Commitment Procedures and Alternatives

 

When family or friends are confronted with caring for an individual who has serious mental health or substance abuse problems, many critical factors must be considered and decisions made in order to get help for that person.  If the person's condition becomes so severe that he or she appears to be dangerous to self or others, or can't take care of basic needs, involuntary civil commitment may become necessary. If the person is mentally ill, developmentally disabled or chemically dependent, and especially if he or she refuses to accept treatment voluntarily, civil commitment may be the most appropriate and even the kindest route for loved ones to take.

 

Civil Commitment

What does civil commitment mean?  Civil commitment has developed over the years as an extension of the State's power to protect the individual and the power to protect others.  It generally involves that state's authority to deprive the person of his or her liberty and such important civil rights such as the loss of freedom and ability to make certain treatment choices.  The courts have held that due process procedures must be followed and that a dangerousness standard must be followed.  The following is a general description of due process for all civil commitment procedures.  The actual statute should be consulted for more specific information.

 

Dangerousness is defined by statute as:

 

1.  Danger to self by recent attempts or threats of suicide or serious bodily harm;

 

2.  Danger to others by recent homicidal or other violent behavior, or by placing others in reasonable fear or violent by a recent overt act or threat:  

 

3.  Judgment sufficiently impaired by a pattern of recent acts that there is a substantial probability of injury to self;

 

4.  Inability to meet basic needs for food, shelter, medical care, or safety such that without prompt and adequate treatment, death, serious disability, physical injury or serious physical disease will imminently ensue; or

 

5.  Fifth Standard:  This is an automatic order to treat an individual in an inpatient setting with medications.  Via a three-party petition, petitioners must submit evidence to the Corporation Counsel's office that:

      

       A.  The individual is mentally ill;

       B.  The individual evidences one of the following:

            1)  Incapability, because of mental illness, of expressing an understanding of the advantages and disadvantages of accepting

                 medication or treatment and the alternatives, after the advantages and disadvantages of the alternatives to accepting a 

                 particular medication or treatment have been explained to him or her; or

            2)  Substantial incapability, because of mental illness, of applying and understanding of the advantages, disadvantages

                 and alternatives to his or her mental illness in order to make an informed choice as to whether to accept or refuse

                 medication or treatment, after the advantages and disadvantages of and alternatives to accepting a particular medication

                 or treatment have been explained to him or her; 

       C.  A substantial probability, as demonstrated by both the individual's treatment history and his or her recent acts or

           omissions, that the individual needs care or treatment to prevent further disability or deterioration;

       D.  A substantial probability that he or she will, if left untreated, lack service necessary for his or her health safety, and suffer

           severe mental health, or emotional harm or physical harm; and

       E.  The (harm) will result in the loss of the individual's ability to function independently in the community of the loss of

           cognitive or volitional control over his or her thoughts or actions.

 

How To Start A Commitment Procedure

If you have reason to believe that a member of your family or a friend is mentally ill, in need of treatment, and meets one or more of the criteria for dangerousness as described as above, there are four ways to get help if the individual refuses voluntary admission to a psychiatric facility.

 

1.  Emergency Detention (Sec.51.15 (1) Wis. Stats.)

     If the individual is acting out in seriously violent ways or threatening acts of violence to self or others, call the police immediately.

     A law enforcement officer has the authority to detain the person whom the officer observes behaving in such a way that leads the

     officer to believe that the person may meet the commitment standard.  Alternatively, another person who has observed the 

     individual's behavior may report this to the officer.

 

     In Forest, Oneida and Vilas counties, the officer contacts an Emergency Psychiatric Screener to determine appropriate crisis

     intervention, including inpatient hospitalization or residential crisis bed.  When hospitalization is deemed necessary, the officer

     completes and signs an Emergency Detention (ED).  A copy of the statement of Emergency Detention is filed with the staff at the

     detention facility (usually St. Mary's Hospital in Rhinelander) at the time of admission.  The original statement of detention is filed

     with the court on the next business day.

