A1099

An Act concerning involuntary commitment to treatment for substance use disorders, supplementing chapter 4 of Title 30 of the Revised Statutes, and amending P.L.1991, c.270 and P.L.1987, c.116.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. (New section) The Legislature finds and declares that:

a. Severe drug addiction, particularly from heroin and prescription opioid drugs, has taken a toll on the residents of the State; many have died as a result of addiction, and many other drug addicts pose a danger to themselves or to others; and

b. Many State residents who need treatment for their substance use disorders, which include opioid use disorder, often do not receive treatment. Mandating that persons, who are dangerous to themselves or others because of a substance use disorder, receive treatment in a residential substance use disorders treatment facility would help reduce the number of deaths in the State stemming from substance use disorders.

2. (New section) As used in sections 2 through 18 of P.L. , c. (C. )(pending before the Legislature as this bill):

"Chief executive officer" means the person who is the chief administrative officer of a residential substance use disorders treatment facility.

"Clinical alcohol and drug counselor" means a person who holds a license as a licensed clinical alcohol and drug counselor pursuant to section 4 or 16 of P.L.1997, c.331 (C.45:2D-4 or C.45:2D-16).

"Clinical certificate" means a form prepared by the division and approved by the Administrative Office of the Courts, that is completed by the psychiatrist or other physician who has examined the person who is subject to commitment, within three days of presenting the person for involuntary commitment to treatment for a substance use disorder pursuant to P.L. c, (C. ) (pending before the Legislature as this bill), and which states that the person is in need of involuntary commitment to treatment for a substance use disorder. The form shall also state the specific facts upon which the examining physician has based his conclusion and shall be certified in accordance with the Rules of the Court. A clinical certificate may not be executed by a person who is a relative by blood or marriage to the person who is being screened.

"Clinical director" means the person who is designated by the chief executive officer to organize and supervise clinical services for a substance use disorder provided in a screening service or residential substance use disorders treatment facility. The clinical director shall be a physician.

"Commissioner" means the Commissioner of Human Services.

"County adjuster" means the person appointed pursuant to R.S.30:4-34.

"County counsel" means the chief legal officer or advisor of the governing body of a county.

"Court" means the Superior Court or a municipal court.

"Custody" means the right and responsibility to ensure the provision of care and supervision.

"Dangerous to others or property" means that by reason of a substance use disorder there is a substantial likelihood that the person will inflict serious bodily harm upon another person or cause serious property damage within the reasonably foreseeable future. This determination shall take into account a person's history, recent behavior and any recent act, threat, or serious psychiatric deterioration.

"Dangerous to self" means that by reason of a substance use disorder the person has threatened or attempted suicide or serious bodily harm, or has behaved in such a manner as to indicate that the person is unable to satisfy his need for nourishment, essential medical care or shelter, so that it is probable that substantial bodily injury, serious physical harm, or death will result within the reasonably foreseeable future; however, no person shall be deemed to be unable to satisfy his need for nourishment, essential medical care, or shelter if he is able to satisfy those needs with the supervision and assistance of others who are willing and available. This determination shall take into account a person's history, recent behavior and any recent act, threat, or serious psychiatric deterioration.

"Department" means the Department of Human Services.

"Division" means the Division of Mental Health and Addiction Services in the Department of Human Services.

"In need of involuntary commitment to treatment for a substance use disorder" means that an adult with a substance use disorder, whose substance use disorder causes the person to be dangerous to self or dangerous to others or property and who is unwilling to accept appropriate treatment voluntarily after it has been offered, needs inpatient care at a residential substance use disorders treatment facility because other services are not appropriate or available to meet the person's substance use disorder treatment needs.

"Mental health screener" means a psychiatrist, psychologist, social worker, registered professional nurse, or other individual trained to do outreach only for the purposes of psychological or substance use disorder assessment, who is employed by a screening service and possesses the license, academic training or experience, as required by the commissioner pursuant to regulation; except that a psychiatrist and a State licensed clinical psychologist who meet the requirements for mental health screener shall not have to comply with any additional requirements adopted by the commissioner.

"Mental illness" means a current, substantial disturbance of thought, mood, perception or orientation which significantly impairs judgment, capacity to control behavior or capacity to recognize reality, but does not include simple alcohol intoxication, transitory reaction to drug ingestion, organic brain syndrome, or developmental disability, unless it results in the severity of impairment described herein. The term mental illness is not limited to "psychosis" or "active psychosis," but shall include all conditions that result in the severity of impairment described herein.

"Physician" means a person who is licensed to practice medicine in any one of the United States or its territories, or the District of Columbia.

