9 CSR 80-1.005 - Civil Outpatient Detention and Treatment Programs
(1) The
terms defined in sections
630.005 and
632.005, RSMo are incorporated
by reference for use in
9 CSR
80-1.005(1) through (35).
(2) As used in
9 CSR
80-1.005(1) through (35), unless the
context clearly indicates otherwise, the following terms shall mean:
(A) Care provider, the person or persons who
can demonstrate that they are primarily responsible for the health care of the
person with a mental illness. The term does not apply to any person providing
care through the hospitals, nursing homes, group homes or any other such
facility;
(B) Discharge, formal
dismissal of a client from the recognized mental health program;
(C) Likelihood of serious harm, any one (1)
or more of the following but does not require actual physical injury to have
occurred:
1. A substantial risk that serious
physical harm will be inflicted by a person upon his/her own person, as
evidenced by recent threats, including verbal threats, or attempts to commit
suicide or inflict physical harm on him/herself. Evidence of substantial risk
may also include information about patterns of behavior that historically have
resulted in serious harm previously being inflicted by a person upon
him/herself;
2. A substantial risk
that serious physical harm to a person will result or is occurring because of
an impairment in his/her capacity to make decisions with respect to his/her
hospitalization and need for treatment as evidenced by his/her current mental
disorder or mental illness which results in an inability to provide for his/her
own basic necessities of food, clothing, shelter, safety or medical care or
his/her inability to provide for his/her own mental health care which may
result in a substantial risk of serious physical harm. Evidence of that
substantial risk may also include information about patterns of behavior that
historically have resulted in serious harm to the person previously taking
place because of a mental disorder or mental illness which resulted in his/her
inability to provide for his/her basic necessities of food, clothing, shelter,
safety or medical or mental health care; or
3. A substantial risk that serious physical
harm will be inflicted by a person upon another as evidenced by recent overt
acts, behavior or threats, including verbal threats, which have caused such
harm or which would place a reasonable person in reasonable fear of sustaining
such harm. Evidence of that substantial risk may also include information about
patterns of behavior that historically have resulted in physical harm
previously being inflicted by a person upon another person;
(D) Mental illness, a state of
impaired mental processes, which impairment results in a distortion of a
person's capacity to recognize reality due to hallucinations, delusions, faulty
perceptions or alterations of mood, and interferes with an individual's ability
to reason, understand or exercise conscious control over his/her actions. The
term mental illness does not include the following conditions unless they are
accompanied by a mental illness as otherwise defined in Chapter 630, RSMo:
1. Mental retardation, developmental
disability or narcolepsy;
2. Simple
intoxication caused by substances such as alcohol or drugs;
3. Dependence upon or addiction to any
substances such as alcohol or drugs; or
4. Any other disorders such as senility,
which are not of an actively psychotic nature;
(E) Ninety-six (96) hours, shall be construed
and computed to exclude Saturdays, Sundays and legal holidays which are
observed either by the court or by the mental health facility where the
respondent is detained;
(F)
Outpatient commitment, legal status of a person who has been involuntarily
detained for outpatient mental health treatment by the court pursuant to
Chapter 632, RSMo;
(G) Recognized,
a mental health program is considered to be recognized when it has received
written notification from the Department of Mental Health that it has met the
criteria established in
9 CSR
80-1.005(3) and (4) and is authorized
to accept persons for admission who have been involuntarily detained for
outpatient mental health treatment by the court pursuant to Chapter 632, RSMo;
and
(H) Release, termination of a
detention order as a result of reaching the specified end date or resulting
from change in client mental status, behavior, or admission status.
(3) To be eligible to be
recognized by the department as a treatment program for persons who are
detained for outpatient mental health treatment by the court pursuant to
Chapter 632, RSMo, a mental health program must-
(A) Be a comprehensive community-based mental
health program that is designated to provide targeted case management (TCM) and
holds current and valid certification without limitations by the Department of
Mental Health as a Community Psychiatric Rehabilitation (CPR) program and as an
outpatient program;
(B) Operate or
arrange for availability of a twenty-four (24)-hour crisis response system for
psychiatric clients; and
(C) Have a
current purchase of service contract with the Division of Comprehensive
Psychiatric Services.
(4)
CPR or outpatient program providers with provisional or probationary
certification status shall not be recognized by the department and are not
eligible to admit persons who are detained for outpatient mental health
treatment by the court pursuant to Chapter 632, RSMo.
