ESSB 6665 -
By Committee on Human Services
NOT CONSIDERED 03/06/2008
Strike everything after the enacting clause and insert the following:
"Sec. 1 RCW 70.96A.800 and 2005 c 504 s 220 are each amended to
read as follows:
(1) The secretary shall select and contract with counties to
provide intensive case management for chemically dependent persons with
histories of high utilization of crisis services at two sites. In
selecting the two sites, the secretary shall endeavor to site one in an
urban county, and one in a rural county; and to site them in counties
other than those selected pursuant to RCW 70.96B.020, to the extent
necessary to facilitate evaluation of pilot project results. Within
funds provided for this specific purpose, the secretary may contract
with additional counties to provide intensive case management.
(2) The contracted sites shall implement the pilot programs by
providing intensive case management to persons with a primary chemical
dependency diagnosis or dual primary chemical dependency and mental
health diagnoses, through the employment of chemical dependency case
managers. The chemical dependency case managers shall:
(a) Be trained in and use the integrated, comprehensive screening
and assessment process adopted under RCW 70.96C.010;
(b) Reduce the use of crisis medical, chemical dependency and
mental health services, including but not limited to, emergency room
admissions, hospitalizations, detoxification programs, inpatient
psychiatric admissions, involuntary treatment petitions, emergency
medical services, and ambulance services;
(c) Reduce the use of emergency first responder services including
police, fire, emergency medical, and ambulance services;
(d) Reduce the number of criminal justice interventions including
arrests, violations of conditions of supervision, bookings, jail days,
prison sanction day for violations, court appearances, and prosecutor
and defense costs;
(e) Where appropriate and available, work with therapeutic courts
including drug courts and mental health courts to maximize the outcomes
for the individual and reduce the likelihood of reoffense;
(f) Coordinate with local offices of the economic services
administration to assist the person in accessing and remaining enrolled
in those programs to which the person may be entitled;
(g) Where appropriate and available, coordinate with primary care
and other programs operated through the federal government including
federally qualified health centers, Indian health programs, and
veterans' health programs for which the person is eligible to reduce
duplication of services and conflicts in case approach;
(h) Where appropriate, advocate for the client's needs to assist
the person in achieving and maintaining stability and progress toward
recovery;
(i) Document the numbers of persons with co-occurring mental and
substance abuse disorders and the point of determination of the co-occurring disorder by quadrant of intensity of need; and
(j) Where a program participant is under supervision by the
department of corrections, collaborate with the department of
corrections to maximize treatment outcomes and reduce the likelihood of
reoffense.
(3) The pilot programs established by this section shall begin
providing services by March 1, 2006.
(4) This section expires June 30, ((2008)) 2009.
Sec. 2 RCW 70.96B.800 and 2005 c 504 s 217 are each amended to
read as follows:
(1) The Washington state institute for public policy shall evaluate
the pilot programs and make ((a)) preliminary reports to appropriate
committees of the legislature by December 1, 2007, and June 30, 2008,
and a final report by ((September 30, 2008)) June 30, 2010.
(2) The evaluation of the pilot programs shall include:
(a) Whether the designated crisis responder pilot program:
(i) Has increased efficiency of evaluation and treatment of persons
involuntarily detained for seventy-two hours;
(ii) Is cost-effective;
(iii) Results in better outcomes for persons involuntarily
detained;
(iv) Increased the effectiveness of the crisis response system in
the pilot catchment areas;
(b) The effectiveness of providing a single chapter in the Revised
Code of Washington to address initial detention of persons with mental
disorders or chemical dependency, in crisis response situations and the
likelihood of effectiveness of providing a single, comprehensive
involuntary treatment act.
(3) The reports shall consider the impact of the pilot programs on
the existing mental health system and on the persons served by the
system.