"Psychiatrist" means a physician who has completed the training requirements of the American Board of Psychiatry and Neurology.

"Reasonably foreseeable future" means a time frame that may be beyond the immediate or imminent, but not longer than a time frame as to which reasonably certain judgments about a person's likely behavior can be reached.

"Residential substance use disorders treatment facility" means a facility licensed by the department or Department of Health, as applicable, to provide an array of substance use disorder treatment and recovery services, including medical services on site, in a residential setting to individuals with a substance use disorder.

"Screening certificate" means a clinical certificate executed by a psychiatrist or other physician affiliated with a screening service.

"Screening outreach visit" means an evaluation provided by a mental health screener wherever the person may be when clinically relevant information indicates the person may need involuntary commitment to treatment pursuant to P.L.1987, c.116, or P.L. , c. (C. )(pending before the Legislature as this bill) and is unable or unwilling to come to a screening service.

"Screening service" means a public or private ambulatory care service designated by the commissioner, which provides mental health and substance use disorder treatment services including assessment, emergency and referral services to persons with mental illness or a substance use disorder in a specified geographic area.

"Substance use disorder" means substance use disorder as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.

"Treatment team" means one or more persons, including at least one clinical alcohol and drug counselor, one psychiatrist or physician, and may include a psychologist, social worker, nurse, and other appropriate service providers. A treatment team provides services to a patient of a residential substance use disorders treatment facility.

"Voluntary admission" means that an adult with a substance use disorder, which causes the person to be dangerous to self or dangerous to others or property, is willing to be admitted to a residential substance use disorders treatment facility voluntarily for care, and needs care at the facility because other facilities or services are not appropriate or available to meet the person's treatment needs. A person may also be voluntarily admitted to a residential substance use disorders treatment facility if the person's substance use disorder presents a substantial likelihood of rapid deterioration in functioning in the near future, there are no appropriate community alternatives available, and the residential substance use disorders treatment facility can admit the person and remain within its rated capacity.

3. (New section) The standards and procedures set forth in P.L. , c. (C. ) (pending before the Legislature as this bill) shall apply to an adult involuntarily committed to treatment for a substance use disorder pursuant to P.L. , c. (pending before the Legislature as this bill) and an adult voluntarily admitted for treatment for a substance use disorder pursuant to P.L. , c. (pending before the Legislature as this bill) from a screening service to a residential substance use disorders treatment facility. The standards and procedures shall not apply to adults who are voluntarily admitted if admission to the residential substance use disorders treatment facility was not from a screening service, except as provided in section 13 or 18 of P.L. , c. (C. )(pending before the Legislature as this bill).

4. (New section) The commissioner shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) regarding a screening service and its staff that effectuate the following purposes and procedures:

a. A screening service shall serve as the facility wherein a person believed to be in need of involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. )(pending before the Legislature as this bill) undergoes an assessment to determine what substance use disorder services are appropriate for the person and where those services may be most appropriately provided.

The screening service may provide emergency and consensual treatment to the person receiving the assessment, and may transport the person or detain the person up to 24 hours for the purposes of providing the treatment and conducting the assessment.

b. When a person is assessed by a mental health screener, and involuntary commitment to treatment for a substance use disorder seems necessary, the screener shall provide, on a screening document prescribed by the division, information regarding the person's history and available alternative facilities and services that are deemed inappropriate for the person. When appropriate and available, and as permitted by law, the screener shall make reasonable efforts to gather information from the person's family or significant others for the purposes of preparing the screening document. If a psychiatrist, in consideration of this document and in conjunction with the psychiatrist's own complete assessment, concludes that the person is in need of commitment to treatment for a substance use disorder, the psychiatrist shall complete the screening certificate. The screening certificate shall be completed by a psychiatrist, except in those circumstances where the division's contract with the screening service provides that another physician may complete the certificate.

Upon completion of the screening certificate, screening service staff shall determine, in consultation with the psychiatrist or another physician, as appropriate, the appropriate treatment of the person, taking into account the person's prior history of hospitalization and treatment and the person's current condition.

If a person has been admitted three times or has been an inpatient for 30 days at a residential substance use disorders treatment facility during the preceding 12 months, consideration shall be given to placing the person in a residential substance use disorders treatment facility.