(5) Only recognized programs can admit
persons who have a mental illness and are detained for outpatient mental health
treatment by the court pursuant to Chapter 632, RSMo.
(6) Eligible programs shall make a written
application for recognition to the Division of Comprehensive Psychiatric
Services.
(A) The written application shall
specify the name of the agency, the name of the executive director of the
agency, the name of the CPR program it operates and the program director
name(s), the geographic area served, the judicial districts included in the
service area, the average number of clients enrolled in outpatient and CPR at
any given time, the client capacity for each of its programs, copies of
required certificates for CPR and outpatient programs, the name of the contact
person for department or court communications, an affidavit attesting to
compliance with 9 CSR 80-1.005(1) through
(35) and any other information deemed
necessary by the department.
(B)
For programs requesting renewal of their recognition status, the written
request shall be submitted to the department at least sixty (60) days prior to
expiration of recognition.
(C) The
department reserves the right to request additional information prior to
recognizing the program or at any time while the program is recognized by the
department.
(D) The department
reserves the right to conduct unannounced, on-site review activities of
applicants or recognized programs.
(7) Upon receipt of the written request for
recognition, the department shall review the request and issue its written
decision regarding the request within thirty (30) working days.
(A) The department may recognize a program
for a time period not to exceed one (1) year. The written notice to the
applicant/program shall specify the expiration date of the
recognition.
(B) The department may
deny recognition to a program if-
1. The
program does not meet the criteria established in sections (3) and (4)
above;
2. The application includes
information that is false;
3. The
program is found to have committed fraud or illegal activities or had reason to
know its staff were engaged in fraud or illegal activities;
4. The program employs any individual to
provide services for which the individual is not licensed as required by
law;
5. The program employs any
individual who is statutorily excluded from service as a result of convictions
under sections 630.170 and
660.317, RSMo, specifically-
A. A person who has been convicted of, found
guilty to, pled guilty to or nolo contendere to any of the following crimes
shall be disqualified from holding any position in the agency:
(I) Physical abuse or Class I Neglect of a
patient, resident or client;
(II)
Furnishing unfit food to patients, residents or clients; and
(III) Failure of a specified professional to
report suspected abuse or neglect of a patient;
B. A person who has been convicted of, found
guilty to, pled guilty to or nolo contendere to any of the following felonies
shall be disqualified from holding any direct-care position in the agency:
(I) First or second degree murder; second
degree murder;
(II) Voluntary
manslaughter (includes assistance in self-murder);
(III) Involuntary manslaughter;
(IV) First or second degree
assault;
(V) Assault while on
school property;
(VI) Unlawful
endangerment of another;
(VII)
First or second degree assault of a law enforcement officer;
(VIII) Tampering with a judicial
officer;
(IX) Kidnapping;
(X) Felonious restraint;
(XI) False imprisonment;
(XII) Interference with custody;
(XIII) Parental kidnapping;
(XIV) Child abduction;
(XV) Elder abuse in the first degree or the
second degree;
(XVI)
Harassment;
(XVII)
Stalking;
(XVIII) Forcible
rape;
(XIX) First or second degree
statutory rape;
(XX) Sexual
assault;
(XXI) Forcible
sodomy;
(XXII) First or second
degree statutory sodomy;
(XXIII)
First or second degree child molestation;
(XXIV) Deviate sexual assault;
(XXV) First degree sexual
misconduct;
(XXVI) Sexual
abuse;
(XXVII) Endangering the
welfare of a child;
(XXVIII) Abuse
of a child;
(XXIX) Robbery in the
first degree or second degree;
(XXX) Arson in the first or second
degree;
(XXXI) First or second
degree pharmacy robbery;
(XXXII)
Incest;
(XXXIII) Causing
catastrophe;
(XXXIV) First degree
burglary; or
(XXXV) Any equivalent
felony offense; or
6. The program interferes with or refuses
access by authorized agents of the Department of Mental Health to the program's
sites of operation, to client or other records required in this rule, or to
staff.
(C) The department
shall include the reason for denial of recognition in its written notification
to the agency.
(8) The
department may suspend or revoke recognition of a program at any time that-
(A) The program does not meet the criteria
established in sections (3) and (4) above;
(B) The program is not in substantial
compliance with the requirements codified in
9 CSR
80-1.005(1) through (35);
(C) The application includes information that
is false;
(D) The program is found
to have committed fraud or illegal activities or had reason to know its staff
were engaged in fraud or illegal activities;
(E) The program employs any individual to
provide services for which the individual is not licensed as required by law or
is disqualified from employment as specified in paragraph (7)(B)5. above;
or
(F) The program interferes with
or refuses access by authorized agents of the Department of Mental Health to
the program's sites of operation, to client or other records required in this
rule, or to staff.