 

     Within 72-hours of the admission (excluding weekends and legal holidays), a court hearing must be held to determine Probable Cause

     that the individual is mentally ill and dangerous.  The detention facility staff has until the time of the hearing to determine if the

     person should be detained or released.  If it is decided that the person may meet the commitment standard and should be detained,

     the case must be presented in court.  The officer's statement of dangerousness on the Emergency Detention, the hospital medical

     report and any other information available, will be presented at the Probable Cause hearing as evidence.  The statement of Emergency

     Detention serves as a petition to start an involuntary commitment.

 

2.  Three-Party Petition - For Mental Illness or Drug Dependence (Sec. 51.20 Wis. Stats.); For Alcoholism (Sec 51.45 Wis. Stats.)

     All three petitioners must be adults and at least one petitioner must have personal knowledge of the individual's behavior.  They should

     be aware that they may be called to testify in person or, if they can't be available in person, to testify by telephone.  For s. 51.20, the

     petition must allege the subject is mentally ill, drug dependent or developmentally disabled and dangerous.  For s. 51.45, the petition

     must allege the subject habitually lacks self-control as to the use of alcohol, that because of this their health is substantially impaired,

     and that social or economic functioning is substantially disrupted.  Additionally, it shall allege that because of this condition, the

     subject engages in a pattern of conduct that is dangerous to the person or to others.

 

     To start the petition procedure, call the Corporation Counsel secretary (Forest County:  715-623-3989; Oneida County:  715-369-6155; Vilas

     County:  715-479-3714) and schedule an appointment.  Since the information you give will be incorporated into a sworn statement, it

     will be necessary for you to meet with the Corporation Counsel.  Once the petition is completed. it will be reviewed by a judge to

     guarantee there are sufficient grounds to issue a pick-up order.

 

     The pick-up order is filed with the Sheriff's Department, who may or may not be able to complete the pick-up that day, depending on

     their schedule.  When your family member or friend is picked up, they will be taken to St. Mary's Hospital in Rhinelander, WI, where

     he or she will be held until the Probable Cause hearing.  AFTER THIS POINT, THE PROCESS BECOMES THE SAME, REGARDLESS OF

     WHETHER YOU OR THE POLICE INITIATED THE PROCEDURE.

 

3.  Fifth Standard (1995 Wis. Act 292)

     A petition under the Fifth Standard can be inititated in two ways: 1) on an emergency basis, or 2) by a three-party petition.

 

     In cases where the petition arises out of an emergency detention, the detaining officer should gather the information, which the

     Attorney General's Office needs to review in order to make an informed decision on whether the petition should be approved.  This

     information includes testimony from a psychiatrist or psychologist regarding their professional opinion as to whether the person

     sought to be committed is substantially likley to deteriorate further if not treated; also, the person's treatment history needs to be

     obtained.

 

     If a petition is submitted by way of a three-party petition, the parties initiating the petition should gather the information and submit

     it to the Attorney General's Office to assist in making a decision on whether the petition should be approved.  The Attorney General's

     Office has 12-hours to make this decision, starting from the time the petition is received.

 

     If the petition is approved, the person is detained and the procedure is the same as the emergency detention and three-party petition

     procedure.

 

4.  51.45(11) Alcohol Protective Custody:  Basis For Placement

     Persons who are intoxicated in a public place may be assisted by law enforcement to home, or an approved treatment facility or other

     health facility, if such person consents to the proffered help.  This is a volutary admission.

 

     A person who appears to be incapacitated by alcohol shall be placed under protective custody by a law enforcement officer at an

     approved treatment facility for emergency treatment.

 

        A.  "Intoxicated person," means a person whose mental or physical functioning is substantially impaired as a result of the use of

             alcohol.

        B.  "Incapacitated by alcohol" means:

            1)  That a person, as a result of the use or withdrawal from alcohol, is unconscious or;

            2)  Has his or her judgment otherwise so impaired that he or she is incapable of making a rational decision, as evidenced

                 objectively by such indicators as extreme physical debilitation, physical harm or threats of harm to himself or herself or to any

                 other person or to property. 

 

     The hospital or treatment facility holding the person in protective custody is deemed upon transfer to have protective custody of the

     subject.  A person, who by examination, is found to be incapacitated at the time of admission shall be detained for the duration of the

     incapacity, but may not be detained when no longer incapacitated by alcohol.  If the subject is still incapacitated after 72-hours

     (exclusive of weekends and legal holidays), the burden is on the facility to initiate an emergency commitment proceeding.  However,

     a person may consent to remain in the facility as long as the physician in charge believes it is appropriate.