The person shall be admitted to the appropriate facility as soon as possible. Screening service staff are authorized to transport the person or arrange for transportation of the person to the appropriate facility.

c. If the mental health screener determines that the person is not in need of commitment to treatment for a substance use disorder, the screener shall refer the person to an appropriate facility licensed by the department to provide substance use disorder treatment on an outpatient basis.

d. A mental health screener shall make a screening outreach visit if the screener determines, based on clinically relevant information provided by an individual with personal knowledge of the person subject to screening, that the person may need involuntary commitment to treatment for a substance use disorder and the person is unwilling or unable to come to the screening service for an assessment.

e. If the mental health screener, pursuant to this assessment, determines that there is reasonable cause to believe that a person is in need of involuntary commitment to treatment for a substance use disorder, the screener shall so certify the need on a form prepared by the division.

f. If the mental health screener, pursuant to this assessment, determines that there is reasonable cause to believe that a person has a co-occurring mental illness, is in need of involuntary commitment to treatment pursuant to P.L.1987, c.116 (30:4-27.1 et seq.), and has a substance use disorder for which the person is also in need of involuntary commitment, the screener shall include this information on the form specified in subsection e. of this section.

5. (New section) A State or local law enforcement officer shall take custody of a person and take the person immediately and directly to a screening service if:

a. On the basis of personal observation, the law enforcement officer has reasonable cause to believe that the person is in need of involuntary commitment to treatment for a substance use disorder;

b. A mental health screener has certified on a form prescribed by the division that based on a screening outreach visit the person is in need of involuntary commitment to treatment for a substance use disorder and has requested the person be taken to the screening service for a complete assessment;

c. The court orders that a person subject to an order of conditional discharge issued pursuant to subsection c. of section 14 of P.L. , c. (C. ) (pending before the Legislature as this bill) who has failed to follow the conditions of the discharge be taken to a screening service for an assessment.

The involvement of the law enforcement authority shall continue at the screening service as long as necessary to protect the safety of the person in custody and the safety of the community from which the person was taken.

6. (New section) a. A law enforcement officer or screening service staff person, or their respective employer, acting in good faith pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill), who takes reasonable steps to assess, take custody of, detain, or transport an individual for the purposes of assessment or treatment of a substance use disorder is immune from civil and criminal liability.

b. An emergency services or medical transport person, or their respective employer, acting in good faith pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill) and pursuant to the direction of a person designated in subsection a. of this section, who takes reasonable steps to take custody of, detain, or transport an individual for the purposes of assessment or treatment of a substance use disorder is immune from civil and criminal liability.

For the purposes of this subsection, "emergency services or medical transport person" means a member of a first aid, ambulance, or rescue squad or a fire department, whether paid or volunteer, auxiliary police officer, or paramedic.

7. (New section) The commissioner shall designate one or more residential substance use disorders treatment facilities in each county or multi-county region in the State as designated residential substance use disorders treatment facilities. The commissioner shall so designate a facility only with the approval of the facility's governing body.

8. (New section) a. A residential substance use disorders treatment facility shall effectuate the following purposes and procedures:

(1) The chief executive officer of a residential substance use disorders treatment facility shall have custody of a person while that person is detained in the facility pursuant to P.L. , c. (C. )(pending before the Legislature as this bill), and shall notify:

(a) appropriate public or private agencies to arrange for the care of any dependents and to ensure the protection of the person's property; and

(b) appropriate facilities licensed by the department to provide substance use disorders treatment on an outpatient basis for the purposes of beginning discharge planning.

(2) If a person is admitted to a residential substance use disorders treatment facility, the chief executive officer of the facility shall promptly notify the county adjuster of the admitting county that the person has been admitted to the facility.

(3) The facility is authorized to provide assessment, treatment, and recovery services, and shall provide discharge planning services as required pursuant to section 17 of P.L. , c. (C. )(pending before the Legislature as this bill).

(4) The facility is authorized to detain persons involuntarily committed to the facility.

b. (1) A person shall not be involuntarily committed to treatment at a residential substance use disorders treatment facility unless the person is in need of involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. )(pending before the Legislature as this bill).

(2) The person shall be admitted involuntarily to a residential substance use disorders treatment facility only by referral from a screening service or by a temporary court order.

(3) The person may be admitted voluntarily to a residential substance use disorders treatment facility only after the person has been advised orally and in writing of the discharge provisions established pursuant to P.L. , c. (C. )(pending before the Legislature as this bill) and of the subsequent possibility that the facility may initiate involuntary commitment proceedings for the person.

c. A residential substance use disorders treatment facility may detain a person, admitted to the facility involuntarily by referral from a screening service without a temporary court order, for no more than 72 hours from the time the screening certificate was executed. During this period of time the facility shall initiate court proceedings for the involuntary commitment of the person pursuant to section 9 of P.L. , c. (C. ) (pending before the Legislature as this bill).