Sec. 3 RCW 70.96B.010 and 2005 c 504 s 202 are each amended to
read as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Admission" or "admit" means a decision by a physician that a
person should be examined or treated as a patient in a hospital, an
evaluation and treatment facility, or other inpatient facility, or a
decision by a professional person in charge or his or her designee that
a person should be detained as a patient for evaluation and treatment
in a secure detoxification facility or other certified chemical
dependency provider.
(2) "Antipsychotic medications" means that class of drugs primarily
used to treat serious manifestations of mental illness associated with
thought disorders, which includes but is not limited to atypical
antipsychotic medications.
(3) "Approved treatment program" means a discrete program of
chemical dependency treatment provided by a treatment program certified
by the department as meeting standards adopted under chapter 70.96A
RCW.
(4) "Attending staff" means any person on the staff of a public or
private agency having responsibility for the care and treatment of a
patient.
(5) "Chemical dependency" means:
(a) Alcoholism;
(b) Drug addiction; or
(c) Dependence on alcohol and one or more other psychoactive
chemicals, as the context requires.
(6) "Chemical dependency professional" means a person certified as
a chemical dependency professional by the department of health under
chapter 18.205 RCW.
(7) "Commitment" means the determination by a court that a person
should be detained for a period of either evaluation or treatment, or
both, in an inpatient or a less restrictive setting.
(8) "Conditional release" means a revocable modification of a
commitment that may be revoked upon violation of any of its terms.
(9) "Custody" means involuntary detention under either chapter
71.05 or 70.96A RCW or this chapter, uninterrupted by any period of
unconditional release from commitment from a facility providing
involuntary care and treatment.
(10) "Department" means the department of social and health
services.
(11) "Designated chemical dependency specialist" or "specialist"
means a person designated by the county alcoholism and other drug
addiction program coordinator designated under RCW 70.96A.310 to
perform the commitment duties described in RCW 70.96A.140 and this
chapter, and qualified to do so by meeting standards adopted by the
department.
(12) "Designated crisis responder" means a person designated by the
county or regional support network to perform the duties specified in
this chapter.
(13) "Designated mental health professional" means a mental health
professional designated by the county or other authority authorized in
rule to perform the duties specified in this chapter.
(14) "Detention" or "detain" means the lawful confinement of a
person under this chapter, or chapter 70.96A or 71.05 RCW.
(15) "Developmental disabilities professional" means a person who
has specialized training and three years of experience in directly
treating or working with individuals with developmental disabilities
and is a psychiatrist, psychologist, or social worker, and such other
developmental disabilities professionals as may be defined by rules
adopted by the secretary.
(16) "Developmental disability" means that condition defined in RCW
71A.10.020.
(17) "Discharge" means the termination of facility authority. The
commitment may remain in place, be terminated, or be amended by court
order.
(18) "Evaluation and treatment facility" means any facility that
can provide directly, or by direct arrangement with other public or
private agencies, emergency evaluation and treatment, outpatient care,
and timely and appropriate inpatient care to persons suffering from a
mental disorder, and that is certified as such by the department. A
physically separate and separately operated portion of a state hospital
may be designated as an evaluation and treatment facility. A facility
that is part of, or operated by, the department or any federal agency
does not require certification. No correctional institution or
facility, or jail, may be an evaluation and treatment facility within
the meaning of this chapter.
(19) "Facility" means either an evaluation and treatment facility
or a secure detoxification facility.
(20) "Gravely disabled" means a condition in which a person, as a
result of a mental disorder, or as a result of the use of alcohol or
other psychoactive chemicals:
(a) Is in danger of serious physical harm resulting from a failure
to provide for his or her essential human needs of health or safety; or
(b) Manifests severe deterioration in routine functioning evidenced
by repeated and escalating loss of cognitive or volitional control over
his or her actions and is not receiving such care as is essential for
his or her health or safety.
(21) "History of one or more violent acts" refers to the period of
time ten years before the filing of a petition under this chapter, or
chapter 70.96A or 71.05 RCW, excluding any time spent, but not any
violent acts committed, in a mental health facility or a long-term
alcoholism or drug treatment facility, or in confinement as a result of
a criminal conviction.
