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EMERGENCY MENTAL HEALTH CARE:
HOW TO NAVIGATE IN HARRIS COUNTY
AMY R. PARSONS, JD, LMSW, NCG
LITIGATION & MENTAL HEALTH STAFF ATTORNEY
HARRIS COUNTY PROBATE COURT NO. THREE,
HONORABLE RORY R. OLSEN, PRESIDING
201 Caroline, 7th Floor
Houston, Texas 77002
Tel: (713) 368-6739
Fax: (713) 368-7166
Email: [email protected]
Texas Society of Certified Public Accountants
& Houston CPA Society
“2014 CPE By The Sea” Conference
June 13, 2014
Galveston, Texas
Emergency Mental Health Care: How To Navigate In Harris County
Amy R. Parsons
Harris County Probate Court No. Three
201 Caroline, 7th Floor
Houston, Texas 77002
[email protected]
(713) 368-6739
EDUCATION/LICENSURE
Juris Doctorate, South Texas College of Law, December 2010
Master of Social Work, University of Houston, 1999
Bachelor of Social Work, Stephen F. Austin State University, 1995
State Bar of Texas Admission, January 2011
Attorney Ad-Litem: Guardianship Certification, February 2013
US District Court Southern District of Texas, May 2011
Nationally Certified Guardian, NGF, July 2004
Licensed Master Social Worker, TSBSWE, August 1999
Licensed Social Worker, TSBSWE, March 1996
PROFESSIONAL EXPERIENCE
Mar 2004- present
Probate Court No. Three, Judge Rory R. Olsen, Harris County, TX
Staff Attorney: Litigation/Mental Health
2011-present
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•
•
•
Mental Health Staff Attorney
General Litigation Docket
Docket Control/Trial Orders
Heirship Docket
Court Investigator
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•
•
•
•
2004-2011
Investigated new guardianship referrals
Prepared/filed guardianship recommendations to the court
Monitored/audited 1,000 guardianships (person/estate)
Directed court visitor program
Served on state and local guardianship boards
Jan 1996- Mar 2004 Harris County Guardianship Program, Houston, TX
Supervisor
2000-2004
Legal Liaison
1999-2000
Case Manager
1996-1999
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Emergency Mental Health Care: How To Navigate In Harris County
PRESENTATIONS/PUBLICATIONS
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Presentation, Houston Bar Association CLE “Probate Judge’s Panel”, April 2014.
Presentation, Probate Court No. Three, Mental Health CLE, “Assisted Out-patient Treatment”,
March 2014.
Presentation, Probate Court No. Three, Mental Health CLE, “Mental Health Docket: Duties of
the Attorney Ad-Litem , November 2013.
th
Article & Presentation, Texas Society of Certified Public Accountants- 18 Annual CPE
Conference, “Basic Concepts of Probate and Mental Health”, June 2013.
Article & Presentation, Houston Bar Association-AAL Guardianship Certification, “Probate
Court Investigators: Guardianship Gatekeepers”, February 2013.
Article, (co-authored with Honorable Rory R. Olsen) Houston Lawyer Magazine, “Emergency
Mental Health Care: How To Navigate In Harris County”, January/February 2013.
Article (researched for the author, Judge Georgia Akers), Estate Planning & Community
Property Law Journal- “Mind”ing Your Business: Estate Planning Documents and the Levels of
Capacity Required for Execution, Fall 2010, Vol. 3, Book 1
Presentation, University of Houston-Guardianship Law Class, “Guardianship Investigations”,
Spring 2009.
PROFESSIONAL AFFILIATIONS/ACTIVITIES
•
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Guardianship Certification Board- (2011- present)
Houston Bar Association- (2011- present)
American Bar Association-(2006-2013)
Family Law Clinic-South Texas College of Law- (Fall 2010)
Mock Trial Summer Academy, South Texas College of Law- (Summer 2009)
Family/Probate Law Student Association, (2009-2010)
South Texas College of Law Student Bar Association- (2006-2010)
HHSC Guardianship Advisory Board (2006 – 2009), Co-Chair, (2007-2009)
National Association of Social Workers: Houston Newsletter Editor (2002 – 2006)
Texas Guardianship Association: (2003-present), Board of Directors-VP (2003-2007)
National Guardianship Association: (2004- present), Conference Planning Committee Member
(2005- 2007)
Adult Protective Services Advisory Board member, (2002-2007)
Texas Department of Human Services: Personal Care Home Task Force, (2001)
Youth and Family Services: Conference- Program Committee (2002)
Houston Association of Volunteer Administrators, member (2004- 2010)
AWARDS
Mock Trial - Summer Academy Semi-Finalist Team, South Texas College of Law, (2009)
Personal Achievement Award, (2000),
Team of the Month, (December 1999 & March 1999)
Employee of the Month, (April 1999 & December 1999),
Outstanding Employee, (1997),
Group Personal Achievement Award, (1997)
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Emergency Mental Health Care: How To Navigate In Harris County
TABLE OF CONTENTS
I.