9. (New section) a. A residential substance use disorders treatment facility shall initiate court proceedings for involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill) by submitting to the court a clinical certificate completed by a psychiatrist on the patient's treatment team and the screening certificate which authorized admission of the patient to the facility; provided, however, that both certificates shall not be signed by the same psychiatrist, unless the psychiatrist has made a reasonable but unsuccessful attempt to have another psychiatrist conduct the evaluation and execute the certificate.

b. Court proceedings for the involuntary commitment to treatment for a substance use disorder of any person not referred by a screening service may be initiated by the submission to the court of two clinical certificates, at least one of which is prepared by a psychiatrist. The person shall not be involuntarily committed before the court issues a temporary court order.

c. Any person who is a relative by blood or marriage of the person being screened who executes a clinical certificate, or any person who signs a clinical certificate for any purpose or motive other than for purposes of care, treatment, and confinement of a person in need of involuntary commitment to treatment for a substance use disorder, shall be guilty of a crime of the fourth degree.

d. Upon receiving these documents, the court shall immediately review them in order to determine whether there is probable cause to believe that the person is in need of involuntary commitment to treatment for a substance use disorder.

e. If the court finds that there is probable cause to believe that the person is in need of involuntary commitment to treatment for a substance use disorder, it shall issue a temporary order authorizing the admission to or retention of the person in the custody of the residential substance use disorders treatment facility pending a final hearing.

f. If the court finds that there is probable cause to believe that a person is in need of involuntary commitment to treatment for a substance use disorder and has a co-occurring mental illness, the court shall include this information on a temporary order and issue the temporary order authorizing the admission to or retention of the person in a short-term care or psychiatric facility or a special psychiatric hospital pending a final hearing.

10. (New section) A patient admitted to a residential substance use disorders treatment facility, either on a voluntary or involuntary basis, shall have the following rights:

a. The right to have examinations and services provided in the patient's primary means of communication, including, as soon as possible, the aid of an interpreter if needed because the patient is of limited English-speaking ability or suffers from a speech or hearing impairment;

b. The right to a verbal explanation of the reasons for admission to the facility, the availability of an attorney, and the rights provided in P.L. , c. (C. )(pending before the Legislature as this bill); and

c. The right to be represented by an attorney and, if unrepresented or unable to afford an attorney, the right to be provided with an attorney paid for by the appropriate government agency. An attorney representing a patient has the right to inspect and copy the patient's clinical chart.

The clinical director of the residential substance use disorders treatment facility, or the director's designee, shall ensure that a written statement of the rights provided in P.L. c. (C. ) (pending before the Legislature as this bill) is provided to patients at the time of admission, or as soon as possible thereafter, and to patients and their families upon request.

11. (New section) a. A patient who is involuntarily committed to treatment for a substance use disorder pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill) shall receive a court hearing with respect to the issue of continued need for involuntary commitment within 20 days from initial commitment unless the patient has been administratively discharged pursuant to section 16 of P.L. , c. (C. ) (pending before the Legislature as this bill).

b. The assigned county counsel shall be responsible for presenting the case for the patient's involuntary commitment to the court, unless the county adjuster is licensed to practice law in this State, in which case the county adjuster shall present the case for the patient's involuntary commitment to the court.

c. A patient subject to involuntary commitment to treatment for a substance use disorder shall have counsel present at the hearing and shall not be permitted to appear at the hearing without counsel.

12. (New section) a. At least 10 days prior to a court hearing, the county adjuster of the admitting county shall cause notice of the court hearing to be served upon the patient, the patient's guardian if any, the patient's next-of-kin, the patient's attorney, the chief executive officer, or other individual who has custody of the patient, and any other individual specified by the court. The notice shall contain the date, time, and location of the court hearing. The patient and the patient's attorney shall also receive copies of the clinical certificates and supporting documents, the temporary court order, and a statement of the patient's rights at the court hearing.

b. A psychiatrist or physician on the patient's treatment team who has conducted a personal examination of the patient as close to the court hearing date as possible, but in no event more than five calendar days prior to the court hearing, shall testify at the hearing to the clinical basis for the need for involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill). Other members of the patient's treatment team, and any other witness with relevant information offered by the patient or the persons presenting the case for civil commitment, shall also be permitted to testify at the hearing.

c. The patient's next-of-kin may attend and testify at the court hearing if the court so determines.

d. The court shall transcribe the court hearing and arrange for the payment of expenses related thereto in the same manner as for other court proceedings.