(22) "Imminent" means the state or condition of being likely to
occur at any moment or near at hand, rather than distant or remote.
(23) "Intoxicated person" means a person whose mental or physical
functioning is substantially impaired as a result of the use of alcohol
or other psychoactive chemicals.
(((23))) (24) "Judicial commitment" means a commitment by a court
under this chapter.
(((24))) (25) "Licensed physician" means a person licensed to
practice medicine or osteopathic medicine and surgery in the state of
Washington.
(((25))) (26) "Likelihood of serious harm" means:
(a) A substantial risk that:
(i) Physical harm will be inflicted by a person upon his or her own
person, as evidenced by threats or attempts to commit suicide or
inflict physical harm on oneself;
(ii) Physical harm will be inflicted by a person upon another, as
evidenced by behavior that has caused such harm or that places another
person or persons in reasonable fear of sustaining such harm; or
(iii) Physical harm will be inflicted by a person upon the property
of others, as evidenced by behavior that has caused substantial loss or
damage to the property of others; or
(b) The person has threatened the physical safety of another and
has a history of one or more violent acts.
(((26))) (27) "Mental disorder" means any organic, mental, or
emotional impairment that has substantial adverse effects on a person's
cognitive or volitional functions.
(((27))) (28) "Mental health professional" means a psychiatrist,
psychologist, psychiatric nurse, or social worker, and such other
mental health professionals as may be defined by rules adopted by the
secretary under the authority of chapter 71.05 RCW.
(((28))) (29) "Peace officer" means a law enforcement official of
a public agency or governmental unit, and includes persons specifically
given peace officer powers by any state law, local ordinance, or
judicial order of appointment.
(((29))) (30) "Person in charge" means a physician or chemical
dependency counselor as defined in rule by the department, who is
empowered by a certified treatment program with authority to make
assessment, admission, continuing care, and discharge decisions on
behalf of the certified program.
(((30))) (31) "Private agency" means any person, partnership,
corporation, or association that is not a public agency, whether or not
financed in whole or in part by public funds, that constitutes an
evaluation and treatment facility or private institution, or hospital,
or approved treatment program, that is conducted for, or includes a
department or ward conducted for, the care and treatment of persons who
are mentally ill and/or chemically dependent.
(((31))) (32) "Professional person" means a mental health
professional or chemical dependency professional and shall also mean a
physician, registered nurse, and such others as may be defined by rules
adopted by the secretary pursuant to the provisions of this chapter.
(((32))) (33) "Psychiatrist" means a person having a license as a
physician and surgeon in this state who has in addition completed three
years of graduate training in psychiatry in a program approved by the
American medical association or the American osteopathic association
and is certified or eligible to be certified by the American board of
psychiatry and neurology.
(((33))) (34) "Psychologist" means a person who has been licensed
as a psychologist under chapter 18.83 RCW.
(((34))) (35) "Public agency" means any evaluation and treatment
facility or institution, or hospital, or approved treatment program
that is conducted for, or includes a department or ward conducted for,
the care and treatment of persons who are mentally ill and/or
chemically dependent, if the agency is operated directly by federal,
state, county, or municipal government, or a combination of such
governments.
(((35))) (36) "Registration records" means all the records of the
department, regional support networks, treatment facilities, and other
persons providing services to the department, county departments, or
facilities which identify persons who are receiving or who at any time
have received services for mental illness.
(((36))) (37) "Release" means legal termination of the commitment
under chapter 70.96A or 71.05 RCW or this chapter.
(((37))) (38) "Secretary" means the secretary of the department or
the secretary's designee.
(((38))) (39) "Secure detoxification facility" means a facility
operated by either a public or private agency or by the program of an
agency that serves the purpose of providing evaluation and assessment,
and acute and/or subacute detoxification services for intoxicated
persons and includes security measures sufficient to protect the
patients, staff, and community.
(((39))) (40) "Social worker" means a person with a master's or
further advanced degree from an accredited school of social work or a
degree deemed equivalent under rules adopted by the secretary.
