Navigating the Involuntary Commitment Process

Background: Arizona, like every other state, has a process through which a person may be involuntarily committed. And although Arizona has a fairly straightforward civil commitment process, navigating through it can be quite difficult. This is especially so when the person needing to carry out the process must also manage the anxiety, confusion, possible danger and heartbreak which often surrounds the need for involuntary treatment. The aim of this article is to create a roadmap for those who may need to utilize the involuntary commitment process. 1: Application for Evaluation

The first step in the process is the Application for Involuntary Evaluation (AIE). Any responsible adult may complete and submit an Application for a person who as a result of a mental disorder is a danger to self (DTS) or others (DTO), is persistently or acutely disabled (PAD), or is gravely disabled (GD), and who is unwilling or unable to receive a voluntary evaluation. This responsible person is commonly a family member, a friend, a social worker, but may be anyone else in the community. The AIE itself is quite simple, but must be backed up by factual allegations. Once completed, if in Maricopa County, the AIE is submitted to one of three locations: Connections AZ in downtown Phoenix, Community Bridges in Mesa, or RI International on 99th Ave. and Peoria. Upon receipt of the AIE, the health care agency performs a prepetition screening. The prepetition screening is a fact gathering process where the screening agency will obtain as much information as possible. This includes reviewing documents, talking to the applicant and interviewing the proposed patient. After the screening is done, the screening agency will decide if it has reasonable cause to believe that due to a mental disorder, the person is DTO, DTS, PAD, or GD, and is unwilling or unable to accept treatment. A report is prepared with these findings. If the screening agency does not believe there is not reasonable cause, the process stops. However, if there is reasonable cause, the screening agency will file a Petition for Court Ordered Evaluation (PCOE). Now, if an emergency exists, there is a slightly different procedure. The statutes state an emergency means that the person is a danger to self or others, and is likely to suffer serious physical harm or illness, or is likely to inflict serious physical harm upon another individual if not immediately hospitalized. If there is an emergency, an Application for Emergency Admission for Evaluation is filed. Unlike the AIE, the emergency application requires the applicant to have personal knowledge of the DTO/DTS behavior and state the specific nature of the danger. If after reviewing this document, the screening agency believes there is reasonable cause to believe that an emergency examination is necessary, an examiner from the screening agency will file a Petition for Court Ordered Evaluation. If brought in on an emergency evaluation, the agency must either Petition for COE or release within 24 hours. The court reviews the petitions and accompanying documentation. If the court believes there is reasonable cause to believe that due to a mental disorder, the person is DTO, DTS, PAD, or GD and is unwilling or unable to accept treatment, the court will appoint legal counsel. It will also issue a detention order for involuntary hospitalization and evaluation. Sometimes a patient will be picked up by police and brought to a hospital. For both the family and the patient, this is one of the most difficult parts of the process. While police are trained to be calm and compassionate in this situation, it is still difficult to be placed in the back of a squad car and taken away against your will. On top of this, the patient is taken to Connections AZ, a hospital downtown, where many of the people there are extremely mentally ill. This can be a scary situation even for those who have been to Connections AZ many times. These realities are just some of the factors to keep in mind when thinking about an AIE. 2. Court-Ordered Evaluation At this state, two physicians must evaluate the person and situation within 72 hours. The physicians will interview the patients, review the records, and consider the surrounding circumstances. Upon completion, if the physicians believe that as a result of a mental disorder the person is a danger to self (DTS) or others (DTO), is persistently or acutely disabled (PAD), or is gravely disabled (GD), and who is unwilling or unable to receive a voluntary evaluation, a Petition for Court Ordered Treatment is filed with the court (PCOT).

3. Court-Ordered Treatment Within six business days of the PCOT being filed, a hearing will be scheduled. At this hearing the proposed patient will have all the rights he or she would at a regular trial. He or she is mandated to receive notice at least 72 hours before, will have counsel appointed if it cannot be afforded, has the right to be present and present evidence, a verbatim record will be created if requested, and witnesses may be subpoenaed and cross-examined. The petitioner will present the evidence provided by the evaluating physicians, as well as two witnesses acquainted with the person at the time of the mental disorder. Once the evidence is presented to the court, the judge will decide if there is clear and convincing evidence that as a result of a mental disorder the person is a danger to self (DTS) or others (DTO), is persistently or acutely disabled (PAD), or is gravely disabled (GD), and who is unwilling or unable to receive a voluntary evaluation. If there is clear and convincing evidence, the person may be ordered to inpatient treatment, outpatient treatment, or a combination of both. There are limitations to the length of the court orders. The maximum period for one court order is 365 days. Inpatient treatment may be ordered for no more than 90 days if a danger to self, 180 days if persistently or acutely disabled or danger to others, and 365 days if gravely disabled. The person has a right to appeal the decision. The appeal must be based on legal grounds and notice filed within 30 days. The person also has a right to judicial review 60 days after the decision and every 60 days thereafter. Judicial review is a way to inform the court of changed circumstances. If circumstances have changed enough, the court may modify the order or may release the person entirely. Court orders based on GD and PAD may be extended in an annual examination. At the examination, legal counsel is appointed and the party seeking renewal must present clear and convincing evidence to the court. Orders based on DTO or DTS will automatically terminate on the last day specified in the order. In those cases, if the person still needs court ordered treatment, the process must start again. 4. Conclusion While involuntary commitment should be one of the last resorts because of its invasion to a person's liberty, if an individual is consistently resistant to treatment, it may be the only way to get someone started on the road to recovery. Hopefully this column helps to understand how the process works. If you have any questions, please do not hesitate to call.