§ 5100.86. Involuntary emergency examination and treatment not to exceed 120 hours.

 (a)  Written applications, warrants, and written statements made under section 302 of the act (50 P. S. §  7302), shall be made on Form MH-783 issued by the Department.

 (b)  A State-operated facility shall not accept an application for involuntary emergency examination and treatment unless there is a preexisting agreement of waiver approved by the Deputy Secretary of Mental Health, between the State facility and the administrator which designates the State facility as the only provider of inpatient services in the county program; or, there is a preexisting letter of agreement approved by the regional commissioner of mental health, between the State facility and the administrator which designates the State facility as:

   (1)  A substitute provider of inpatient services when an emergency need arises and there are no other appropriate and approved facilities available; or

   (2)  A provider of specialized forensic inpatient services when a need for security arises. Such letters of agreement shall define the nature of security to be available and the responsibilities of both the State facility and the Administrator for specific services including aftercare planning and referral.

 (c)  Any person authorized under section 302 of the act to take a person to a treatment facility for involuntary emergency examination and treatment shall explain to the person in need of such examination and treatment the nature and purpose of the action to be undertaken.

 (d)  The escorting individual shall make every effort to use the least force necessary and shall act to the extent possible in a courteous manner toward such individual giving attention to the dignity of the person. Transportation to and from a facility remains the ultimate responsibility of the administrator.

 (e)  Upon arrival at a facility previously designated as a provider of emergency examinations. Form MH-783 shall be completed and Form MH-783-B shall be given to the person subject to the examination. The person shall be informed of his right to counsel and be advised that if he cannot afford counsel, counsel can be provided.

 (f)  If the examining physician determines that the person is not severely mentally disabled or not in need of immediate treatment, the administrator shall be notified of the results of the examination and shall assure that the person is provided with transportation to an appropriate location within the community, as he may request.

 (g)  If the person is determined to be severely mentally disabled and in need of immediate treatment:

   (1)  The examining physician shall make certain that the person has received a copy of forms MH-782, Bill of Rights, and MH-783-A, Explanation of Rights Under Involuntary Emergency Commitment.

   (2)  The facility shall notify the administrator, if applicable, that:

     (i)   No warrant has been issued and there is reasonable probability that a previous application, based upon the same behavior, had been sought;

     (ii)   A bed is needed at another facility; or

     (iii)   Public funding will be involved.

   (3)  When the examining facility recommends emergency involuntary treatment and has no bed available, the administrator in designating a facility for treatment, shall also authorize transportation between facilities.

 (h)  The administrator shall designate an appropriate treatment facility which may be the examining facility or, if no bed is available there, the nearest appropriate facility which is capable of immediately providing such treatment. If county OMH funding is not involved, the patient’s choice of facilities is to be respected whenever an appropriate bed is available.

 (i)  The involuntary emergency treatment of the individual, or the arrangement of such, shall be initiated immediately but shall be limited to:

   (1)  Conducting a physical examination.

   (2)  Performing diagnostic evaluations of the individual’s mental health.

   (3)  Providing that necessary treatment required to protect the health and safety of the individual and others. As a first priority, the treating physician shall seek to respond to the emergency condition necessitating commitment unless the individual consents to additional treatment.

 (j)  Examination preliminaries.

   (1)  The facility shall deliver Forms MH-782, and MH-783-A to each person to be examined and shall inform him or her of the purpose and nature of the examination.

   (2)  The person shall be requested to furnish the names of up to three parties whom he may want notified and kept informed of his status. The parties may, at the request of the patient, be informed of any major change in the person’s status, including transfer, escape, major change in medical condition or discharge.

   (3)  The person shall be informed of his right to counsel.

   (4)  Reasonable use of the telephone shall mean at least three completed phone calls. If assistance is required, the facility shall assist the individual in completing phone calls. The cost of any toll calls shall be borne by the person in need of treatment, although actual payment shall not be a precondition to the person’s use of the telephone.

   (5)  The treating facility shall immediately undertake to obtain information regarding what steps should be taken to assure that the health and safety needs of any dependents of the person are safeguarded and that his personal property and premises are secured.

   (6)  The facility shall immediately communicate the information obtained to the office or person designated by the administrator.

   (7)  Before any facility is designated as the provider of involuntary emergency examination and treatment, the administrator shall have specified in writing the procedures to be followed by his office and those facilities to be designated in carrying out of the responsibilities of section 302(c)(2) of the act (50 P. S. §  7302(c)(2)). These procedures must specify what types of reasonable actions shall be taken, how quickly they shall be taken, and who is responsible for them. Such procedures shall be based on the availability of resources within the community.

   (8)  The administrator’s office shall coordinate and record any action taken in each case. At least annually the administrator and each approved facility shall review and consider needed amendments to the procedures.

 (k)  Reasonable steps to assure that the health and safety needs of a person’s dependents are met and the property is secure.

   (1)  The actions of a facility director or county administrator taken under section 302(c)(2) of the act should be well defined, and reflective of local resources.

   (2)  Because of community differences, no one Statewide plan can serve all possible contingencies. The act comtemplates that reasonable efforts be taken to assure protection of person’s dependents and property. The efforts must, as a minimum include a documented assessment of the patient’s need for protective services. This would mean that those initially working with a patient would attempt to determine what is needed by talking with the patient or his family or friends. Once the information is gathered, it should be transmitted to the person responsible for implementation of protective services or if incomplete, this fact should be transmitted to those responsible for a more thorough assessment. The act does not contemplate that mental health professionals will actually provide all needed services for all patients but relies upon professional linkage referral and follow-up to assure that the needed protections are in fact, provided and maintained. The implementation of protective services requires community organization efforts by the county administrator’s office in developing interagency liaison on continuing basis.

   (3)  Each mental health administrative unit should develop its own plan which addresses the most typical or usual contingencies. State in the plan that deviations will be handled on a case-by-case basis. The most essential element in meeting the requirement of this section is for the county administrator to have a well-developed local plan which shows the involvement of all possible resources, such as local health, welfare, housing agencies, and protective services determines which individuals, or agencies are responsible for particular activities and when they are to be involved. The plan should show initial procedures for involving the patient’s family, legally responsible relatives, or friends designated by the patient. Agencies should be utilized only as necessary. The plan should define the communication flow and the specific duties and responsibilities for action of the mental health provider agencies, the administrator’s office, and protective agencies. The plan should also indicate general provisions for the resolution of problems and how exceptional cases will be provided for.

   (4)  Once a referral is made and the information is conveyed to the appropriate agencies, the only remaining responsibility for the administrator is the periodic follow up necessary to demonstrate that the protection continues to be made available to the patient in need.

   (5)  Plans developed under this section should be reviewed at least annually by the participating agencies and will be subject to review and approval by the office of Mental Health.

Notes of Decisions

   Under the terms of the Mental Health and Mental Retardation Act of 1966 and the Mental Health Procedures Act, when a court orders treatment at a designated State mental hospital, the designated facility must admit the patient for treatment; at that time, the facility is without recourse to deny admission. In re Bishop, 717 A.2d 1114 (Pa. Cmwlth. 1998); appeal denied 738 A.2d 458 (Pa. 1999).



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