(((40))) (41) "Treatment records" means registration records and
all other records concerning persons who are receiving or who at any
time have received services for mental illness, which are maintained by
the department, by regional support networks and their staffs, and by
treatment facilities. Treatment records do not include notes or
records maintained for personal use by a person providing treatment
services for the department, regional support networks, or a treatment
facility if the notes or records are not available to others.
(((41))) (42) "Violent act" means behavior that resulted in
homicide, attempted suicide, nonfatal injuries, or substantial damage
to property.
Sec. 4 RCW 70.96B.020 and 2005 c 504 s 203 are each amended to
read as follows:
(1) The secretary, after consulting with the Washington state
association of counties, shall select and contract with regional
support networks or counties to provide two integrated crisis response
and involuntary treatment pilot programs for adults and shall allocate
resources for both integrated services and secure detoxification
services in the pilot areas. In selecting the two regional support
networks or counties, the secretary shall endeavor to site one in an
urban and one in a rural regional support network or county; and to
site them in counties other than those selected pursuant to RCW
70.96A.800, to the extent necessary to facilitate evaluation of pilot
project results. Within funds provided for this specific purpose, the
secretary may contract with additional regional support networks or
counties to provide integrated crisis response and involuntary
treatment pilot programs to adults.
(2) The regional support networks or counties shall implement the
pilot programs by providing integrated crisis response and involuntary
treatment to persons with a chemical dependency, a mental disorder, or
both, consistent with this chapter. The pilot programs shall:
(a) Combine the crisis responder functions of a designated mental
health professional under chapter 71.05 RCW and a designated chemical
dependency specialist under chapter 70.96A RCW by establishing a new
designated crisis responder who is authorized to conduct investigations
and detain persons up to seventy-two hours to the proper facility;
(b) Provide training to the crisis responders as required by the
department;
(c) Provide sufficient staff and resources to ensure availability
of an adequate number of crisis responders twenty-four hours a day,
seven days a week;
(d) Provide the administrative and court-related staff, resources,
and processes necessary to facilitate the legal requirements of the
initial detention and the commitment hearings for persons with a
chemical dependency;
(e) Participate in the evaluation and report to assess the outcomes
of the pilot programs including providing data and information as
requested;
(f) Provide the other services necessary to the implementation of
the pilot programs, consistent with this chapter as determined by the
secretary in contract; and
(g) Collaborate with the department of corrections where persons
detained or committed are also subject to supervision by the department
of corrections.
(3) The pilot programs established by this section shall begin
providing services by March 1, 2006.
Sec. 5 RCW 70.96B.050 and 2007 c 120 s 1 are each amended to read
as follows:
(1) When a designated crisis responder receives information
alleging that a person, as a result of a mental disorder, chemical
dependency disorder, or both, presents a likelihood of serious harm or
is gravely disabled, the designated crisis responder may, after
investigation and evaluation of the specific facts alleged and of the
reliability and credibility of any person providing information to
initiate detention, if satisfied that the allegations are true and that
the person will not voluntarily seek appropriate treatment, file a
petition for initial detention. Before filing the petition, the
designated crisis responder must personally interview the person,
unless the person refuses an interview, and determine whether the
person will voluntarily receive appropriate evaluation and treatment at
either an evaluation and treatment facility, a detoxification facility,
or other certified chemical dependency provider.
(2)(a) An order to detain to an evaluation and treatment facility,
a detoxification facility, or other certified chemical dependency
provider for not more than a seventy-two hour evaluation and treatment
period may be issued by a judge upon request of a designated crisis
responder: (i) Whenever it appears to the satisfaction of a judge of
the superior court, district court, or other court permitted by court
rule, that there is probable cause to support the petition, and (ii)
that the person has refused or failed to accept appropriate evaluation
and treatment voluntarily.
(b) The petition for initial detention, signed under penalty of
perjury or sworn telephonic testimony, may be considered by the court
in determining whether there are sufficient grounds for issuing the
order.