13. (New section) A person subject to involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill) has the following rights at a court hearing and any subsequent review court hearing:

a. The right to be represented by counsel or, if indigent, by appointed counsel;

b. The right to be present at the court hearing, unless the court determines that because of the person's conduct at the court hearing the proceeding cannot reasonably continue while the person is present;

c. The right to present evidence;

d. The right to cross examine witnesses; and

e. The right to a hearing in camera.

14. (New section) a. (1) If the court finds by clear and convincing evidence that the patient needs continued involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill), it shall issue an order authorizing the involuntary commitment of the patient for a substance use disorder and shall schedule a subsequent court hearing in the event the patient is not administratively discharged pursuant to section 16 of P.L. , c. (C. ) (pending before the Legislature as this bill) prior thereto.

(2) If the court finds by clear and convincing evidence that the patient needs continued involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. )(pending before the Legislature as this bill) and has a co-occurring mental illness, it shall issue an order authorizing the involuntary commitment to treatment of the patient pursuant to P.L.1987, c.116 (C.30:4-27.1 et seq.) and shall schedule a subsequent court hearing in the event the patient is not administratively discharged pursuant to section 16 of P.L. , c. (C. ) (pending before the Legislature as this bill) prior thereto.

b. If the court finds that the patient does not need continued involuntary commitment to treatment for a substance use disorder, the court shall so order. A patient shall be discharged by the residential substance use disorders treatment facility within 48 hours of the court's verbal order or by the end of the next working day, whichever is longer, with a discharge plan prepared pursuant to section 17 of P.L. , c. (C. ) (pending before the Legislature as this bill).

c. (1) The court may discharge the patient subject to conditions, if the court finds that the person does not need involuntary or continued involuntary commitment to treatment for a substance use disorder and the court finds that:

(a) the patient's history indicates a high risk of repeated admissions to residential substance abuse treatment facilities because of the patient's failure to comply with discharge plans; or

(b) there is substantial likelihood that by reason of a substance use disorder the patient will be dangerous to self, others, or property if the patient does not receive other appropriate and available services that render involuntary commitment to treatment unnecessary.

(2) Conditions imposed pursuant to this section shall include those recommended by the residential substance use disorders treatment facility and a facility that is licensed by the department to provide substance use disorder treatment on an outpatient basis, as applicable, and developed with the participation of the patient. Conditions imposed on the patient shall be specific, and their duration shall not exceed 90 days.

(3) The designated staff person of a facility that is licensed by the department to provide substance use disorder treatment on an outpatient basis shall notify the court if the patient fails to meet the conditions of the discharge plan, and the court shall issue an order directing that the person be taken to a screening service for an assessment. The court shall determine, in conjunction with the findings of a screening service, if the patient needs to be readmitted to a residential substance use disorders treatment facility and, if so, the patient shall be returned to the facility. The court shall hold a hearing within 20 days of the day the patient was returned to the facility to determine if the order of conditional discharge should be vacated.

15. (New section) a. A patient committed pursuant to a court order, who is not administratively discharged pursuant to section 16 of P.L. , c. (C. ) (pending before the Legislature as this bill), shall be afforded periodic court review hearings of the need for involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (pending before the Legislature as this bill). The review hearing shall be conducted in the manner provided in section 14 of P.L. , c. (C. ) (pending before the Legislature as this bill). If the court determines at a review hearing that involuntary commitment to treatment for a substance use disorder shall be continued, it shall execute a new order.

The court shall conduct the first review hearing 30 days from the date of the first hearing, and every 30 days thereafter. The court may schedule additional review hearings but, except in extraordinary circumstances, not more often than once every 21 days.

b. At a court review hearing, when the advanced age of the patient or another factor by reason of a substance use disorder renders it appropriate and when it would be impractical to obtain the testimony of a psychiatrist as required in section 12 of P.L. , c. (C. ), the court may permit a physician on the patient's treatment team, who has personally conducted an examination of the patient as close to the hearing date as possible, but in no event more than five days prior to the hearing date, to testify at the hearing to the clinical basis for the need for involuntary commitment to treatment for a substance use disorder.

16. (New section) The treatment team at a residential substance use disorders treatment facility shall administratively discharge a patient from involuntary commitment status if the treatment team determines that the patient no longer needs involuntary commitment to treatment for a substance use disorder. If a discharge plan has not been developed pursuant to section 17 of P.L. , c. (C. )(pending before the Legislature as this bill), it shall be developed forthwith.