INTRODUCTION ……………………………………………… 4
II.
JURISDICTION………………………………………………… 4
III.
ENTRANCE TO EMERGENCY MENTAL HEALTH……… 4
a. Peace Officer…………………………………………………. 5
b. Court Appointed Guardian…………………………………. 6
c. Adult Who Witnessed Behavior…………………………….. 6
IV.
EMERGENCY DETENTION………………………………….. 7
V.
PROTECTIVE CUSTODY……………………………………... 7
VI.
PROBABLE CAUSE……………………………………………. 8
VII. COURT ORDERED MENTAL HEALTH SERVICES………. 9
VIII. FORCED MEDICATIONS……………………………………... 9
IX.
MENTAL HEALTH RECORDS………………………………..10
X.
COMMITMENT CONSEQUENCES………………………….. 11
XI.
CONCLUSION………………………………………………… ...12
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Emergency Mental Health Care: How To Navigate In Harris County
EMERGENCY MENTAL HEALTH CARE:
HOW TO NAVIGATE IN HARRIS COUNTY
I.
INTRODUCTION
You receive a call from your client who is in a panic about her son, Charlie. She tells you that
Charlie has bi-polar disorder and has not been taking his medication. He is refusing to eat, drink,
or bathe and mumbles something about “all going to die.”. He is refusing to go to the doctor or
the hospital. What does she need to do to get the sick person treated quickly and safely? Which
court has jurisdiction? What law applies? How does the law work? Of course, contacting an
attorney familiar with mental health laws is always advisable. The Houston Bar Association has
an extensive referral list available and contact information can be found on the website.
1
Although not all inclusive, this paper’s goal is provide basic insight on to how to access the
mental health system and what to expect during that process.
II.
JURISDICTION
Probate Court No. 3 has primary responsibility for mental illness proceedings in Harris County. 2
Probate Court No. 4 has secondary responsibility. 3 Probate Court No. 3 has staff at the Harris
County Psychiatric Center (“HCPC”) located at 2800 S. MacGregor Way, Houston, Texas, to
handle administration of the 625 average monthly mental health applications. 4
III.
ENTRANCE TO THE EMERGENCY MENTAL HEALTH SYSTEM
Texas Health and Safety Code sections 573 and 574 provide three alternate ways a person can be
brought into the mental health system for evaluation, against their will. 5 The person can be
brought into a mental health facility by either their guardian or by a peace officer. Also, any
1
2
3
4
5
http://www.hba.org/
TEX. GOV’T CODE ANN. § 25.1034 (Vernon Supp. 2004).
Id.
Id.
TEX. HEALTH & SAFETY CODE ANN. §§ 573 & 574 (Vernon 2010).
4
Emergency Mental Health Care: How To Navigate In Harris County
adult who has witnessed a mentally ill person exhibiting dangerous behavior may file an
application to have the person apprehended. 6
a. Peace Officer
If the person is actively homicidal or suicidal,
THE POLICE!
DO NOT WASTE TIME-----CALL
This option is available twenty four hours a day. If your client lives in the
Houston city limits, when she calls 911, she should request a Crisis Intervention Team (“CIT”)
officer from the Houston Police Department’s (“HPD”) Mental Health Unit. These HPD officers
are specially trained in techniques allowing for safe detention and transport of a mentally ill
citizen. 7 The Harris County Sherriff’s office, which covers the entire county outside of the
Houston city limits, has a similar unit specially trained in dealing with mentally ill persons.
Specifically requesting a specially trained peace officer may reduce the chance of injury for
everyone involved. However, any peace officer may take a person to the nearest mental health
facility for evaluation when he believes there is not enough time to obtain a warrant. 8 The peace
officer can do so when he reasonably believes that because of a mental illness there is a
substantial risk of serious harm to the person or others unless the person is immediately
restrained. 9 The officer can take custody of your client’s son solely from information she
provides or from the circumstances surrounding his encounter with the son. 10 You can reassure
your client that Charlie will be taken only to a designated mental health hospital ---not jail--- as
the officer can transport him to jail only under an extreme emergency. 11 Be aware that if Charlie
is found with a firearm, the officer has the right to seize that firearm. 12
If brought in to the hospital by a peace officer, the officer is required ONLY to fill out the “Peace
Officer’s Notification of Detention” Form and CANNOT be required to fill out any additional
paperwork. 13 This form is created by statute and cannot be altered. 14 When the officer presents
6
Id. §§ 573.001, 573.003, 573.011.