(9)
When recognition has been denied, suspended, or revoked, a program may appeal
to the director of the department within thirty (30) days of receiving notice
of the denial or revocation. The director of the department shall conduct a
hearing under procedures set out in Chapter 536, RSMo and shall issue findings
of fact, conclusions of law and a decision that shall be the final decision of
the department.
(10) A recognized
program shall be responsible for notifying the department of material changes
in status that occur during their recognition period such as, but not limited
to, change in location, change in ownership, change in corporate status, legal
proceedings initiated against the agency, change in regulatory status,
accreditation or certification status, or other substantive changes in the
program's status or ability to perform its duties related to outpatient
detention and treatment.
(11) The
department shall maintain a listing of programs recognized to admit and serve
persons who have been detained for outpatient mental health
treatment.
(12) At a minimum the
program shall have the capability to conduct clinical screenings on a
twenty-four (24)-hour-per-day basis, seven (7) days per week to allow for next
day admissions for persons detained by the court for outpatient mental health
treatment.
(A) The method to contact the
program to arrange for admissions shall be specified in written form to the
access/crisis intervention system (ACI) hotline and all mental health
coordinators in the program's service area.
(B) An individual who has been detained by
the court for outpatient treatment shall not be placed on a waiting list for
admission or services.
(13) For each person admitted for outpatient
mental health treatment by the court pursuant to Chapter 632, RSMo, the program
must have made a determination that the program can and will provide necessary
and appropriate care, treatment and services to the individual in the least
restrictive environment that will reasonably assure the individual's safety and
the safety of the public.
(A) The program
shall promptly provide this information for inclusion in the petition to the
court.
(B) If a clinical screening
is required to make a determination of appropriateness for admission, the
screening shall be conducted within twenty-four (24) hours of the
request.
(C) Screening and
evaluation activities shall be adequate to address a broad range of clinical,
social, and environmental factors that have relevance to the decision to accept
or deny admission including, but not limited to:
1. Determination that the person has a mental
illness;
2. Interventions and
adaptations necessary to reasonably assure client and public safety including
the frequency and nature of monitoring efforts designed for the
individual;
3. Amount and nature of
available support of family, friends and other social supports;
4. History of response to treatment and
willingness to comply with medication and other necessary treatments;
5. Person's motivation and available
resources for living in the community;
6. Assessment of the person's need for
guardianship and the program's obligation to petition for guardianship, if
needed; and
7. Adequacy of the
recommended services to provide needed support to the person to live safely in
the community.
(D) When a
program has made a determination to accept a person for admission, the program
shall also specify, in writing, specific conditions of participation
individualized to address the person's situation. These conditions of
commitment shall be included in the petition to the court and the program shall
review the conditions with the person to be admitted as well as care providers
and other caregivers, as appropriate and consistent with statutes and
regulations governing client confidentiality.
(14) A person shall not be considered
eligible for admission to a recognized agency for involuntary outpatient
detention and mental health treatment if the person-
(A) Has been committed to the Department of
Mental Health for treatment pursuant to Chapter 552, RSMo and such commitment
remains in force;
(B) Is under the
age of eighteen (18) and has a parent or legal guardian responsible for making
treatment decisions; or
(C) Has
been determined to be incapacitated and a guardian has been appointed by the
probate court pursuant to Chapter 475, RSMo.
(15) When a person is determined to be
eligible for admission to the program for outpatient mental health treatment,
the program shall specify in writing the range of care, treatment and services
that shall be provided to the person, the source of funding for the specified
interventions, the individualized conditions of commitment for the person, and
the name of the inpatient mental health facility that has agreed to accept the
person for admission and treatment at the direction of the program. This
information shall be promptly furnished to the court in written form.
(16) Within seven (7) days of admission or
sooner if clinically indicated, a treatment plan shall be completed that
encompasses the requirements set forth in section (15) above.
(A) Services shall be designed to educate and
assist the individual to comply with treatment that results in return to
voluntary status as soon as possible.
(B) To the extent possible and consistent
with client confidentiality, the treatment planning process should include
family members, care providers, caregivers and other members of the client's
support system.
