Civil Involuntary Detention

 

Frequently Asked Questions

 

For some people, mental illness leaves them unable to make decisions about caring for their basic human needs such as food, shelter, and medical care. A few people may say or do things that could place them in danger of hurting themselves or someone else. This can be a very confusing and frightening experience for them as well as their families and friends. With appropriate treatment, and continued care, most people with mental illness can return to their normal lives.

 

As with most types of medical evaluation and treatment, people either decide to participate (voluntary), or refuse to participate in treatment.  Missouri state regulations Chapter 632 RSMo., provides the statutory authority to provide involuntary treatment under certain conditions with appropriate due process.  This process is called Civil Involuntary Detention.

 

Who can initiate a Civil Involuntary Detention?

Any person may file an application for detention, evaluation, and treatment with the probate division of the circuit court where the person is currently located.  Law enforcement personnel, under their police power authority, may apprehend a person they observe to be imminently harmful and transport them to a mental health facility.  Staff of the Access Crisis Intervention (ACI) System, the 24-hour crisis hotline, can also assist with the civil involuntary detention process. By calling the toll-free 24-hour ACI crisis number, the caller can speak to a mental health counselor who will evaluate the current situation and assist with the appropriate response.

 

If the situation is an emergency, what do I do?

• If possible, get the person to the emergency room of a hospital that treats people with mental illness.
• If the person is currently receiving psychiatric treatment, call the person responsible for the treatment. They should provide you with an emergency plan to follow.
• Call the police or sheriff. Tell them about the situation and why it is an emergency. Remember, they may have to observe the person’s dangerous behavior before taking them into custody and transporting them to a mental health facility.

 

If the situation is not an immediate emergency, what do I do?

• If the person is currently receiving psychiatric treatment, call the person responsible for the treatment. They should assist you.
• Call the toll-free 24-hour Access Crisis Intervention (ACI) crisis hotline. You will be able to speak to a mental health counselor who will evaluate the current situation and assist you with the appropriate response.

 

How long will a person be detained, evaluated and treated?

The initial period is for up to 96 hours, excluding weekends and certain holidays. After the initial period, the person’s treating physician will decide if further detention, evaluation, and treatment are needed. If so, the treating psychiatrist may initiate a court hearing for the appropriate time frame, 21 days, 90 days, or one year.

 

What happens in court?

If an application for 96 hours is presented to the Probate Division of the Circuit Court, the judge may have an informal (ex parte) hearing to decide whether to order the person detained, evaluated, and treated in a mental health facility for up to 96 hours.

 

If a petition is filed for 21 days, 90 days, or one year of detention, a full evidenciary hearing will be held to hear facts supporting the petition. This hearing is an adversarial hearing with both sides represented by attorneys, much the same as any other judicial process. The judge makes the final decision.

 

Will I be asked to testify in court?

If you have observed recent behavior of a person that supports the allegation in the petition, you will usually be asked to testify. Sometimes family members or friends are the only persons who have witnessed harmful behavior.

 

Does Missouri have an outpatient commitment law?

Missouri has a provision for conditionally releasing a person from a mental health facility to outpatient treatment. The statutory provision allows for a mental health facility to set conditions for a person’s release and provides authority to return a person to a mental health facility if the conditions are not met. The law also allows the judge to consider detention to the least restrictive environment.

 

Do Missouri statutes include “gravely disabled” criteria?

Yes. The criteria that a person must be mentally disordered and, as a result, present harm to self or others includes a standard that a person may be harmful if, as a result or an impairment, he or she is unable to make decisions regarding hospitalization or treatment as evidenced by not providing for basic necessities of food, clothing, shelter, safety, or medical care. A mental disorder is described in the state regulations 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”.

 

Are there any other laws that can be used to help persons who are incapacitated by mental illness?

Yes. If a person continues to be unable to make basic decisions because of an impairment, guardianship should be considered. This legal process places the personal decision-making in the hands of another person who is legally able to authorize needed services. This law has provisions for limited guardianship that allows the guardian to only have decision-making powers under certain conditions.

 

Does a person have to be suicidal or homicidal before he or she is able to be civilly detained?

No. Verbal threats to do harm are sufficient, or even placing a person in fear of harm is sufficient. The standard is “a likelihood of serious physical harm to self or others”. Likelihood of serious harm means any one of the following but does not require actual physical injury to have occurred:

a)      A substantial risk that serious physical harm will be inflicted on oneself as evidenced by recent threats, including verbal threats, or attempts to commit suicide or inflict physical harm. Evidence of substantial risk may also include information about patterns of behavior that historically have resulted in serious harm on self.

b)      A substantial risk that serious physical harm to a person will result or is occurring because of an impairment in the person’s capacity to make decisions with respect to hospitalization and need for treatment as evidenced by a current mental disorder or mental illness which results in an inability to provide for basic necessities of food, clothing, shelter, safety or medical care. Evidence of that substantial risk may also include information about patterns of behavior that have historically resulted in serious harm to the person.

c)      A substantial risk that serious physical will be inflicted by a person upon another person as evidence by recent overt acts, behavior or threats, including verbal threats which would place a reasonable person in fear of sustaining such harm. Evidence of that substantial risk may also include information about patterns of behavior that historically have resulted in physical harm upon another person.