17. (New section) a. A person discharged either by the court or administratively from a residential substance use disorders treatment facility shall have a discharge plan developed by the treatment team at the facility pursuant to this section. The treatment team shall give the patient an opportunity to participate in the formulation of the discharge plan.

b. A facility licensed by the department to provide substance use disorder treatment on an outpatient basis, and which is designated by the department to participate in formulating the discharge plan, shall participate in formulating the plan. The residential substance use disorders treatment facility shall advise the designated facility which provides services on an outpatient basis of the date of the patient's discharge, and the designated facility shall provide follow-up care to the patient pursuant to regulations adopted by the commissioner.

c. This section shall not preclude discharging a patient to an appropriate professional.

d. The residential substance use disorders treatment facility shall give notice of the discharge to the county adjuster of the county in which the patient has legal settlement.

18. (New section) A voluntary patient at a residential substance use disorders treatment facility shall be discharged by the treatment team at the patient's request. The treatment team shall document all requests for discharge, whether oral or written, in the patient's clinical record. The facility shall discharge the patient as soon as possible but in every case within 48 hours or at the end of the next working day from the time of the request, whichever is longer; except that if the treatment team determines that the patient needs involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill), the treatment team shall initiate court proceedings pursuant to section 9 of P.L. , c. (C. ) (pending before the Legislature as this bill). The facility shall detain the patient beyond 48 hours or the end of the next working day from the time of the request for discharge only if the court has issued a temporary court order.

19. Section 1 of P.L.1991, c.270 (C.2A:62A-16) is amended to read as follows:

1. a. Any person who is licensed in the State of New Jersey to practice psychology, psychiatry, medicine, nursing, clinical social work or marriage counseling, whether or not compensation is received or expected, is immune from any civil liability for a patient's violent act against another person or against himself unless the practitioner has incurred a duty to warn and protect the potential victim as set forth in subsection b. of this section and fails to discharge that duty as set forth in subsection c. of this section.

b. A duty to warn and protect is incurred when the following conditions exist:

(1) The patient has communicated to that practitioner a threat of imminent, serious physical violence against a readily identifiable individual or against himself and the circumstances are such that a reasonable professional in the practitioner's area of expertise would believe the patient intended to carry out the threat; or

(2) The circumstances are such that a reasonable professional in the practitioner's area of expertise would believe the patient intended to carry out an act of imminent, serious physical violence against a readily identifiable individual or against himself.

c. A licensed practitioner of psychology, psychiatry, medicine, nursing, clinical social work or marriage counseling shall discharge the duty to warn and protect as set forth in subsection b. of this section by doing any one or more of the following:

(1) Arranging for the patient to be admitted voluntarily to a psychiatric unit of a general hospital, a short-term care facility, a special psychiatric hospital or a psychiatric facility, under the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.);

(2) Initiating procedures for involuntary commitment to treatment of the patient to an outpatient treatment provider, a short-term care facility, a special psychiatric hospital, or a psychiatric facility, under the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.), or to a residential substance use disorders treatment facility under the provisions of P.L. , c. (C. ) (pending before the Legislature as this bill);

(3) Advising a local law enforcement authority of the patient's threat and the identity of the intended victim;

(4) Warning the intended victim of the threat, or, in the case of an intended victim who is under the age of 18, warning the parent or guardian of the intended victim; or

(5) If the patient is under the age of 18 and threatens to commit suicide or bodily injury upon himself, warning the parent or guardian of the patient.

d. A practitioner who is licensed in the State of New Jersey to practice psychology, psychiatry, medicine, nursing, clinical social work or marriage counseling who, in complying with subsection c. of this section, discloses a privileged communication, is immune from civil liability in regard to that disclosure.

(cf: P.L.2009, c.112, s.21)

20. Section 2 of P.L.1987, c.116 (C.30:4-27.2) is amended to read as follows:

2. As used in P.L.1987, c.116 (C.30:4-27.1 et seq.) and P.L.2009, c.112:

a. "Chief executive officer" means the person who is the chief administrative officer of an institution or psychiatric facility.

b. "Clinical certificate" means a form prepared by the division and approved by the Administrative Office of the Courts, that is completed by the psychiatrist or other physician who has examined the person who is subject to commitment within three days of presenting the person for involuntary commitment to treatment, and which states that the person is in need of involuntary commitment to treatment. The form shall also state the specific facts upon which the examining physician has based his conclusion and shall be certified in accordance with the Rules of the Court. A clinical certificate may not be executed by a person who is a relative by blood or marriage to the person who is being screened.

