The Involuntary Treatment Act (ITA) sets forth the procedures, rights, and requirements for involuntary behavioral health treatment of adults.  A person may be committed by a court for involuntary behavioral health treatment if he or she, due to a mental health or substance use disorder, poses a likelihood of serious harm, is gravely disabled, or is in need of assisted outpatient behavioral health treatment (AOBHT).

A designated crisis responder (DCR) is a mental health professional responsible for investigating and determining whether a person may be in need of involuntary treatment.  A person may be committed for involuntary inpatient treatment only on the basis of likelihood of serious harm or grave disability.  Where the petition is based on the person being in need of AOBHT, the commitment may only be for treatment in an outpatient setting under a less restrictive alternative treatment (LRA) order.  The provisions governing involuntary treatment of minors over the age of 13 are parallel with the adult ITA in many respects, but do not include provisions for involuntary commitment based on a minor being in need of AOBHT.
 
Assisted Outpatient Behavioral Health Treatment.

A person is in need of AOBHT if the person, as a result of a behavioral health disorder:

• has been committed by a court to detention for involuntary behavioral health treatment during the preceding 36 months;
• is unlikely to voluntarily participate in outpatient treatment without an LRA order, based on a history of nonadherence with treatment or in view of the person's current behavior;
• is likely to benefit from LRA treatment; and
• requires LRA treatment to prevent a relapse, decompensation, or deterioration that is likely to result in the person presenting a likelihood of serious harm or the person becoming gravely disabled within a reasonably short time.

 
In order to file a petition for AOBHT, the DCR must conduct an investigation and determine that the person meets criteria.  The DCR may spend up to 48 hours to conduct the investigation.  If the DCR finds that a person is in need of AOBHT, the DCR files a petition for up to 90 days of LRA treatment and must provide the person with a summons to the court hearing and serve the petition on the person and the person's attorney.  The probable cause hearing must be held within five judicial days of the filing of the petition.  If the court finds that the person meets criteria, the court may enter an order for 90 days of LRA treatment.
 
Less Restrictive Alternative Treatment.
When entering an order for involuntary treatment, if the court finds that treatment in a less restrictive alternative than detention is in the best interest of the person, the court must order an appropriate less restrictive course of treatment rather than inpatient treatment.  Less restrictive alternative treatment must include specified components, including assignment of a care coordinator, an intake evaluation and psychiatric evaluation, a schedule of regular contacts with the treatment provider, a transition plan addressing access to continued services at the end of the order, and individual crisis plan.  In addition, LRA treatment may include additional requirements, including a requirement to participate in medication management, psychotherapy, residential treatment, and periodic court review.

Enforcement of Less Restrictive Alternative Orders.
Either a DCR or the agency or facility providing services under an LRA order may take a number of actions if a person fails to adhere to the terms of the LRA order, if the person is suspected of experiencing substantial deterioration in functioning or substantial decompensation that can with reasonable probability be reversed, or if the person poses a likelihood of serious harm.

 
A DCR or the secretary of the Department of Social and Health Services may revoke the LRA order by placing the person in detention and filing a petition for revocation.  A hearing on the petition must be held within five days.  Except for cases where the LRA order is based on AOBHT, the court must determine whether:   the person has adhered to the terms of the LRA order; substantial deterioration in functioning has occurred; there is evidence of substantial decompensation with a reasonable probability that it can be reversed by inpatient treatment; or there is a likelihood of serious harm.  If the court makes one of these findings, the court may reinstate or modify the order, or it may order a further period of detention for inpatient treatment. 
 
If the LRA order is based solely on the person being in need of AOBHT, the court must determine whether to continue the detention for inpatient treatment or reinstate or modify the person's LRA order.  To continue the detention, the court must find that the person, as a result of a behavioral health disorder, presents a likelihood of serious harm or is gravely disabled and no less restrictive alternatives to involuntary detention and treatment are in the best interest of the person or others.

Assisted outpatient behavioral health treatment is renamed assisted outpatient treatment (AOT).  New standards and procedures are established for commitments for persons who are in need of AOT.