(c) The order shall designate retained counsel or, if counsel is
appointed from a list provided by the court, the name, business
address, and telephone number of the attorney appointed to represent
the person.
(3) The designated crisis responder shall then serve or cause to be
served on such person, his or her guardian, and conservator, if any, a
copy of the order to appear, together with a notice of rights and a
petition for initial detention. After service on the person, the
designated crisis responder shall file the return of service in court
and provide copies of all papers in the court file to the evaluation
and treatment facility or secure detoxification facility and the
designated attorney. The designated crisis responder shall notify the
court and the prosecuting attorney that a probable cause hearing will
be held within seventy-two hours of the date and time of outpatient
evaluation or admission to the evaluation and treatment facility,
secure detoxification facility, or other certified chemical dependency
provider. If requested by the detained person or his or her attorney,
the hearing may be postponed for a period not to exceed forty-eight
hours. The hearing may be continued subject to the petitioner's
showing of good cause for a period not to exceed twenty-four hours.
The person may be accompanied by one or more of his or her relatives,
friends, an attorney, a personal physician, or other professional or
religious advisor to the place of evaluation. An attorney accompanying
the person to the place of evaluation shall be permitted to be present
during the admission evaluation. Any other person accompanying the
person may be present during the admission evaluation. The facility
may exclude the person if his or her presence would present a safety
risk, delay the proceedings, or otherwise interfere with the
evaluation.
(4) The designated crisis responder may notify a peace officer to
take the person or cause the person to be taken into custody and placed
in an evaluation and treatment facility, a secure detoxification
facility, or other certified chemical dependency provider. At the time
the person is taken into custody there shall commence to be served on
the person, his or her guardian, and conservator, if any, a copy of the
original order together with a notice of detention, a notice of rights,
and a petition for initial detention.
Sec. 6 RCW 70.96B.100 and 2005 c 504 s 211 are each amended to
read as follows:
((If a person is detained for additional treatment beyond fourteen
days under RCW 70.96B.090, the professional staff of the agency or
facility may petition for additional treatment under RCW 70.96A.140.))
(1) A person detained for fourteen days of involuntary chemical
dependency treatment under RCW 70.96B.090 or subsection (6) of this
section shall be released from involuntary treatment at the expiration
of the period of commitment unless the professional staff of the agency
or facility files a petition for an additional period of involuntary
treatment under RCW 70.96A.140, or files a petition for sixty days less
restrictive treatment under this section naming the detained person as
a respondent. Costs associated with the obtainment or revocation of an
order for less restrictive treatment and subsequent involuntary
commitment shall be provided for within current funding.
(2) A petition for less restrictive treatment must be filed at
least three days before expiration of the fourteen-day period of
intensive treatment, and comport with the rules contained in RCW
70.96B.090(2). The petition shall state facts that support the finding
that the respondent, as a result of a chemical dependency, presents a
likelihood of serious harm or is gravely disabled, and that continued
treatment pursuant to a less restrictive order is in the best interest
of the respondent or others. At the time of filing such a petition,
the clerk shall set a time for the respondent to come before the court
on the next judicial day after the day of filing unless such appearance
is waived by the respondent's attorney.
(3) At the time set for appearance the respondent must be brought
before the court, unless such appearance has been waived and the court
shall advise the respondent of his or her right to be represented by an
attorney. If the respondent is not represented by an attorney, or is
indigent or is unwilling to retain an attorney, the court shall
immediately appoint an attorney to represent the respondent. The court
shall, if requested, appoint a reasonably available licensed physician,
psychologist, or psychiatrist, designated by the respondent to examine
and testify on behalf of the respondent.
