HOUSE OF REPRESENTATIVES
THIRTIETH LEGISLATURE, 2020
STATE OF HAWAII
A BILL FOR AN ACT
relating to mental health.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that Hawaii's current standard for involuntary hospitalization does not adequately prevent harm, either to persons suffering from mental illness or substance abuse, or to members of the public. By requiring proof that a person is "imminently dangerous to self or others", the law essentially requires the point of danger--and thus potential harm--to have already been reached. Instead, the standard should be more flexible to allow the person to receive treatment before the point of danger has been reached and avoidable harm occurs.
The legislature notes that the National Alliance on Mental Illness, in its December 2016 public policy platform, asserts that states should "adopt broader, more flexible standards that would provide for involuntary commitment and/or court ordered treatment when an individual, due to mental illness . . . is gravely disabled", in addition to other grounds. The policy platform defines a "gravely disabled" person as one who "is substantially unable . . . to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety[.]" The policy platform also explains that requiring proof of dangerousness often produces "unsatisfactory outcomes because individuals are allowed to deteriorate needlessly before involuntary commitment and/or court-ordered treatment can be instituted".
The legislature acknowledges that, collectively, Act 221, Session Laws of Hawaii 2013, and Act 114, Session Laws of Hawaii 2016, deleted the "gravely disabled" and "obviously ill" categories from the criteria for involuntary hospitalization, in furtherance of a pilot program for assisted community treatment that is now permanent. Mentally ill persons in either of these categories may not be imminently dangerous to themselves or others, but still pose a very real danger to themselves or the public and thus should be covered by the law. While the legislature supports the continuation of the assisted community treatment program and its complementary role in treating mental illness and substance abuse on an outpatient basis, the legislature is cognizant that a portion of the mentally ill population, including the chronically homeless, are being deprived of urgent, medically appropriate mental health intervention that is best administered on an inpatient basis.
Accordingly, the purpose of this Act is to more effectively protect mentally ill individuals and the public by:
(1) Restoring the categories of "gravely disabled" and "obviously ill" to the criteria for involuntary hospitalization that were deleted by Act 221, Session Laws of Hawaii 2013; and
(2) Increasing the maximum period of emergency hospitalization from forty-eight hours to seventy-two hours.
SECTION 2. Section 334-1, Hawaii Revised Statutes, is amended by adding two new definitions to be appropriately inserted and to read as follows:
""Gravely disabled" means a condition in which a person, as a result of a mental disorder:
(1) Is unable to provide for their basic personal needs for food, clothing, or shelter;
(2) Is unable to make or communicate rational or responsible decisions concerning their personal welfare; and
(3) Lacks the capacity to understand the aforementioned disabilities.
"Obviously ill" means a condition in which a person's current behavior and previous history of mental illness, if known, indicate a disabling mental illness, and the person is incapable of understanding that there are serious and highly probable risks to health and safety involved in refusing treatment, or the advantages of accepting treatment and the alternatives to the particular treatment offered, after the advantages, risks, and alternatives have been explained to the person."
SECTION 3. Section 334-59, Hawaii Revised Statutes, is amended as follows:
1. By amending subsections (a) and (b) to read:
"(a) Initiation of proceedings. An emergency admission may be initiated as follows:
(1) If a law
enforcement officer has reason to believe that a person is [
dangerous to self or others[
(B) Gravely disabled; or
(C) Obviously ill,
the officer shall call for assistance from the mental health emergency workers designated by the director. Upon determination by the mental health emergency workers that the person is imminently dangerous to self or others, is gravely disabled, or is obviously ill, the person shall be transported by ambulance or other suitable means, to a licensed psychiatric facility for further evaluation and possible emergency hospitalization. A law enforcement officer may also take into custody and transport to any facility designated by the director any person threatening or attempting suicide. The officer shall make application for the examination, observation, and diagnosis of the person in custody. The application shall state or shall be accompanied by a statement of the circumstances under which the person was taken into custody and the reasons therefor, which shall be transmitted with the person to a physician, advanced practice registered nurse, or psychologist at the facility.