 

     After the initial detention:  regardless of how the involuntary comiitment process was started, the following are the next steps in the

     process.

 

 Probable Cause Hearing

Within 72-hours of the initial detention (exclusive of weekends and legal holidays), a court hearing will be held at which your friend or family member will be required to be present.  The individual will be there with an attorney, who in most cases, is appointed by the State

Public Defender's Office.  A person may retain their own attorney if they wish.  A representative of Corporation Counsel will appear on

behalf of the petitioners and the County.  If the hearing is the result of a Three-Party Petition, the signers of the petition may be requested

to testify by either attorney.

 

The purpose of the hearing is to present testimony to show Probable Cause why your family member or friend should be held in a secure

facility for further evaluation of his or her mental condition or alcohol dependence, pending a final hearing.  If probable cause is found, an order for detention will be signed by a circuit judge.  Your family member or friend usually remains at St. Mary's Hospital until the time of the final hearing, however in some cases, temporary placements in other facilities may be made if appropriate.

 

Before the final hearing, two independent experts examine the person.  For mental illness or drug abuse commitments, the evaluations

can be done by a medical doctor, psychiatrist or psychologist, who will evaluate their mental and/or physical condition and report to the

court.  For alcohol dependency commitments, one medical doctor may be appointed who will also be required to report to the court.

 

Final Hearing

If the subject is detained after the probable cause hearing, the final hearing is held within 14-days of the initial detention.  If the subject is not detained after the probable cause hearing, the final hearing is held within 30-days after the probable cause hearing.  However, this will happen only in few instances.  Generally, if the person is not detained after the probable cause hearing, a Settlement Agreement (see section "Alternative To Commitment" below) has been reached.  If the subject requests to have a jury at the final hearing, they must make the request at least 48-hours prior to the hearing.  The judge, court clerk, court reporter and the subject will again be present with an attorney.  A representative of Corporation Counsel, a staff psychiatrist and other witnesses (e.g. polic officer, friends) will also be present at the hearing.

 

Finding for Mental Illness/Drug Dependency or Alcoholism

If the person is found to be mentally ill or drug dependent, is a proper subject for treatment, and is dangerous under one of the four statutory standards listed previously, he or she will be committed by the judge to the care of the Tri-County Human Services Board for a period not to exceed six months.  The person will then be brought to the least restrictive treatment alternative identified in court or another private facility if accepted by a private doctor.  He or she will become involved in a treatment program, which may include medication, psychotherapy, occupational therapy group, and other programs considered appropriate to the treatment.

 

Lenght of time in more restrictive treatment settings will vary and depend on the needs and overall mental condition of the person being committed.  A person may be detained in a secure treatment facility and gradually moved to less restrictive in-patient settings as his/her condition improves.  In other cases, only a few weeks of inpatient treatment are necessary during the six month commitment.  For the rest of the six-month period, the person is supervised by a Human Service Center Case Manager to make sure they follow their treatment plan.  If the "slip up", they can be brought back to an approved psychiatric hospital or unit, stabilized in a few days and released again.  In some cases, an extension of commitment for one year is requested at the end of the six months.  If this is granted, the Human Service Board supervision continues for another year, at which time an additional extension can be granted.

 

If the person is found to not be mentally ill, dangerous, or drug dependent, the case will be dismissed.  It is possible that under certain circumstances, the proceedings will be turned over to a Protective Placement proceeding under Chapter 55.  This usually only occurs when the person is determined to be incompetent, in need of a guardian and requires placement in a long-term care facility.

 

If the person is found to be alcoholic, in need of treatment and meets the standards under 51.45, the person will be committed by the judge to the care of the Tri-County Human Services Board for 90 days.  A Human Service Center Case Manager will, using results of the evaluationsof professionals who have assessed the client during their initial detention, determine an appropriate treatment setting and regimen and monitor the client to insure compliance.  This regimen may be a continuum of more intensive/restrictive settings to less intensive depending on the needs and progress of the client.  An extension of commitment, up to six months, can be requested at the end of the 90 days.

