9.60 - Assisted outpatient treatment.

* § 9.60 Assisted outpatient treatment.    (a)   Definitions.   For  purposes  of  this  section,  the  following  definitions shall apply:    (1)  "assisted  outpatient  treatment"  shall   mean   categories   of  outpatient  services  which  have  been ordered by the court pursuant to  this section.  Such treatment shall include case management services  or  assertive   community   treatment   team   services   to   provide  care  coordination, and may also include any of the  following  categories  of  services:  medication;  periodic  blood tests or urinalysis to determine  compliance with prescribed medications; individual or group therapy; day  or  partial  day  programming  activities;  educational  and  vocational  training  or  activities;  alcohol  or  substance  abuse  treatment  and  counseling and periodic tests for the presence  of  alcohol  or  illegal  drugs  for  persons  with  a  history  of  alcohol  or  substance abuse;  supervision of living arrangements; and  any  other  services  within  a  local  services  plan  developed  pursuant  to article forty-one of this  chapter, prescribed to treat the person's mental illness and  to  assist  the  person in living and functioning in the community, or to attempt to  prevent a relapse or deterioration that may reasonably be  predicted  to  result in suicide or the need for hospitalization.    (2)  "director"  shall  mean  the  director of community services of a  local governmental unit, or the  director  of  a  hospital  licensed  or  operated  by  the  office  of  mental health which operates, directs and  supervises an assisted outpatient treatment program.    (3) "director of community services"  and  "local  governmental  unit"  shall  have  the  same meanings as provided in article forty-one of this  chapter.    (4) "assisted outpatient treatment program" shall  mean  a  system  to  arrange   for  and  coordinate  the  provision  of  assisted  outpatient  treatment, to monitor treatment compliance by assisted  outpatients,  to  evaluate  the  condition  or  needs  of  assisted  outpatients,  to take  appropriate steps to address the  needs  of  such  individuals,  and  to  ensure compliance with court orders.    (5) "assisted outpatient" shall mean the person under a court order to  receive assisted outpatient treatment.    (6)  "subject  of the petition" or "subject" shall mean the person who  is alleged in a petition, filed  pursuant  to  the  provisions  of  this  section, to meet the criteria for assisted outpatient treatment.    (7)  "correctional  facility"  and "local correctional facility" shall  have the same meanings as provided in section two of the correction law.    (8) "health care proxy" and "health care agent" shall  have  the  same  meanings as provided in article twenty-nine-C of the public health law.    (9)  "program  coordinator"  shall mean an individual appointed by the  commissioner of mental health, pursuant to subdivision  (f)  of  section  7.17  of  this  chapter,  who  is  responsible  for  the  oversight  and  monitoring of assisted outpatient treatment programs.    (b) Programs.  The  director  of  community  services  of  each  local  governmental  unit  shall  operate,  direct  and  supervise  an assisted  outpatient treatment program. The director of  a  hospital  licensed  or  operated  by  the  office  of  mental  health  may  operate,  direct and  supervise an assisted outpatient treatment program, upon approval by the  commissioner. Directors of community  services  shall  be  permitted  to  satisfy  the  provisions  of  this  subdivision through the operation of  joint  assisted  outpatient  treatment   programs.   Nothing   in   this  subdivision   shall  be  interpreted  to  preclude  the  combination  or  coordination of efforts between and among local governmental  units  and  hospitals in providing and coordinating assisted outpatient treatment.(c)  Criteria.  A person may be ordered to receive assisted outpatient  treatment if the court finds that such person:    (1) is eighteen years of age or older; and    (2) is suffering from a mental illness; and    (3)   is   unlikely   to  survive  safely  in  the  community  without  supervision, based on a clinical determination; and    (4) has a history of lack of  compliance  with  treatment  for  mental  illness that has:    (i)  prior  to  the  filing of the petition, at least twice within the  last thirty-six  months  been  a  significant  factor  in  necessitating  hospitalization  in  a hospital, or receipt of services in a forensic or  other  mental  health  unit  of  a  correctional  facility  or  a  local  correctional  facility,  not  including  any  current  period, or period  ending within the last six months, during which the  person  was  or  is  hospitalized or incarcerated; or    (ii) prior to the filing of the petition, resulted in one or more acts  of  serious  violent  behavior  toward  self or others or threats of, or  attempts at, serious physical harm to self or  others  within  the  last  forty-eight  months,  not including any current period, or period ending  within the last six months, in which the person was or  is  hospitalized  or incarcerated; and    (5)  is,  as  a  result  of  his  or  her  mental illness, unlikely to  voluntarily participate in outpatient treatment that would enable him or  her to live safely in the community; and    (6) in view of his or her treatment history and current  behavior,  is  in  need  of assisted outpatient treatment in order to prevent a relapse  or deterioration which would be likely to result in serious harm to  the  person or others as defined in section 9.01 of this article; and    (7) is likely to benefit from assisted outpatient treatment.    (d) Health care proxy. Nothing in this section shall preclude a person  with  a  health  care proxy from being subject to a petition pursuant to  this chapter and consistent with article  twenty-nine-C  of  the  public  health law.    (e)  Petition  to  the  court. (1) A petition for an order authorizing  assisted outpatient treatment may be filed  in  the  supreme  or  county  court  in  the county in which the subject of the petition is present or  reasonably believed to be present. Such petition may be  initiated  only  by the following persons:    (i) any person eighteen years of age or older with whom the subject of  the petition resides; or    (ii)  the  parent,  spouse, sibling eighteen years of age or older, or  child eighteen years of age or older of the subject of the petition; or    (iii) the director of a hospital in which the subject of the  petition  is hospitalized; or    (iv)  the director of any public or charitable organization, agency or  home providing mental health services to the subject of the petition  or  in whose institution the subject of the petition resides; or    (v)  a  qualified psychiatrist who is either supervising the treatment  of or treating the subject of the petition for a mental illness; or    (vi)  a  psychologist,  licensed  pursuant  to  article  one   hundred  fifty-three  of the education law, or a social worker, licensed pursuant  to article one hundred fifty-four of the education law, who is  treating  the subject of the petition for a mental illness; or    (vii)  the  director of community services, or his or her designee, or  the social services official, as defined in the social services law,  of  the  city  or  county in which the subject of the petition is present or  reasonably believed to be present; or(viii) a parole officer or probation officer assigned to supervise the  subject of the petition.    (2) The petition shall state:    (i)  each  of  the  criteria  for assisted outpatient treatment as set  forth in subdivision (c) of this section;    (ii) facts which support the petitioner's belief that the  subject  of  the  petition  meets  each  criterion,  provided that the hearing on the  petition need not be limited to the stated facts; and    (iii) that the subject of the petition is present,  or  is  reasonably  believed to be present, within the county where such petition is filed.    (3)  The  petition shall be accompanied by an affirmation or affidavit  of a physician, who shall not be the petitioner, stating either that:    (i) such physician has personally examined the subject of the petition  no more  than  ten  days  prior  to  the  submission  of  the  petition,  recommends   assisted  outpatient  treatment  for  the  subject  of  the  petition, and is willing and able to  testify  at  the  hearing  on  the  petition; or    (ii)  no  more than ten days prior to the filing of the petition, such  physician or his or her designee has made appropriate attempts  but  has  not  been  successful in eliciting the cooperation of the subject of the  petition to submit to an  examination,  such  physician  has  reason  to  suspect that the subject of the petition meets the criteria for assisted  outpatient  treatment, and such physician is willing and able to examine  the subject of the petition and testify at the hearing on the petition.    (4) In counties with a population of less than seventy-five  thousand,  the  affirmation  or  affidavit  required  by  paragraph  three  of this  subdivision may be made by a physician who is an employee of the office.  The office is authorized to make available, at no cost to the county,  a  qualified  physician  for  the  purpose  of  making  such affirmation or  affidavit consistent with the provisions of such paragraph.    (f) Service. The petitioner shall cause written notice of the petition  to be given to the subject of the petition and  a  copy  thereof  to  be  given  personally  or  by  mail to the persons listed in section 9.29 of  this article, the mental hygiene legal service, the health care agent if  any such agent is known  to  the  petitioner,  the  appropriate  program  coordinator, and the appropriate director of community services, if such  director is not the petitioner.    (g) Right to counsel. The subject of the petition shall have the right  to  be  represented  by  the  mental hygiene legal service, or privately  financed counsel, at all stages of a  proceeding  commenced  under  this  section.    (h) Hearing. (1) Upon receipt of the petition, the court shall fix the  date for a hearing. Such date shall be no later than three days from the  date  such  petition  is  received  by  the  court, excluding Saturdays,  Sundays and holidays. Adjournments shall  be  permitted  only  for  good  cause shown. In granting adjournments, the court shall consider the need  for  further examination by a physician or the potential need to provide  assisted outpatient treatment expeditiously. The court shall  cause  the  subject  of  the petition, any other person receiving notice pursuant to  subdivision (f) of this section, the  petitioner,  the  physician  whose  affirmation  or  affidavit  accompanied  the  petition,  and  such other  persons as the court may determine to be advised of such date. Upon such  date, or upon such other date to which the proceeding may be  adjourned,  the  court  shall  hear testimony and, if it be deemed advisable and the  subject of the  petition  is  available,  examine  the  subject  of  the  petition  in  or  out  of court. If the subject of the petition does not  appear at the hearing, and appropriate attempts to elicit the attendance  of the subject have failed, the court may conduct  the  hearing  in  thesubject's  absence.  In such case, the court shall set forth the factual  basis for conducting the hearing without the presence of the subject  of  the petition.    (2)  The court shall not order assisted outpatient treatment unless an  examining physician, who recommends assisted  outpatient  treatment  and  has  personally  examined  the  subject of the petition no more than ten  days before the filing of the  petition,  testifies  in  person  at  the  hearing.   Such   physician   shall   state   the   facts  and  clinical  determinations which support the allegation  that  the  subject  of  the  petition meets each of the criteria for assisted outpatient treatment.    (3)  If  the  subject  of the petition has refused to be examined by a  physician,  the  court  may  request  the  subject  to  consent  to   an  examination by a physician appointed by the court. If the subject of the  petition  does  not  consent  and  the  court  finds reasonable cause to  believe that the allegations in the petition are  true,  the  court  may  order peace officers, acting pursuant to their special duties, or police  officers who are members of an authorized police department or force, or  of  a  sheriff's  department  to  take  the subject of the petition into  custody and transport him or her to a  hospital  for  examination  by  a  physician.  Retention  of  the  subject of the petition under such order  shall not exceed twenty-four hours. The examination of  the  subject  of  the  petition  may  be  performed  by the physician whose affirmation or  affidavit accompanied  the  petition  pursuant  to  paragraph  three  of  subdivision (e) of this section, if such physician is privileged by such  hospital  or  otherwise  authorized  by  such hospital to do so. If such  examination is performed by another physician, the  examining  physician  may   consult   with   the  physician  whose  affirmation  or  affidavit  accompanied the petition as to whether the subject  meets  the  criteria  for assisted outpatient treatment.    (4)  A  physician  who  testifies  pursuant  to  paragraph two of this  subdivision shall state: (i) the facts which support the allegation that  the  subject  meets  each  of  the  criteria  for  assisted   outpatient  treatment, (ii) that the treatment is the least restrictive alternative,  (iii)  the  recommended  assisted  outpatient  treatment,  and  (iv) the  rationale for the recommended  assisted  outpatient  treatment.  If  the  recommended  assisted  outpatient  treatment  includes  medication, such  physician's testimony shall describe the types or classes of  medication  which   should   be   authorized,  shall  describe  the  beneficial  and  detrimental physical and mental effects of such  medication,  and  shall  recommend   whether  such  medication  should  be  self-administered  or  administered by authorized personnel.    (5) The subject of the petition shall be afforded  an  opportunity  to  present  evidence,  to  call  witnesses  on  his  or  her behalf, and to  cross-examine adverse witnesses.    (i) Written treatment plan. (1) The court  shall  not  order  assisted  outpatient  treatment  unless  a  physician appointed by the appropriate  director, in consultation with such director, develops and  provides  to  the  court a proposed written treatment plan. The written treatment plan  shall include case management services or assertive community  treatment  team  services  to provide care coordination. The written treatment plan  also shall include all categories of services, as set forth in paragraph  one of subdivision (a) of this section, which such physician  recommends  that the subject of the petition receive. All service providers shall be  notified regarding their inclusion in the written treatment plan. If the  written  treatment plan includes medication, it shall state whether such  medication should be self-administered  or  administered  by  authorized  personnel,  and  shall  specify type and dosage range of medication most  likely to provide maximum  benefit  for  the  subject.  