(4) The court shall conduct a hearing on the petition for sixty
days less restrictive treatment on or before the last day of the
confinement period. The burden of proof shall be by clear, cogent, and
convincing evidence and shall be upon the petitioner. The respondent
shall be present at such proceeding. The rules of evidence shall
apply, and the respondent shall have the right to present evidence on
his or her behalf, to cross-examine witnesses who testify against him
or her, to remain silent, and to view and copy all petitions and
reports in the court file. The physician-patient privilege or the
psychologist-client privilege shall be deemed waived in accordance with
the provisions under RCW 71.05.360(9). Involuntary treatment shall
continue while a petition for less restrictive treatment is pending
under this section.
(5) The court may impose a sixty-day less restrictive order if the
evidence shows that the respondent, as a result of a chemical
dependency, presents a likelihood of serious harm or is gravely
disabled, and that continued treatment pursuant to a less restrictive
order is in the best interest of the respondent or others. The less
restrictive order may impose treatment conditions and other conditions
which are in the best interest of the respondent and others. A copy of
the less restrictive order shall be given to the respondent, the
designated crisis responder, and any program designated to provide less
restrictive treatment. A program designated to provide less
restrictive treatment and willing to supervise the conditions of the
less restrictive order may modify the conditions for continued release
when the modification is in the best interests of the respondent, but
must notify the designated crisis responder and the court of such
modification.
(6) If a program approved by the court and willing to supervise the
conditions of the less restrictive order or the designated crisis
responder determines that the respondent is failing to adhere to the
terms of the less restrictive order or that substantial deterioration
in the respondent's functioning has occurred, then the designated
crisis responder shall notify the court of original commitment and
request a hearing to be held no less than two and no more than seven
days after the date of the request to determine whether or not the
respondent should be returned to more restrictive care. The designated
crisis responder may cause the respondent to be immediately taken into
custody of the secure detoxification facility pending the hearing if
the alleged noncompliance causes an imminent risk to the safety of the
respondent. The designated crisis responder shall file a petition with
the court stating the facts substantiating the need for the hearing
along with the treatment recommendations. The respondent shall have
the same rights with respect to notice, hearing, and counsel as for the
original involuntary treatment proceedings. The issues to be
determined at the hearing are whether the conditionally released
respondent did or did not adhere to the terms and conditions of his or
her release to less restrictive care or that substantial deterioration
of the respondent's functioning has occurred and whether the condition
of release should be modified or the respondent should be returned to
a more restrictive setting. The hearing may be waived by the
respondent and his or her counsel and his or her guardian or
conservator, if any, but may not be waived unless all such persons
agree to the waiver. If court finds in favor of the petitioner, or the
respondent waives a hearing, the court may order the respondent to be
committed to a secure detoxification facility for fourteen days of
involuntary chemical dependency treatment, or may order the respondent
to be returned to less restrictive treatment on the same or modified
conditions.
Sec. 7 RCW 70.96B.900 and 2005 c 504 s 219 are each amended to
read as follows:
Sections 202 through 216 ((of this act)), chapter 504, Laws of 2005
expire ((July 1, 2008)) June 30, 2009.
NEW SECTION. Sec. 8 Sections 3 through 6 of this act expire June
30, 2009.
Sec. 9 2007 c 120 s 4 (uncodified) is amended to read as follows:
Sections 1 and 2 ((of this act)), chapter 120, Laws of 2007 expire
((July 1, 2008)) June 30, 2009."
Correct the title.
EFFECT: Language was added to section 6 to allow a designated
crisis responder to seek an additional sixty days of less restrictive
treatment of a person being held for fourteen days involuntary
treatment upon revocation of the less restrictive alternative.
Modifies the language to make consistent references to the person
who is the subject of a petition as the respondent.
Adds language that requires costs associated with the obtainment or
the revocation of an order for less restrictive treatment be provided
within existing funds.
Removes reference to RCW 71.05.360(8) and adds language describing
the rights of a detained person at a hearing regarding a petition for
an order for less restrictive treatment.
Removes the reference to "outpatient treatment" in section 6(6) and
simply refers to program designated to provide less restrictive
treatment.
The term "secure detox" is replaced with "secure detoxification
facility."
Removes the provision authorizing the involuntary administration of
antipsychotic medication.