Section 6 Civil Detention for Mental Disorder

• Library: Mental Health 2006

As part of the duty of health care providers to protect patients, there is a duty to initiate civil detention when the statutory criteria are met. Civil detention shall be initiated when there is reasonable cause to believe that a person presents a likelihood of serious harm as a result of a mental disorder.

“Likelihood of serious harm” includes any 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 own person, as evidenced by recent threats, including verbal threats, or attempts to commit suicide or inflict physical harm on himself
2. A substantial risk that serious physical harm to a person will result or is occurring because of an impairment in his capacity to make decisions with respect to his hospitalization and need for treatment as evidenced by his current mental disorder or mental illness which results in an inability to provide for his own basic necessities of food, clothing, shelter, safety or medical care or his inability to provide for his own mental health care which may result in a substantial risk of serious physical harm . . .; 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 would place a reasonable person in reasonable fear of sustaining such harm

Section 632.005(9), RSMo 2000.

“Evidence of substantial risk may . . . include information about patterns of behavior that historically have resulted in serious harm” to the person or others. Section 632.005(9)(a). A “reasonable cause to believe” that such person is mentally disordered and presents a likelihood of serious self-harm or harm to others must be based on an investigation that includes evaluating the allegations and data and evaluating the reliability and credibility of all sources of information. Section 632.300.2, RSMo 2000. The decision to initiate civil detention is valid if it is based on personal observations or the results of an investigation with information obtained from witnesses. Civil detention is not appropriate for persons who are mentally retarded, developmentally disabled, or senile unless they are also mentally ill.

For initiation of civil detention, there must be a reasonable belief that the person is “mentally disordered.” “Mental disorder” is defined as “any organic, mental or emotional impairment which has substantial adverse effects on a person’s cognitive, volitional or emotional function and which constitutes a substantial impairment in a person’s ability to participate in activities of normal living.” Section 630.005(22), RSMo 2000. This condition is much broader than that required for continuation of civil detention beyond the initial 96 hours. A court will only order detention for involuntary treatment beyond 96 hours if it finds, based on clear and convincing evidence, that the person is mentally ill. Section 632.335.4, RSMo 2000. “Mental illness” is defined as “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 actions.” Section 630.005(23). “Mental disorder” is purposefully broader than “mental illness” to permit health care providers to detain persons who are likely to cause harm while they diagnose the cause of the person’s condition and determine what legal action, if any, needs to be initiated, e.g., additional civil detention or guardianship.

Any adult may initiate an application for civil detention. It must be initiated within 24 hours after the person’s arrival at the health care facility, excluding Saturdays, Sundays, and legal holidays. Section 632.315, RSMo 2000. It is appropriate, and even required, that the person be restrained and prevented from leaving during the process of completing the investigation to determine whether civil detention is necessary and, if so, while initiating the application for civil detention. Civil detention is initiated by completing forms provided by the Missouri Department of Mental Health, Form DMH 128, Application to Court for 96 Hour Detention, Evaluation and Treatment/Rehabilitation, and Form DMH 142, Affidavit in Support of Application for Detention, Evaluation and Treatment/Rehabilitation—Admission for 96 Hours. These forms are available at:

www.oa.mo.gov/gs/form/fm_indiv.htm

If the application for civil detention is initiated by a mental health coordinator, by a physician or registered professional nurse designated by the facility and approved by the Department of Mental Health, or by a mental health professional, the detention is effective immediately without requiring court approval. Section 632.310.1, RSMo 2000. “Mental health professional” includes a “psychiatrist, resident in psychiatry, psychologist, psychiatric nurse or psychiatric social worker.” Section 632.005(12). If the civil detention is initiated by any other adult, the court must authorize the detention. Section 632.305.2, RSMo 2000. Additionally, civil detention may be initiated by a peace officer if the likelihood of serious harm is imminent unless the person is immediately taken into custody. Section 632.305.3. “Peace officer” includes “a sheriff, deputy sheriff, county or municipal police officer or highway patrolman.” Section 632.005(15).

If the application for civil detention must be brought before the court, there is no requirement to involve an attorney. Section 632.305.2. The application may be filed in the court having probate jurisdiction in any county where the person is located. Id. The court will determine if there is probable cause to approve the application, based either on testimony or on the affidavits filed with the application. Id.

If the court approves the application for civil detention, it shall direct a peace officer to take the person into custody and transport the person to a mental health facility. Whenever a court has authorized civil detention, a public mental health facility shall and a private mental health facility may accept the application and person. Section 632.310.1.

(§5.7) Civil Detention for Alcohol or Drug Abuse

If there is reasonable cause to believe that a person presents a likelihood of serious self-harm or harm to others as a result of alcohol or drug abuse, civil detention can be initiated by filing Form DMH 132, Application for 96 Hour Imminent Harm Admission to a Mental Health or Alcohol and Drug Abuse Facility, and Form DMH 142, Affidavit in Support of Application for Detention, Evaluation and Treatment/Rehabilitation—Admission for 96 Hours. These forms are available at:

www.oa.mo.gov/gs/form/fm...