PROPOSED CHANGES IN COLORADO’S CIVIL COMMITMENT LAWS

Catherine Strode, MPA Health Care Advocacy Program

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Moe Keller VP of Public Policy & Strategic Initiatives Mental Health America

Amanda Kearney-Smith, MS Executive Director Colorado Mental Wellness Network

PRESENTERS

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BILL DRAFT

•February 18, 2013

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INTRODUCTIONThree Colorado StatutesCivil Commitment HoldsConsolidationExtends Length of Mental Health Holds

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PUBLIC AND PERSONAL SAFETY

Adds “Substantial Probability” to Hold Criteria

Problems for Law EnforcementProblems for Parents and Families

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COLORADO’S SUBSTANCE USE RATES* Abuse Rates Higher Than National Average

All Age Ranges

*The Substance Abuse and Mental Health Services Administration

http://www.samhsa.gov/

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]COLORADO’S MENTAL HEALTH INDICATORS* Serious Psychological Distress at National Average

Major Depressive Episodes Above

National Average

*The Substance Abuse and Mental Health Services Administrationhttp://www.samhsa.gov/ 7

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ACCESS CHALLENGES

Lack of CoverageLack of Resources Lack of Short Term Care BedsLack of Community SupportsLack of Providers

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CRISIS CARE NEEDS“Danger to Himself or Herself”Increased Victimization*Continuum of CareIncrease Speed of Medicaid Approval

*www.ncbi.nlm.nih.gov9

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GOVERNOR’S INITIATIVES

‘Right Services at the Right Time’:•Streamline StatutesStatewide HotlineExpand Bed CapacityHousing VouchersCommunity Supports/ACT Teams

Medicaid Expanded For Substance Use Disorder Services

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GOALS OF STATUTE CHANGE

Quick Intervention and Stabilization

Integration of Mental Health, Alcohol and Substance Use Disorders

“Substantial Probability” Added As Third Criterion for Hold

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INTERVENTION CHANGES• 72-Hour Hold Increased to 5 Days

•Evaluation Required Within 24 Hours

•“Substantial Probability” Initiates Hold

•“Substantial Probability” in regards to harm to self

•“Probability” in regards to harm to others*

*February 18 Draft

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“SUBSTANTIAL PROBABILITY”

VS “SUBSTANTIAL RISK”

Bill RedraftedLanguage Changed

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EVALUATION CHANGES

Broadens Standard of Involuntary Commitment

Creates New Definitions: ‘Professional Persons’ ‘Designated Facility’ ‘Gravely Disabled’

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REVISED DEFINITIONS

Danger to Self or Others

Family Member

Gravely Disabled

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CRISIS CARE SCENARIO Client Profile

Client Condition

Inclusion of an Advanced

Directive (crisis plan)

Maximum 5 Day Hold Period

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CLIENT RIGHTS

Opportunity for individuals to request an evaluation

Ability to be advised of individual rights while under an involuntary hold

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EXTENDED HOLD SCENARIO Short-term Civil Commitment

Evaluation within 24 hours

Legal procedures for reporting

Least restrictive standards

Advanced directives

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STAKEHOLDER PERSPECTIVES

Individual

Family

Provider

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STATUTE CHALLENGES

Communication barriers

Translation into practice

Client payment

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PROVIDER CHANGES

Who can initiate?

Who can certify?

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BILL PROPOSAL

Sponsors/Timeline

Involvement of State

Departments

Implementation

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RESOURCES  Colorado General Assembly Websitehttp://www.leg.state.co.us/clics/clics2013A/cslFrontPages.nsf/HomeSplah?OpenForm  Treatment Advocacy Centerhttp://www.treatmentadvocacycenter.org/index.php?option=com_content&view=article&id=201&Itemid=136  Colorado Department of Human Serviceshttp://www.colorado.gov/cs/Satellite/CDHS-Main/CBON/1251575083520  Office of Behavioral Healthhttp://www.colorado.gov/cs/Satellite/CDHS- BehavioralHealth/CBON/1251578892077  National Resource Center on Psychiatric Advance

Directiveshttp://www.nrc-pad.org/• WEBINAR RECORDING www.advocacydenver.org

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YOUR QUESTIONS AND INPUT

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