c. "Clinical director" means the person who is designated by the director or chief executive officer to organize and supervise the clinical services provided in a screening service[,] or a short-term care or psychiatric facility. The clinical director shall be a psychiatrist[,]; however, those persons currently serving in the capacity [will] shall not be affected by this provision. This provision shall not alter any current civil service laws designating the qualifications of such position.

d. "Commissioner" means the Commissioner of Human Services.

e. "County counsel" means the chief legal officer or advisor of the governing body of a county.

f. "Court" means the Superior Court or a municipal court.

g. "Custody" means the right and responsibility to ensure the provision of care and supervision.

h. "Dangerous to self" means that by reason of mental illness the person has threatened or attempted suicide or serious bodily harm, or has behaved in such a manner as to indicate that the person is unable to satisfy his need for nourishment, essential medical care or shelter, so that it is probable that substantial bodily injury, serious physical harm or death will result within the reasonably foreseeable future; however, no person shall be deemed to be unable to satisfy his need for nourishment, essential medical care or shelter if he is able to satisfy such needs with the supervision and assistance of others who are willing and available. This determination shall take into account a person's history, recent behavior and any recent act, threat or serious psychiatric deterioration.

i. "Dangerous to others or property" means that by reason of mental illness there is a substantial likelihood that the person will inflict serious bodily harm upon another person or cause serious property damage within the reasonably foreseeable future. This determination shall take into account a person's history, recent behavior and any recent act, threat or serious psychiatric deterioration.

j. "Department" means the Department of Human Services.

k. "Director" means the chief administrative officer of a screening service, short-term care facility or special psychiatric hospital.

l. "Division" means the Division of Mental Health Services in the Department of Human Services.

m. "In need of involuntary commitment" or "in need of involuntary commitment to treatment" means that an adult with mental illness, whose mental illness causes the person to be dangerous to self or dangerous to others or property and who is unwilling to accept appropriate treatment voluntarily after it has been offered, needs outpatient treatment or inpatient care at a short-term care or psychiatric facility or special psychiatric hospital because other services are not appropriate or available to meet the person's mental health care needs.

n. "Institution" means any State or county facility providing inpatient care, supervision and treatment for persons with developmental disabilities; except that with respect to the maintenance provisions of Title 30 of the Revised Statutes, institution also means any psychiatric facility for the treatment of persons with mental illness.

o. "Mental health agency or facility" means a legal entity which receives funds from the State, county or federal government to provide mental health services.

p. "Mental health screener" means a psychiatrist, psychologist, social worker, registered professional nurse or other individual trained to do outreach only for the purposes of psychological or substance use disorder assessment who is employed by a screening service and possesses the license, academic training or experience, as required by the commissioner pursuant to regulation; except that a psychiatrist and a State licensed clinical psychologist who meet the requirements for mental health screener shall not have to comply with any additional requirements adopted by the commissioner.

q. "Mental hospital" means, for the purposes of the payment and maintenance provisions of Title 30 of the Revised Statutes, a psychiatric facility.

r. "Mental illness" means a current, substantial disturbance of thought, mood, perception or orientation which significantly impairs judgment, capacity to control behavior or capacity to recognize reality, but does not include simple alcohol intoxication, transitory reaction to drug ingestion, organic brain syndrome or developmental disability unless it results in the severity of impairment described herein. The term mental illness is not limited to "psychosis" or "active psychosis," but shall include all conditions that result in the severity of impairment described herein.

s. "Patient" means a person over the age of 18 who has been admitted to, but not discharged from a short-term care or psychiatric facility, or who has been assigned to, but not discharged from an outpatient treatment provider.

t. "Physician" means a person who is licensed to practice medicine in any one of the United States or its territories, or the District of Columbia.

u. "Psychiatric facility" means a State psychiatric hospital listed in R.S.30:1-7, a county psychiatric hospital, or a psychiatric unit of a county hospital.

v. "Psychiatrist" means a physician who has completed the training requirements of the American Board of Psychiatry and Neurology.

w. "Psychiatric unit of a general hospital" means an inpatient unit of a general hospital that restricts its services to the care and treatment of persons with mental illness who are admitted on a voluntary basis.

x. "Psychologist" means a person who is licensed as a psychologist by the New Jersey Board of Psychological Examiners.

y. "Screening certificate" means a clinical certificate executed by a psychiatrist or other physician affiliated with a screening service.

z. "Screening service" means a public or private ambulatory care service designated by the commissioner, which provides mental health and substance use disorder treatment services including assessment, emergency and referral services to persons with mental illness or a substance use disorder as defined in section 2 of P.L. , c. (C. )(pending before the Legislature as this bill) in a specified geographic area.