Definitions.
The definition of "in need of assisted outpatient treatment" is revised.  A person is in need of AOT if:

• The person has a behavioral health disorder.
• Based on a clinical determination and in view of the person's treatment history and current behavior, at least one of the following is true:
  • The person is unlikely to survive safely in the community without supervision and the person's condition is substantially deteriorating.
  • The person is in need of AOT in order to prevent a relapse or deterioration that would be likely to result in grave disability or a likelihood of serious harm.
• The person has a history of lack of compliance with treatment, in that at least one of the following is true:
  • The person's behavioral health disorder has, at least twice within the last 36 months, been a substantial factor in necessitating hospitalization, or receipt of services in a forensic or other mental health unit of a state correctional facility or local correctional facility, not including any period during which the person was hospitalized or incarcerated immediately preceding the filing of the petition.
  • The person's behavioral health disorder has, at least twice within the last 36 months, been a substantial factor in:  necessitating emergency medical care; necessitating hospitalization for behavioral health-related medical conditions including overdose, infected abscesses, sepsis, endocarditis, or other maladies; or behavior that resulted in the person's incarceration.
  • The person's behavioral health disorder has resulted in one or more violent acts, threats, or attempts to cause serious physical harm to themselves or another within the last 48 months, not including any period in which the person was hospitalized or incarcerated immediately preceding the filing of the petition.
• The person has been offered an opportunity to participate in a treatment plan, and the person continues to not engage in treatment.
• Participation in an AOT program would be the least restrictive alternative necessary to ensure the person's recovery and stability.
• The person will benefit from AOT.

 
Petition Process.
Assisted outpatient treatment is removed from the DCR investigation and petition process.  Instead, a petition for up to 18 months of LRA treatment on the basis that a person is in need of AOT may be filed by:

• the director of a hospital where the person is hospitalized;
• the director of a behavioral health service provider providing behavioral health care or residential services to the person;
• the person's treating mental health professional or substance use disorder professional or one who has evaluated the person;
• a DCR;
• a release planner from a corrections facility; or
• an emergency room physician.

 
The petitioner must personally interview the person, unless the person refuses an interview, to determine whether the person will voluntarily receive appropriate treatment.  The petitioner must allege specific facts based on personal observation, evaluation, or investigation, and must consider the reliability or credibility of any person providing information material to the petition.
 
The petition must include the following:

• a statement of the circumstances under which the person's condition was made known and the basis for the opinion that the person is in need of AOT;
• a declaration from a physician, physician assistant, advanced registered nurse practitioner, or the person's treating mental health professional or substance use disorder professional, who has examined the person no more than 10 days prior to the filing of the petition and who is willing to testify in support of the petition, or who alternatively has attempted to examine the person within the same period but has not been able to obtain the person's cooperation, and who is willing to testify to the reasons they believe that the person meets AOT criteria;
• the declarations of any additional witnesses supporting the petition;
• the name of an agency, provider, or facility that agrees to provide LRA treatment; and
• if the person is detained at the time of the petition, the anticipated release date of the person and any other details needed to facilitate successful reentry and transition into the community.

 
The petition must be served on the county prosecuting attorney.  The prosecutor must review the petition, and if appropriate, consult with the petitioner to conform the petition with the requirements of law.  The prosecutor may decline to proceed with a petition that does not meet legal requirements.
 
When appropriate, the prosecutor must schedule the petition for a hearing and cause the petition, summons and additional information to be served upon the person and the person's guardian, if any. 
 
If the petition involves a person whom the prosecutor knows, or has reason to know, is an American Indian or Alaska Native who receives medical or behavioral health services from a tribe within Washington, the prosecutor must notify the tribe and Indian health care provider.
 
Less restrictive alternative treatment, including for conditional release to LRA treatment for persons who have been civilly committed under criminal insanity laws, may include a requirement to participate in partial hospitalization.

Less restrictive alternative treatment orders based on a person being in need of AOT are subject to the same standards for modification or revocation as for other LRA orders.  This includes allowing the court to order the respondent to be detained for inpatient treatment if:  the person has failed to adhere to the court order; experienced substantial deterioration in functioning; experienced substantial decompensation which can be reversed by inpatient treatment; or presents a likelihood of serious harm and detention for inpatient treatment is appropriate. 
  
The law governing involuntary behavioral health treatment for minors is amended to allow a petition for LRA treatment for adolescents who are 13 to 17 years old on the basis that the adolescent is in need of AOT, under the same standards that apply for adults in need of AOT.

Behavioral health administrative services organizations must employ an AOT program coordinator to oversee system coordination and legal compliance for AOT.  
 
The development of an individualized discharge plan for a person committed to a state hospital for 90 or 180 days must include consideration of whether a petition should be filed for LRA treatment on the basis the person is in need of AOT.