews and either: approves the application to move
forward or declines to process the application due to lack of criteria.
handout
Titled: Application for Temporary Mental Health Services
35
The Application Process
(continued)
What documentation is needed to prove a patient is
diagnosed with a mental illness?
Certificate of Medical Examination for mental illness (CME)
Who provides this documentation?
– A CME is obtained from a medical doctor. A psychiatrist may
complete the CME, but it is not a requirement. Any Medical Doctor
licensed to practice medicine in the state of Texas may complete the
CME.
– Typically a CME is obtained by a family member who accompanies
the patient to the doctor’s office.
– If an individual is already a client of MHMR, then the MHMR physician
may complete a CME if it is clinically indicated.
– A CME is required to be submitted to the Probate Court at the time the
application is submitted
handout
Titled: Certificate of Medical Examination for Mental Illness
36
Questions: Admission
What are the possible ways an individual may receive
inpatient psychiatric treatment?
– Voluntarily or Involuntarily
– Involuntarily:
The individual meets criteria for an emergency A&D.
The individual receives court ordered mental health treatment as the
result of an application being filed.
– Voluntarily:
The individual is 16 years or older and signs themselves in for inpatient
treatment. An individual who is 16 years of age or older may be admitted
for inpatient treatment without the consent of their parent, managing
conservator or guardian.
The individual is under 16 years of age and is or has been married may
sign themselves in for inpatient treatment without the consent of their
parent, managing conservator or guardian.
A parent, managing conservator or guardian of an individual younger than
18 years of age who is not and has not been married may request the
admission of the individual to an inpatient mental health facility by filing a
request with the administrator of the facility to which admission is
requested.
37
Questions: Admission
(continued)
What documents are commonly presented in an effort to
obtain inpatient psychiatric treatment for an adult?
– Guardianship
– Medical Power of Attorney
– Durable Power of Attorney
Do these documents allow a person to consent for inpatient
psychiatric treatment for an individual?
– No. None of these documents allow for any individual to be forced
into inpatient psychiatric care without consent of the proposed
patient. These documents typically only permit medical treatment (as
opposed to mental health treatment).
– Guardians can consent for a preliminary psychiatric examine but
cannot consent for inpatient psychiatric facility or for forced
medication.
– Legal Reference: Probate Code, Chapter XIII Guardianship, Section
770 Care of Ward: Commitment
38
After an A&D?
What happens after an emergency A&D is done?
– The patient is transported by the Investigator to the appropriate crisis
stabilization unit (Millwood or UBH).
– The patient receives care at the facility until the next available court
date.
– The Investigator returns to pick up the patient from the facility to
transport the patient to court.
Is it acceptable for a friend or family member to transport the
patient?
– No, the Investigator that detains the patient is responsible for the
safety of that patient; therefore, the MHIU maintains custody of the
patient until the court hearing.
– During the court hearing the patients family member or friend may
request permission from the judge to transport the patient to the
state hospital. The judge must approve alternate transportation of
patients.
39
Court Hearings
Why does the patient go to court?
– So the judge can evaluate the evidence and
determine whether the order for detention
shall remain in effect and the patient to
receive further treatment.
– There are two types of hearings:
Probable Cause Hearing
Final Hearing
40
Court Hearings:
Probable Cause
A probable cause hearing occurs within 72 hours after the
detention was initiated unless the time period ends on a
Saturday, Sunday or holiday, then the hearing is held on
the next business day. In Denton County, the patient
typically attends a hearing the day following and emergency
A&D.
The hearing is to determine whether probable cause exists
to continue the detention and treatment of the patient.
Prior to the hearing the patient is treated at a crisis
stabilization facility contracted by MHMR and DCSO.
After the hearing the patient is treated at NTSH – Wichita
Falls Campus, unless the patient/patient’s family has made
arrangements for treatment at a private facility.
Hearsay is admissible during the probable cause hearing.
41
Court Hearings:
Final
A final hearing occurs:
for Temporary Mental Health Services
– 10-14 days after a probable cause hearing, or
– to address an application filed requesting temporary mental health services, or
– to address an application filed requesting extended mental health services.
The hearing is to determine whether clear and convincing evidence exists to
continue or initiate the detention and treatment of the patient.
Prior to the hearing the patient may be:
– treated at a state hospital
– living in the community
(residence, group home)
– housed in the county jail
– treated at a local hospital, nursing
home, psychiatric facility, etc.
After the hearing the patient is treated at NTSH – Wichita Falls Campus, unless
the patient/patient’s family has made arrangements for treatment at a private
facility.
Hearsay is not admissible during the final hearing.
The outcome of a final hearing may have one of three results:
– Continued court-ordered inpatient treatment
– Continued or modification of a court order to outpatient treatment
– Dismissal of the case and release of the patient
42
Court Hearings
(continued)
What is the length of the commitment?
– It varies depending on the type of services filed for.
– Probable Cause Hearing: the patient receives up to 10-14 days of
treatment then returns to court for a final or extended hearing
– Final Hearing for Temporary Mental Health Services: the patient
receives up to 90 days of treatment. If still hospitalized after 90 days
the facility may submit an application for extended mental health
services
– Final Hearing for Extended Mental Health Services: the patient
receives up to one year of treatment. If still hospitalized after one
year the facility may submit an additional application for extended
mental health services. The facility may submit an application for
extended services each year. To qualify for an extended application,
the individual must have had 60 consecutive days of inpatient
treatment within the previous 12 months.
handout