To learn more call (713)-971-4620 or visit http://www.houstoncit.org/
8
TEX. HEALTH & SAFETY CODE ANN. § 573.001 (Vernon 2010).
9
Id.
10
Id.
11
Id.
12
Id.
13
Id. § 573.002
7
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Emergency Mental Health Care: How To Navigate In Harris County
the notification form to the facility the facility MUST accept the person for initial evaluation. 15
The hospital must keep this form in Charlie’s medical chart. 16 This form proves that the hospital
has the right to detain the person. The purpose of this simple form is to efficiently get Charlie
help while swiftly getting the officer back on patrol.
b. Court Appointed Guardian
A second less traumatic transport is realistic is some situations. If your client is the court
appointed guardian of the person of her adult child (“ward”), she can transport him directly,
without a warrant or peace officer assistance, to HCPC or any of the local mental health facilities
for evaluation. 17 Your client can take Charlie for in-patient evaluation when she has the same
concerns as the officer. 18 She can also transport Charlie if he demonstrates behavior, emotional
distress and deterioration in his mental condition so that he cannot remain at liberty. 19 This
option is also available at any time of the day or night.
Having a familiar family
member/guardian take him to the hospital reduces the amount of stress on the mentally ill ward.
The guardian, upon arrival, must immediately file an application for emergency detention with
the facility. 20 This application is sent for the court’s approval in order for the facility to detain
the person for initial evaluation. 21
c. Adult Who Witnessed Behavior
Third, ANY adult, regardless of their relation, who has ACTUALLY witnessed the mentally ill
person acting in a dangerous manner, may apply for emergency detention of that person. 22 This
option is available during regular court business hours. The application should be filed with the
county clerk/court at HCPC and must include the person’s location and clear details of what he
has said or done that causes concern for his or others’ safety. 23 Examples of granted applications
are “my brother is hallucinating that I am the devil and threatened to kill me” or “my brother is
14
15
16
17
18
19
20
21
22
23
Id.
Id.
Id.
Id. § 573.003.
Id.
Id.
Id. §§ 573.002 & 573.004.
Id.
Id. § 573.011.
Id.
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Emergency Mental Health Care: How To Navigate In Harris County
bi-polar and has not eaten or bathed in 3 days and is refusing medications.”. Examples that
won’t meet the code’s standard and are likely to be denied by the court are “my brother is not
following directions.” or “my brother is agitated.”, or “my sister told me that my brother hit her”.
Your client will need to identify which hospital is willing to accept Charlie for admission. If
Charlie is indigent, then HCPC will often be the hospital of choice. However, many of the
mental health hospitals do take Medicaid and other forms of private insurance. Inform your
client that she may be at HCPC for a few hours while the clerk/court processes the application
for the judge’s review. 24 25
IV.
EMERGENCY DETENTION
During regular business hours, a statutory probate judge or associate judge reviews the
application for emergency detention and signs the warrants. 26
After hours, an assigned
magistrate reviews and signs the warrants. 27 Upon review of the application and finding that
Charlie’s behaviors are a substantial, imminent risk to himself or others unless he is immediately
restrained, the judge or magistrate will issue a warrant to an on-duty peace officer. 28 In Harris
County, the majority of warrants are served by select Precinct One constables, who are also
housed at HCPC. Usually, within a few hours the constables will locate, take into custody and
transport Charlie to the identified hospital for treatment. Regardless of how Charlie arrived, he
initially can be detained in the mental health facility for only forty-eight hours and must be
examined by the physician within the first twelve hours. 29
V.
PROTECTIVE CUSTODY
If the physician feels that Charlie needs in-patient treatment then he must file with the court a
statement describing how Charlie’s mental illness is causing him and/or others imminent risk of
harm and that immediately detaining him in the hospital is the least restrictive means for
24
25
26
27
28
29
TEX. HEALTH & SAFETY CODE ANN. § 573.012 (Vernon Supp. 2010).
For a list of mental health facilities in Harris County, contact the court at HCPC at (713)-741-6020.
TEX. HEALTH & SAFETY CODE ANN. § 573.012 (Vernon Supp. 2010).
Id.
Id.
TEX. HEALTH & SAFETY CODE ANN. § 573.021 (Vernon 2010) & § 574.022 (Vernon Supp. 2010).