(C) In addition to
meeting the requirements of the appropriate CPR certification standards, the
treatment plan for each person detained for outpatient mental health treatment
shall also address conditions of commitment and the following issues, at a
minimum:
1. Monitoring and limitations of
client residence, movement and travel;
2. Communication protocols and coordination
with other health care providers during the period of involuntary commitment to
reasonably assure client and public safety;
3. Consequences of noncompliance related to
criteria for referral to inpatient treatment;
4. Medication compliance and monitoring;
and
5. Conditions of release from
involuntary outpatient commitment.
(D) The treatment plan shall be reviewed on a
periodic basis but no less frequently than monthly, and more often if
clinically indicated.
(E) The
program shall notify the court when a client detained for outpatient treatment
fails to comply with conditions of commitment and the program is no longer able
to reasonably assure client and/or public safety.
(F) A copy of the client's ITP shall be sent
to the inpatient facility that has agreed to accept the client when directed by
the program.
(17) The
program shall maintain a client listing of persons currently being served by
the program who have been involuntarily detained for outpatient mental health
treatment. To assure continuity of care, the list shall be updated on a daily
basis and shall be provided, with a current treatment plan and additional
clinical information as indicated, to the hotline staff of the appropriate ACI
system and to the mental health coordinator for the area in which the client
lives.
(18) When a client has been
detained for outpatient mental health treatment and the program has good cause
to believe that immediate detention to an inpatient setting is required because
the client presents a likelihood of serious harm as defined in subsection
(2)(C) due to mental illness, the program-
(A)
Shall confirm and document in the client record, based on an evaluation by a
qualified mental health professional, that the client requires immediate
detention to an inpatient setting;
(B) Shall involve the responsible physician,
if appropriate, in the decision to arrange inpatient admission;
(C) Shall initiate the admission process with
appropriate staff of the inpatient facility specified in the petition or court
order that agreed to accept the client;
(D) Shall direct that the client be detained
for up to ninety-six (96) hours at an appropriate inpatient facility that has
agreed to accept the client;
(E)
May authorize the sheriff to detain and transport the client to the inpatient
facility;
(F) Shall promptly
provide a letter or other written documentation to the inpatient facility
directing the inpatient facility to admit the client and detailing the clinical
reasons for the inpatient admission, including specific violations of
conditions of commitment, as appropriate, and other relevant clinical
information;
(G) Shall provide
written notice to the client of the clinical reasons for the inpatient
admission, including violation of conditions of commitment;
(H) Shall immediately provide written
notification to the committing court including copies of correspondence and
notice described in (18)(G) and (H) above; and
(I) Shall provide copies of documents
referenced in (18)(G) and (H) above to counsel for the client and counsel for
the petitioner.
(19) The
program director shall release any person who is involuntarily detained for
outpatient treatment when, in his/her opinion and based on a determination by a
qualified mental health professional, the person is no longer mentally ill or,
although mentally ill, does not present a likelihood of serious harm as defined
in subsection 2(C), even though the detention period has not expired.
(A) The release decision shall be based on
information gathered in observation of the client including but not limited to
response to treatment, and mental status as well as information gathered from
family and others who interact with the client.
(B) The program shall document in the client
record their clinical rationale for the release decision.
(C) When the program releases a person prior
to expiration of the detention order, the program shall send written
notification to the court and the mental health
coordinator.
(20)
Whenever a client who has been detained for outpatient treatment requests to be
voluntarily admitted to the program and the program agrees and accepts the
person for voluntary admission, the involuntary detention shall end and the
program shall send written notice to the court and the mental health
coordinator.
(A) Upon request by a client for
voluntary admission, the program shall evaluate the request to include
considerations such as, but not limited to, client's mental status and
competency to make decisions, the genuineness of the request, whether the
client still meets commitment criteria of likelihood of serious harm, and the
client's understanding of the proposed course of outpatient treatment. The
program shall utilize information gained through observation of the client and
information gathered from family, care providers and others.
(B) If, as a result of the review of the
request, it is determined that the client is capable of making decisions, has
made the request in good faith, and consents to voluntarily participate in
outpatient treatment to reasonably assure client and public safety, the program
shall grant the request in a timely manner.
(C) Changing a client's status from
involuntary to voluntary shall not be used solely to avoid civil detention
proceedings or for staff convenience.
(D) The program shall document their
activities and clinical judgments related to acceptance or denial of changes in
client admission status in response to client requests.