Titled: Application for Extended Mental Health Services
43
Questions: Discharge
If a patient voluntarily admits themselves for
inpatient psychiatric treatment can they leave when
they want to?
– Not necessarily. A patient is entitled to leave after a
written request (signed, timed and dated) for discharge is
filed with the facility. Within the four hours, the physician
responsible for the patient’s treatment must be notified
and the patient discharged unless the physician has
reason to believe that the patient might meet criteria for
court-ordered mental health services.
– Within 24 hours after the request for discharge is filed the
physician shall discharge the patient, unless it is
determined that the person meets the criteria for courtordered mental health services.
44
(continued)
What does the psychiatric facility need to do after it
is determined that the patient meets criteria for
court-ordered mental health services?
– The physician shall, not later than 4 p.m. on the next
succeeding business day after the date on which the
examination occurs, either discharge the patient or file an
application for court-ordered mental health services and
obtain a written order from the court for further detention.
– The physician shall notify the patient if they intend to
detain the patient under this law.
– This applies to individuals over the age of 18.
– The patient is transported to Probate Court to attend a
probable cause hearing.
45
(continued)
Can a patient under 18 years old follow the
same procedure for requesting discharge?
– Yes, they also provide the facility with a written
request for discharge.
– The patient’s parent, managing conservator or
guardian must be notified by the facility regarding the
discharge.
– If they object in writing to the patient’s discharge the
facility shall continue treatment of the patient as a
voluntary patient.
46
(continued)
When an individual receives court ordered mental
health treatment who determines when the patient is
ready to be discharged?
– Probate Court Judge
At the probable cause hearing the judge may determine that there
is not enough evidence to continue detaining the individual and
releases the patient.
At the final hearing or extended hearing (when considering
discharge), the judge may determine that the individual:
– will not benefit from any further mental health treatment or
– will benefit from court ordered outpatient treatment
– Facility responsible for the patient’s treatment
The treating psychiatrist or facility administrator may discharge the
patient if it is determined that the patient no longer meets criteria
for court-ordered mental health services.
The facility may file, for a modified order that directs the patient to
participate in court-ordered outpatient mental health services.
47
Recidivism
Does MHMR and/or the MHIU come into contact with
individuals who have multiple admissions in short periods of
time?
Yes.
What measures are in place to assist these individuals?
– An application for Extended Mental Health Services may be filed with
the court. This application states that the patient has received a
minimum of 60 consecutive days of inpatient psychiatric treatment
with the past 12 months. If the extended order is granted the patient
may receive up to one year of court-ordered inpatient or outpatient
mental health services.
– MHMR’s ACT (Assertive Community Treatment) Team provides an
array of mental health and support services to a high-risk population
of individual with mental illness. ACT team provides base-line skills
and intensive interaction to consumers to maintain stability in the
community.
48
Recidivism
(continued)
– Group homes monitor patients closely and
provide them with a place to live. The group
home assists the patient with transportation to
doctor’s visits and reminds the patients when
it is time to take prescribed medication.
– Unfortunately some patients require multiple
admissions before they are able to become
stable members of the community. These
patients either undergo multiple emergency
A&D’s, applications for court-ordered mental
health services or a combination of both.
49
Transportation
The MHIU transports emotionally
disturbed persons to and from:
– designated psychiatric hospitals
– Probate Court
– state hospitals (Civil, Criminal and Adolescent
Commitments)
– additional locations as determined through the
court or as a result of an investigation
50
Civil Commitment Hospitals
Primarily Denton County utilizes the North Texas
State Hospital Wichita Falls Campus for all Adult
and Adolescent Civil Commitments, but
circumstances arise and patients are transported
to alternate facilities for court ordered treatment.
Austin State Hospital
Big Spring State Hospital
Wichita Falls State Hospital
Terrell State Hospital
Rusk State Hospital
Waco Center for Youth
Rio Grande State Center
Kerrville State Hospital
El Paso State Hospital
San Antonio State Hospital
51
Criminal Commitment Hospitals
When a criminal is ordered by a court to undergo a
stay at an inpatient state hospital the MHIU
transports that individual one of five designated
forensic facilities.
Big Spring State Hospital
El Paso Psychiatric
Center
Kerrville State Hospital
North Texas State
Hospital – Vernon
Campus
Rusk State Hospital
52
Aftercare
DCMHMR provides aftercare services to
individuals who are discharged from any
state hospital or with on our voluntary
contact. This provides continuity of care.
The individual is automatically eligible for at
least one psychiatric evaluation and one
case management appointment. Individuals
are seen within 7 days of discharge to
ensure their medication regimen is continued
to promote and maintain stability.
53
Aftercare
(continued)
Individuals are evaluated on the basis of
diagnosis and a number of social aspects to
place individuals into service packages that
meet their needs.
DCMHMR provides aftercare services to
individuals who go to the hospital voluntarily
using their Medicare or Medicaid benefits;
however, they go through the same intake
process everyone else does. They are not
automatically eligible for services.
54
Examples
Paperwork:
– MHMR
Call Sheet
Emergency Screening Form ~ AKA: Pink Sheet
– MHIU
Screening Form
Narrative Form
Peace Officer’s Application for Emergency Detention
Witness and Evidentiary Supplement
Voluntary Statement
Approved Property for State Hospital and Contact Information
55
Contact Information
MHMR
– Crisis Line ~ 940.387.5555 or 800.762.0157
– MHMR Main Line ~ 940.381.5000
DCSO MHIU
– Office ~ 940.349.1930
– Fax ~ 940.349.1939
– Communications/Dispatch (non-emergency) ~
940.349.1600
– Emergency 911
56

Denton County Sheriff`s Office Mental Health Investigative Unit

Transcription

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