7
Emergency Mental Health Care: How To Navigate In Harris County
treatment. 30 If the judge is convinced that a substantial risk does exist, then he may sign the
order of protective custody (“OPC”) and Charlie will either remain in or be transported to the
appropriate mental health facility. 31 However, Charlie does have several rights during this time
including the right to notice of the detention and to have access to and retain an attorney. 32
When an OPC is signed, the court is required to appoint an attorney to represent any patient who
does not already have one. 33 34 An attorney is appointed by each court probate court to represent
all patients appearing on that week’s docket. 35 The attorney represents the patient from the
probable cause hearing through the final court ordered mental health/medication hearings. 36 All
mental health dockets are prosecuted by the county attorney’s office. 37 In Harris County, the
assigned assistant county attorney is Melinda Brents who can be reached at (713)-741-6016.
VI.
PROBABLE CAUSE
A hearing must be held within seventy-two hours of the OPC to determine if there is probable
cause (“PC”) that Charlie is at risk and must remain in the hospital pending the outcome of the
final court ordered mental health hearing. 38 Charlie and his attorney shall receive written notice
stating he has been placed under a protective custody order, the grounds for the order, and the
time and place of the PC hearing. 39 The PC dockets are heard at HCPC on Mondays,
Wednesdays and Fridays. Charlie, through his attorney, can challenge any evidence alleging the
need for him to remain in the hospital. 40 But if the court signs the order for continued detention,
determining that he is at risk to cause harm to himself or others; he will stay in the hospital
pending the remaining proceedings. 41
30
31
32
33
34
35
36
37
38
39
40
41
TEX. HEALTH & SAFETY CODE ANN. § 573.022 (Vernon 2010).
TEX. HEALTH & SAFETY CODE ANN. § 573.012 (Vernon Supp. 2010).
TEX. HEALTH & SAFETY CODE ANN. § 573.025 (Vernon 2010).
Id. § 574.024.
Patients who hire their own attorney are less than 1% of the docket.
TEX. HEALTH & SAFETY CODE ANN. § 574.003 (Vernon 2010).
Id.
Id. § 574.001.
Id. § 574.025.
Id. § 574.024.
Id. § 574.025.
Id. § 574.026.
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Emergency Mental Health Care: How To Navigate In Harris County
VII.
COURT ORDERED MENTAL HEALTH SERVICES
If the physicians evaluating Charlie determine that he needs treatment; then an application for
court ordered mental health services will be filed by the county attorney’s office. 42 The law
requires that court ordered mental health services hearings (“final hearing”) will be held within
fourteen days of the filing of the application. 43 The court may grant one or more continuances
upon a good cause motion/agreement, but the continuances may not extend later than thirty days
from filing of the application. 44 Final hearings are heard at HCPC on Mondays and Fridays. At
the final hearing, Charlie has the right to notice, to be present, to be on the record and to be heard
by a jury. 45 However, most patients do not attend the final hearing and most hearings are bench
trials.
At the final hearing, upon reviewing the certificates of medical examination 46 and the oral
testimony of at least one physician, if the judge finds by clear and convincing evidence that
Charlie is mentally ill and is 1) likely to cause serious harm to himself to others or is suffering
severe and abnormal mental, emotional, or physical distress; 2) is experiencing deterioration in
the ability to function independently or to provide for basic needs; or 3) is unable to make a
rational and informed decision regarding treatment, then the judge will sign the order committing
Charlie for treatment. 47 Charlie will receive in-patient mental health treatment until the doctor
feels that Charlie is no longer a danger to himself or others. The mental health treatment may
include individual and/or group therapy and medication therapy.
VIII. FORCED MEDICATIONS
Psychotropic medications, imperative for improved mental status, are occasionally refused by the
patient. A guardian can consent for the hospital to require the administration of psychotropic
42
Id. § 574.001.
Id. § 574.005.
44
Id.
45
Id. §§ 574.006, 574.031, 574.032.
46
By the hearing, there must be on file at least two sworn certificates of medical examination for mental illness
completed by different physicians each of whom has examined Charlie during the preceding 30 days.
47
TEX. HEALTH & SAFETY CODE ANN. §§ 574.031, 574.034, 574.036 (Vernon 2010).