(2) Upon written or oral application of any licensed physician, advanced practice registered nurse, psychologist, attorney, member of the clergy, health or social service professional, or any state or county employee in the course of employment, a judge may issue an ex parte order orally, but shall reduce the order to writing by the close of the next court day following the application, stating that there is probable cause to believe the person is mentally ill or suffering from substance abuse, is imminently dangerous to self or others, is gravely disabled, or is obviously ill, and in need of care or treatment, or both, giving the findings upon which the conclusion is based. The order shall direct that a law enforcement officer or other suitable individual take the person into custody and deliver the person to a designated mental health program, if subject to an assisted community treatment order issued pursuant to part VIII of this chapter, or to the nearest facility designated by the director for emergency examination and treatment, or both. The ex parte order shall be made a part of the patient's clinical record. If the application is oral, the person making the application shall reduce the application to writing and shall submit the same by noon of the next court day to the judge who issued the oral ex parte order. The written application shall be executed subject to the penalties of perjury but need not be sworn to before a notary public.
(3) Any licensed physician, advanced practice registered nurse, physician assistant, or psychologist who has examined a person and has reason to believe the person is:
(A) Mentally ill or suffering from substance abuse;
dangerous to self or others[
;], gravely disabled, or is obviously
(C) In need of care or treatment;
may direct transportation, by ambulance or other suitable means, to a licensed psychiatric facility for further evaluation and possible emergency hospitalization. A licensed physician, an advanced practice registered nurse, or physician assistant may administer treatment as is medically necessary, for the person's safe transportation. A licensed psychologist may administer treatment as is psychologically necessary.
(b) Emergency examination. A patient who is delivered for emergency examination and treatment to a facility designated by the director shall be examined by a licensed physician or advanced practice registered nurse without unnecessary delay, and may be given such treatment as is indicated by good medical practice. A psychiatrist, advanced practice registered nurse, or psychologist may further examine the patient to diagnose the presence or absence of a mental disorder, assess the risk that the patient may be dangerous to self or others, is gravely disabled, or is obviously ill, and assess whether or not the patient needs to be hospitalized."
2. By amending subsections (d) and (e) to read:
"(d) Emergency hospitalization. If the physician, advanced practice registered nurse, or psychologist who performs the emergency examination has reason to believe that the patient is:
(1) Mentally ill or suffering from substance abuse;
dangerous to self or others[
;], is gravely disabled, or is obviously
(3) In need of care or treatment, or both;
the physician, advanced practice registered nurse, or
psychologist may direct that the patient be hospitalized on an emergency basis
or cause the patient to be transferred to another psychiatric facility for
emergency hospitalization, or both. The
patient shall have the right, immediately, upon admission,
to telephone the patient's guardian [
or], a family member [ including],
a reciprocal beneficiary, or an adult friend, and an attorney. If the patient declines to exercise that
right, the staff of the facility shall inform the adult patient of the right to
waive notification to the guardian, family [ including a] member,
or reciprocal beneficiary, and shall make reasonable efforts to ensure that
the patient's guardian [ or], family [ including a], or
reciprocal beneficiary[ , is] are notified of the emergency
admission, but the patient's family [ including a] or
reciprocal beneficiary[ ,] need not be notified if the patient is an
adult and requests that there be no notification. The patient shall be allowed to confer with an
attorney in private.
Release from emergency hospitalization.
If at any time during the period of emergency hospitalization the
responsible physician concludes that the patient no longer meets the criteria
for emergency hospitalization the physician shall discharge the patient. If the patient is under criminal charges, the
patient shall be returned to the custody of a law enforcement officer. In any event, the patient must be released
forty-eight] seventy-two hours of the patient's
admission, unless the patient voluntarily agrees to further hospitalization, or
a proceeding for court-ordered evaluation or hospitalization, or both, is
initiated as provided in section 334-60.3.
If that time expires on a Saturday, Sunday, or holiday, the time for initiation
is extended to the close of the next court day.
Upon initiation of the proceedings the facility shall be authorized to
detain the patient until further order of the court."
SECTION 4. Section 334-60.2, Hawaii Revised Statutes, is amended to read as follows:
"§334-60.2 Involuntary hospitalization criteria.
A person may be committed to a psychiatric facility for involuntary
,] if the court finds[ :] that the person is:
the person is mentally] Mentally ill or suffering from substance
the person is imminently] Imminently dangerous to self or others[ ;],
gravely disabled, or obviously ill; and
the person is in] In need of care or treatment, or both, and there
is no suitable alternative available through existing facilities and programs [ which]
that would be less restrictive than hospitalization."
SECTION 5. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 7. This Act shall take effect upon its approval.
Mental Illness; Involuntary Hospitalization; Criteria
Restores the categories of "gravely disabled" and "obviously ill" to the criteria for involuntary hospitalization that were deleted by Act 221, SLH 2013. Increases the maximum period of emergency hospitalization from 48 hours to 72 hours.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.