If  the  writtentreatment  plan  includes  alcohol  or  substance  abuse  counseling and  treatment, such plan may include a provision requiring relevant  testing  for  either  alcohol  or  illegal  substances  provided  the physician's  clinical  basis for recommending such plan provides sufficient facts for  the court to find (i) that such person  has  a  history  of  alcohol  or  substance  abuse  that  is clinically related to the mental illness; and  (ii)  that  such  testing  is  necessary  to  prevent   a   relapse   or  deterioration  which  would  be  likely to result in serious harm to the  person or others. If a director is the petitioner, the written treatment  plan shall be provided to the court  no  later  than  the  date  of  the  hearing  on  the  petition.  If  a  person  other than a director is the  petitioner, such plan shall be provided to the court no later  than  the  date  set by the court pursuant to paragraph three of subdivision (j) of  this section.    (2) The physician appointed to  develop  the  written  treatment  plan  shall  provide  the  following  persons  with an opportunity to actively  participate in  the  development  of  such  plan:  the  subject  of  the  petition;  the  treating  physician, if any; and upon the request of the  subject of the  petition,  an  individual  significant  to  the  subject  including  any  relative, close friend or individual otherwise concerned  with the welfare of the subject. If the  subject  of  the  petition  has  executed a health care proxy, the appointed physician shall consider any  directions  included  in  such proxy in developing the written treatment  plan.    (3) The court shall not order assisted outpatient treatment  unless  a  physician  appearing  on  behalf  of a director testifies to explain the  written  proposed  treatment  plan.  Such  physician  shall  state   the  categories  of  assisted outpatient treatment recommended, the rationale  for each such category, facts which establish that such treatment is the  least  restrictive  alternative,  and,  if  the   recommended   assisted  outpatient  treatment  plan  includes  medication,  such physician shall  state the types or classes of medication recommended, the beneficial and  detrimental physical and mental effects of such medication, and  whether  such  medication  should  be  self-administered  or  administered  by an  authorized professional. If the subject of the petition has  executed  a  health care proxy, such physician shall state the consideration given to  any  directions  included  in  such  proxy  in  developing  the  written  treatment plan. If a director is the petitioner, testimony  pursuant  to  this  paragraph  shall  be  given  at  the hearing on the petition. If a  person other than a director is the petitioner, such testimony shall  be  given  on  the  date  set  by  the  court pursuant to paragraph three of  subdivision (j) of this section.    (j) Disposition. (1) If after hearing all relevant evidence, the court  does not find by clear and convincing evidence that the subject  of  the  petition meets the criteria for assisted outpatient treatment, the court  shall dismiss the petition.    (2)  If  after hearing all relevant evidence, the court finds by clear  and convincing evidence that the  subject  of  the  petition  meets  the  criteria  for assisted outpatient treatment, and there is no appropriate  and feasible less restrictive  alternative,  the  court  may  order  the  subject  to  receive assisted outpatient treatment for an initial period  not to exceed six months. In  fashioning  the  order,  the  court  shall  specifically  make  findings  by  clear and convincing evidence that the  proposed treatment is the least restrictive  treatment  appropriate  and  feasible  for  the subject. The order shall state an assisted outpatient  treatment  plan,  which  shall  include  all  categories   of   assisted  outpatient  treatment,  as set forth in paragraph one of subdivision (a)  of this section, which the assisted outpatient is to receive, but  shallnot  include any such category that has not been recommended in both the  proposed written treatment plan and the testimony provided to the  court  pursuant to subdivision (i) of this section.    (3)  If  after hearing all relevant evidence presented by a petitioner  who is not a director, the court finds by clear and convincing  evidence  that  the  subject  of  the  petition  meets  the  criteria for assisted  outpatient treatment, and the court  has  yet  to  be  provided  with  a  written  proposed  treatment  plan and testimony pursuant to subdivision  (i) of this section, the court shall order the appropriate  director  to  provide  the  court with such plan and testimony no later than the third  day, excluding Saturdays, Sundays and  holidays,  immediately  following  the  date  of  such  order.  Upon receiving such plan and testimony, the  court may order assisted outpatient treatment as provided  in  paragraph  two of this subdivision.    (4)  A  court  may  order  the patient to self-administer psychotropic  drugs or accept the administration of such drugs by authorized personnel  as part of an assisted outpatient  treatment  program.  Such  order  may  specify  the  type  and dosage range of such psychotropic drugs and such  order shall be effective for the duration of  such  assisted  outpatient  treatment.    (5)  If  the petitioner is the director of a hospital that operates an  assisted outpatient treatment program, the court order shall direct  the  hospital  director  to provide or arrange for all categories of assisted  outpatient treatment for the assisted outpatient throughout  the  period  of  the  order.  For  all  other  persons,  the  order shall require the  director of community services of  the  appropriate  local  governmental  unit  to  provide  or  arrange for all categories of assisted outpatient  treatment for the assisted  outpatient  throughout  the  period  of  the  order.    (6) The director shall cause a copy of any court order issued pursuant  to  this  section  to  be  served  personally,  or by mail, facsimile or  electronic means, upon the assisted outpatient, the mental hygiene legal  service or anyone  acting  on  the  assisted  outpatient's  behalf,  the  original  petitioner,  identified  service  providers,  and  all  others  entitled to notice under subdivision (f) of this section.    (k) Petition for additional periods of treatment. Within  thirty  days  prior  to  the  expiration of an order of assisted outpatient treatment,  the appropriate director or  the  current  petitioner,  if  the  current  petition was filed pursuant to subparagraph (i) or (ii) of paragraph one  of  subdivision  (e) of this section, and the current petitioner retains  his or her original status pursuant to the applicable subparagraph,  may  petition  the court to order continued assisted outpatient treatment for  a period not to exceed one year from the expiration date of the  current  order.  If the court's disposition of such petition does not occur prior  to the expiration date of the current order,  the  current  order  shall  remain  in  effect  until such disposition. The procedures for obtaining  any order pursuant to this subdivision shall be in accordance  with  the  provisions  of the foregoing subdivisions of this section; provided that  the time restrictions included in paragraph four of subdivision  (c)  of  this section shall not be applicable. The notice provisions set forth in  paragraph  six  of  subdivision (j) of this section shall be applicable.  Any court order requiring periodic blood tests  or  urinalysis  for  the  presence  of  alcohol  or illegal drugs shall be subject to review after  six months by the physician who developed the written treatment plan  or  another  physician  designated by the director, and such physician shall  be authorized to  terminate  such  blood  tests  or  urinalysis  without  further action by the court.(l)  Petition  for an order to stay, vacate or modify. (1) In addition  to any other right or remedy available by law with respect to the  order  for  assisted  outpatient treatment, the assisted outpatient, the mental  hygiene legal service, or anyone acting  on  the  assisted  outpatient's  behalf  may  petition  the court on notice to the director, the original  petitioner, and all others entitled to notice under subdivision  (f)  of  this section to stay, vacate or modify the order.    (2)  The  appropriate  director  shall petition the court for approval  before instituting a proposed material change in the assisted outpatient  treatment plan, unless such change is authorized by  the  order  of  the  court. Such petition shall be filed on notice to all parties entitled to  notice  under  subdivision (f) of this section. Not later than five days  after  receiving  such  petition,  excluding  Saturdays,   Sundays   and  holidays,  the court shall hold a hearing on the petition; provided that  if the assisted outpatient informs the court that he or  she  agrees  to  the  proposed material change, the court may approve such change without  a hearing. Non-material  changes  may  be  instituted  by  the  director  without  court  approval. For the purposes of this paragraph, a material  change is an addition or deletion of a category of services to or from a  current assisted outpatient treatment plan, or any deviation without the  assisted outpatient's consent from the terms of a current order relating  to the administration of psychotropic drugs.    (m) Appeals. Review of an order issued pursuant to this section  shall  be had in like manner as specified in section 9.35 of this article.    (n) Failure to comply with assisted outpatient treatment. Where in the  clinical  judgment  of  a  physician,  (i)  the assisted outpatient, has  failed or refused to comply with the assisted outpatient treatment, (ii)  efforts were  made  to  solicit  compliance,  and  (iii)  such  assisted  outpatient  may  be  in  need  of  involuntary  admission  to a hospital  pursuant to section 9.27 of this article or immediate observation,  care  and  treatment  pursuant  to  section 9.39 or 9.40 of this article, such  physician may request the director of community services, the director's  designee, or any physician  designated  by  the  director  of  community  services pursuant to section 9.37 of this article, to direct the removal  of   such   assisted  outpatient  to  an  appropriate  hospital  for  an  examination to determine if such person has a mental illness  for  which  hospitalization  is  necessary pursuant to section 9.27, 9.39 or 9.40 of  this article. Furthermore, if such assisted outpatient refuses  to  take  medications  as  required  by  the  court order, or he or she refuses to  take, or fails a blood test, urinalysis, or  alcohol  or  drug  test  as  required by the court order, such physician may consider such refusal or  failure  when  determining whether the assisted outpatient is in need of  an examination to determine whether he or she has a mental  illness  for  which  hospitalization is necessary. Upon the request of such physician,  the director, the  director's  designee,  or  any  physician  designated  pursuant  to  section  9.37  of this article, may direct peace officers,  acting pursuant to their special duties,  or  police  officers  who  are  members  of  an  authorized police department or force or of a sheriff's  department to take the assisted outpatient into  custody  and  transport  him  or  her to the hospital operating the assisted outpatient treatment  program or to any hospital  authorized  by  the  director  of  community  services  to  receive such persons. Such law enforcement officials shall  carry out such directive.  Upon  the  request  of  such  physician,  the  director,  the director's designee, or any physician designated pursuant  to section 9.37 of this article, an ambulance  service,  as  defined  by  subdivision  two of section three thousand one of the public health law,  or an approved mobile crisis outreach team as defined in section 9.58 of  this article shall be authorized to take into custody and transport  anysuch  person to the hospital operating the assisted outpatient treatment  program, or  to  any  other  hospital  authorized  by  the  director  of  community  services  to  receive such persons. Any director of community  services,  or  designee, shall be authorized to direct the removal of an  assisted  outpatient  who  is  present  in  his  or  her  county  to  an  appropriate   hospital,  in  accordance  with  the  provisions  of  this  subdivision, based upon a determination of the appropriate  director  of  community  services  directing  the  removal of such assisted outpatient  pursuant  to  this  subdivision.  Such  person  may  be   retained   for  observation,  care and treatment and further examination in the hospital  for up to seventy-two hours to permit a physician to  determine  whether  such  person has a mental illness and is in need of involuntary care and  treatment in a hospital pursuant to the provisions of this article.  Any  continued  involuntary  retention  in  such  hospital beyond the initial  seventy-two hour period shall be in accordance with  the  provisions  of  this  article  relating  to the involuntary admission and retention of a  person. If at any time during the seventy-two hour period the person  is  determined   not   to  meet  the  involuntary  admission  and  retention  provisions of this article, and does not agree to stay in  the  hospital  as  a voluntary or informal patient, he or she must be released. Failure  to comply with an order of assisted outpatient treatment  shall  not  be  grounds  for  involuntary  civil  commitment or a finding of contempt of  court.    (o) Effect of determination that a  person  is  in  need  of  assisted  outpatient  treatment.  The determination by a court that a person is in  need of assisted outpatient treatment  shall  not  be  construed  as  or  deemed  to be a determination that such person is incapacitated pursuant  to article eighty-one of this chapter.    (p) False petition. A person making a  false  statement  or  providing  false information or false testimony in a petition or hearing under this  section shall be subject to criminal prosecution pursuant to article one  hundred seventy-five or article two hundred ten of the penal law.    (q)  Exception.  Nothing  in this section shall be construed to affect  the ability of the director of a hospital to receive, admit,  or  retain  patients  who  otherwise  meet  the provisions of this article regarding  receipt, retention or admission.    (r) Education and training.  (1)  The  office  of  mental  health,  in  consultation  with  the  office  of  court administration, shall prepare  educational and training materials on the use  of  this  section,  which  shall  be  made  available  to  local  governmental  units, providers of  services, judges, court personnel, law  enforcement  officials  and  the  general public.    (2)   The   office,   in   consultation   with  the  office  of  court  administration, shall establish a mental  health  training  program  for  supreme and county court judges and court personnel. Such training shall  focus  on  the use of this section and generally address issues relating  to mental illness and mental health treatment.    * NB Repealed June 30, 2015