(21) Any person who has been committed to the
program on an outpatient basis shall be entitled to a reexamination of the
court order on his/her own motion, or that of his/her parent, spouse, relative,
friend or attorney to the court. Upon receipt of the motion, the court shall
conduct proceedings in accordance with 632.340, RSMo.
(22) At any time that a client who is
detained for outpatient treatment fails to comply with the conditions of the
court order or conditions of commitment, the program shall request a hearing
pursuant to 632.340, RSMo.
(23) At
the end of any detention period ordered by the court, the client shall be
discharged unless-
(A) A petition for further
detention is filed and heard for successive outpatient detention periods;
or
(B) The client consents to
continuing treatment.
(24) As required by section
632.392, RSMo, for all clients
released or discharged from outpatient commitment for any reason-
(A) The program shall provide to the client
and the care provider a written packet of educational information developed and
supplied by the department describing symptoms of common mental illnesses,
early warning signs of decompensation, and availability of other education,
community and statewide services;
(B) The program may disclose confidential
treatment information to the primary care provider or care providers, when such
information is medically necessary for the provision of appropriate health care
treatment by the care provider or is reasonably related to the safety of the
client or care provider;
(C) Prior
to the disclosure of the information specified in subsection (24)(B) above, the
mental health program shall-
1. Provide
written notice to the client;
2.
Request in writing the consent of the client;
3. Work with the client and care provider to
encourage and secure appropriate client authorization;
4. Function as a mediator, negotiating the
boundaries of confidentiality to meet the needs of the client and care
provider; and
5. Work with the
client to stress the importance of keeping the care provider informed and
involved with his/her treatment process;
(D) If the client refuses to consent and the
treating physician deems the information is medically necessary for the
appropriate provision of health care or treatment by the care provider or is
related to the safety of the client or care provider, the information may still
be released to the appropriate care provider;
(E) The reason for the intended disclosure,
the specific information to be released and the persons to whom the disclosure
is to be made, even if consent has not been obtained, will be provided to the
client and care provider; and
(F)
All these procedures shall be documented by the treating physician in the
client record, including a specific notation as to whether client consent was
given.
(25) Whenever
possible, the program shall plan for orderly discharge and referral of
discharged clients to appropriate services and support systems.
(26) The program shall maintain information
to document its participation as a recognized program to accept outpatient
commitments in a format approved by the department.
(A) The program shall document referrals from
the court, admissions, denials, client grievances and their resolution, and
discharges.
(B) The program shall
submit information in aggregate form to the department on a periodic basis or
upon request.
(C) The department
reserves the right to develop a format for submission of such
information.
(D) The department
reserves the right to review and verify such information on-site.
(27) The program shall be
responsible for maintaining clinical records for persons receiving services
consistent with these standards
9 CSR
80-1.005(1) through (35) and other
applicable standards.
(28) The
program shall maintain clinical records for persons who have been committed to
their program on an outpatient basis for at least five (5) years following the
last clinical contact with the person.
(29) For those persons who have been detained
for involuntary outpatient treatment and are enrolled in CPR services, the
program shall submit CPR outcome information required by the department on a
periodic basis and shall appropriately identify individuals on outpatient
commitment status. The program will maintain the ability to track persons on
outpatient commitment separately from other CPR clients.
(30) The department shall have the authority
to access program records and client records for purposes of monitoring the
performance of any recognized program.
(31) The program shall cooperate fully with
any investigations of client abuse, neglect, exploitation or violation of
client rights.
(32) The program
shall cooperate fully with on-site program reviews by authorized agents of the
department related to complaints received about the agency, its staff or
operations.
(33) When these
standards are more stringent than those in other certification or licensure
regulations, these standards shall supersede for persons who are involuntarily
committed on an outpatient basis.
(34) Agency quality assurance and quality
improvement mechanisms and plans at the program should incorporate specific
indicators for monitoring the performance and outcomes for outpatient
commitment clients.
(35) The agency
shall assure that its staff are appropriately trained for provision of
outpatient commitment to its clients ordered for such treatment by the court.
(A) The agency shall send appropriate staff
to training required by the department.
(B) The agency shall implement orientation
and training to assure that staff have adequate information to effectively
perform their staff functions in the provision of outpatient commitment to
detained persons including, but not limited to, training regarding methods to
work with families and promote their involvement in treatment.
(C) The department may require the agency, at
its own expense, to provide additional training to its staff if the agency's
performance is not in substantial compliance with the requirements codified in
9 CSR 801.005(1) through (35).
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.