 

Confidentiality of Court Proceedings

Access to information about court proceedings without the written consent of the patient is limited by Section 51.30 of the Mental Health Act.  All other information about the proceedings is confidential.  Anyone may attend the hearing unless your family member ot friend and/or the defense attorney request a closed hearing, or if the subject is a juvenile (51.20)(12).

 

 

Alternative to Commitment - Negotiated Settlements

Settlement Agreements - In Forest, Oneida and Vilas counties, many civil commitment cases are resolved by negotation and settlement between the various parties' involved - attorneys, the individual who is the subject of the proceedings, treatment staff and family members.  In many cases, an outpatient treatment plan is worked out and presented to the court at the Probable Cause hearing.  This plan may include participation in outpatient therapy, medication, day services, living in a halfway house or other suitable treatment.

 

If the Court agrees to the written Settlement Agreement, the proceedings are delayed for the time period set forth in the Agreement (up to 90 days) (51.20)(8)(bg).  During this time period, the individual is required to receive treatment services as outlined in the Settlement Agreement.  If he or she does not comply, the county Corporation Counsel may request a hearing by filing a sworn statement with the Court that Counsel has reason to believe that the person has violated conditions of the Settlement Agreement.  If the person does not follow the treatment plan set forth in the Settlement Agreement, the proceedings are dismissed at the end of the designated time period. 

 

The Tri-County Human Services Board is responsible for monitoring Settlement Agreements.  Monitoring by the assigned case manager includes contacts with the treatment center staff, the individual, appropriate agencies and family members to determine if the individual is following the requirements in the Settlement Agreement.

 

Resources

1.  Police Department

    Emergency Number:   911

    The police can help in any emergency.  Telephone numbers for all area police departments are listed on the inside front cover of the

    white/yellow pages of your telephone directory.

 

2.  Tri-County Crisis Line

     Toll Free Number:   1-888-299-1188

     This line can be called to help all residents of Forest, Oneida, and Vilas Counties in crisis.  Emergency personnel are available to

     assess what may be needed in crisis, help to meet immediate needs and to refer to other agencies for long-term support.

 

3.  Sacred Heart St. Mary's Hospital

     Mental Health Center

     1044 Kabel Avenue

     Rhinelander, WI 54501

     Phone:  (715) 369-6426

     Inpatient psychiatric and psychotherapy services are provided.  Admission may be voluntary or involuntary.

 

4.  The Human Service Center

     705 E. Timber Drive

     P.O. Box 897

     Rhinelander, WI 54501

     Phone:  (715) 369-2215 or 1-800-236-8787

     Contact the agency and request to speak to a mental health case manager to have your individual needs assessed.

 

5.  Corporation Counsel Offices:

 

 

 

 

 

Bibliography

Chapter 51 of the Mental Health Act of the Wisconsin Statutes.  If you have any questions about the details of this law, please call the Coroporation Counsel's office.

 

      Oneida County Courthouse                                                   Vilas County Courthouse                                  Forest County Courthouse

      P.O. Box 400                                                                              330 Court Street                                                 612 Clermont Street

      Rhinelander, WI 54501                                                            Eagle River, WI 54521                                         Antigo. WI 54409

      (715) 369-6155                                                                            (715) 479-3714                                                       (715) 623-3989

 

 

 

Symptoms of Clinical Depression

 

• A persisent sad, anxious or "empty" mood

 

• Sleeping too little to sleeping too much

 

• Reduce appetite and weight loss or increased appetite or weight gain

 

• Loss of interest or pleasure in actitivities once enjoyed

 

• Restlessness or irritability

 

• Persistent physical symptoms that don't respond to treatment such as headaches, chronic pain, or constipation and other digestive disorders

 

• Difficulty concentrating, remembering, or making decisions

 

• Fatigue or loss of energy

 

• Feeling guilty, hopeless or worthless

 

• Thoughts of death or suicide

 

 

Suicide Warning Signs in Adults

 

• Talking about suicide

 

• Statements about hopelessness, helplessness, or worthlessness

 

• Preoccupation with death

 

• Suddenly happier, calmer

 

• Unusual visiting or calling people one cares about

 

• Making arrangements; settling one's affairs in order

 

• Giving things away

 

• Acquiring guns or stockpiling pills

 

• Previous suicide attempts