43
9
Emergency Mental Health Care: How To Navigate In Harris County
medications, without a court order. 48 If the patient is not under a guardianship then a separate
hearing following the final hearing must be held for the court to require a patient to take
psychotropic medications. 49 The medication hearings are typically heard immediately following
final hearings. 50 Charlie’s rights are the same as in the final hearing and the court will orally
notify him of the ruling. 51
In medication hearings the court will consider Charlie’s preferences, religious beliefs, and
perspective of the risks and benefits of taking the medication. 52 The court also considers
Charlie’s prognosis, the consequences with and without the medication and any lesser intrusive
treatments to psychotropic medications. 53 If the testimony and medical evidence show by clear
and convincing evidence that Charlie lacks the capacity to consent and it is in his best interest,
the court will sign an order allowing the facility to force the administration of psychotropic
medications. 54 Charlie will then receive in-patient treatment, not to exceed ninety days, until the
doctors believe he will not harm himself or others. 55 However, he does have the right to appeal
the final and forced medication hearing. 56
Keep in mind that the forced medication order does not follow Charlie upon discharge from the
hospital and is only applicable while the order of commitment is in effect. 57 So, once Charlie
has been treated and discharged, if he experiences another psychotic break, your client will have
to start the process all over again.
IX.
MENTAL HEALTH RECORDS
Charlie will not need to worry about friend, family or the general public knowing that he was
committed into a mental health facility. The court’s mental health file is a public record of a
48
49
50
51
52
53
54
55
56
57
Id. § 574.103.
Id. § 574.106.
Id.
Id. § 574.105.
Id. § 574.106.
Id.
Id.
Id. § 574.034.
Id. §§ 574.070 & 574.108.
TEX. HEALTH & SAFETY CODE ANN. § 574.110 (Vernon Supp. 2010).
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Emergency Mental Health Care: How To Navigate In Harris County
private nature. 58 This means that it is a sealed record and can only be released to the patient (or
the patient’s legal guardian) or other authorized persons, by court order. 59 The patient may give
written authorization for a third party to access those records, such as the patient’s attorney or
power of attorney holder, etc. 60 The law, however, does allow for the mental health records to
be released if the court finds it is justified and in the public’s best interest or if requested by law
enforcement. 61 The person must come to the court with proper identification and or written
authorization to request a copy of the records. Once the court signs the order allowing the
records to be released, the person must pick up the records IN PERSON at the county clerk’s
office. The clerk will not mail the records.
X.
COMMITMENT CONSEQUENCES
However, there are non-therapeutic state and federal consequences that result from being
involuntarily committed to a mental health facility. First, when a person is committed, the
county clerk is required to notify the Texas Department of Public Safety for forwarding to the
FBI NICS. 62 Second, once committed, the patient no longer has the right to own, possess or use
a firearm or to carry a concealed handgun license. 63 This is called a “firearm disability”. This
firearm disability can be lifted via a separate court hearing, however. 64 The hearing can be
requested only after the person has been released from the involuntary commitment and is
discharged from the hospital. 65 A request for relief of the firearm disability hearing is very rare
in Texas and to date has not occurred in Harris County. The involuntary commitment may also
affect a person’s employment if they work in a designated “secure area”, as defined by the
Transportation Security Administration. 66 Persons working in “secure areas” must have a
Transportation Worker Identification Credential (“TWIC”) card. 67 The professions affected
58
Id. § 571.015.
Id.
60
Id.
61
Id.
62
TEX. GOV’T CODE ANN. §§ 411.052, 411.0521 (Vernon 2012)
63
Id. § 411.172 & 18 U.S.C. § 922(g)(4).
64
TEX. HEALTH & SAFETY CODE ANN § 574.088 (Vernon 2010).
65
Id.
66
Karen Blomstrom, South Texas College of Law-Guardian Ad Litem Certification Course, “The Impact of
Mental Health Commitments on a Person’s TWIC Eligibility or Recertification”, September 19, 2012.
67
Id.
59
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Emergency Mental Health Care: How To Navigate In Harris County
include but are not limited to merchant mariners, port facility employees, long shore workers and
truck drivers. 68 A mental health commitment may disqualify a person to hold a Transportation
Worker Identification Credential (“TWIC”) card. 69 A TWIC card is governed by federal statute
that requires the TWIC card first time/renewal applicant to state whether they have been
involuntarily committed to a mental health facility. 70 If the person’s TWIC eligibility is denied,
he or she can ask for an appeal/waiver and will have to describe why they do not pose a security
threat. 71
XI.
CONCLUSION
Getting the mentally ill person quick, safe and consistent treatment is the key to keeping the
disease at an early stage. Now you are armed and ready with information on how to access help
for all of the Charlie’s out there. Godspeed, Charlie.
68
Id.
Id.
70
49 C.F.R. § 1572, et. seq.
71
Karen Blomstrom, South Texas College of Law-Guardian Ad Litem Certification Course, “The Impact of
Mental Health Commitments on a Person’s TWIC Eligibility or Recertification”, September 19, 2012.
69
12