aa. "Screening outreach visit" means an evaluation provided by a mental health screener wherever the person may be when clinically relevant information indicates the person may need involuntary commitment to treatment pursuant to P.L.1987, c.116, or P.L. , c. (C. )(pending before the Legislature as this bill) and is unable or unwilling to come to a screening service.

bb. "Short-term care facility" means an inpatient, community based mental health treatment facility which provides acute care and assessment services to a person with mental illness whose mental illness causes the person to be dangerous to self or dangerous to others or property. A short-term care facility is so designated by the commissioner and is authorized by the commissioner to serve persons from a specified geographic area. A short-term care facility may be a part of a general hospital or other appropriate health care facility and shall meet certificate of need requirements and shall be licensed and inspected by the Department of Health [and Senior Services] pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) and in accordance with standards developed jointly with the Commissioner of Human Services.

cc. "Special psychiatric hospital" means a public or private hospital licensed by the Department of Health [and Senior Services] to provide voluntary and involuntary mental health services, including assessment, care, supervision, treatment and rehabilitation services to persons with mental illness.

dd. "Treatment team" means one or more persons, including at least one psychiatrist or physician, and may include a psychologist, social worker, nurse and other appropriate services providers. A treatment team provides mental health services to a patient of a screening service, outpatient treatment provider, or short-term care or psychiatric facility.

ee. "Voluntary admission" means that an adult with mental illness, whose mental illness causes the person to be dangerous to self or dangerous to others or property and is willing to be admitted to a facility voluntarily for care, needs care at a short-term care or psychiatric facility because other facilities or services are not appropriate or available to meet the person's mental health needs. A person may also be voluntarily admitted to a psychiatric facility if his mental illness presents a substantial likelihood of rapid deterioration in functioning in the near future, there are no appropriate community alternatives available and the psychiatric facility can admit the person and remain within its rated capacity.

ff. "County adjuster" means the person appointed pursuant to R.S.30:4-34.

gg. "Least restrictive environment" means the available setting and form of treatment that appropriately addresses a person's need for care and the need to respond to dangers to the person, others or property and respects, to the greatest extent practicable, the person's interests in freedom of movement and self-direction.

hh. "Outpatient treatment" means clinically appropriate care based on proven or promising treatments directed to wellness and recovery, provided by a member of the patient's treatment team to a person not in need of inpatient treatment. Outpatient treatment may include, but shall not be limited to, day treatment services, case management, residential services, outpatient counseling and psychotherapy, and medication treatment.

ii. "Outpatient treatment provider" means a community-based provider, designated as an outpatient treatment provider pursuant to section 8 of P.L.1987, c.116 (C.30:4-27.8), that provides or coordinates the provision of outpatient treatment to persons in need of involuntary commitment to treatment.

jj. "Plan of outpatient treatment" means a plan for recovery from mental illness approved by a court pursuant to section 17 of P.L.2009, c.112 (C.30:4-27.15a) that is to be carried out in an outpatient setting and is prepared by an outpatient treatment provider for a patient who has a history of responding to treatment. The plan may include medication as a component of the plan; however, medication shall not be involuntarily administered in an outpatient setting.

kk. "Reasonably foreseeable future" means a time frame that may be beyond the immediate or imminent, but not longer than a time frame as to which reasonably certain judgments about a person's likely behavior can be reached.

(cf: P.L.2009, c.112, s.2.)

21. Section 4 of P.L.1987, c.116 (C.30:4-27.4) is amended to read as follows:

4. The commissioner, in consultation with the appropriate county mental health board and consistent with the approved county mental health plan, shall designate one or more mental health agencies or facilities in each county or multi-county region in the State as a screening service. The commissioner shall so designate an agency or facility only with the approval of the agency's or facility's governing body. In designating the screening services, the commissioner shall ensure that screening services are accessible to all persons in the State who need these services [and], that screening service evaluation is available for persons who may be in need of involuntary commitment to treatment for a substance use disorder pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill), and that screening service evaluation is the preferred process for entry into outpatient treatment, short-term care facilities [or], psychiatric facilities, or residential substance use disorder treatment facilities so that appropriate consideration is given to less restrictive treatment alternatives.

(cf: P.L.2009, c.112, s.4)

22. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulation necessary to effectuate the purposes of this act.

23. This act shall take effect one year after the date of enactment, but the Commissioner of Human Services may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of the act.

STATEMENT

This bill provides for involuntary commitment to treatment for a substance use disorder at residential substance use disorders treatment facilities, under the same standards provided in P.L.1987, c.116 (C.30:4-27.1 et seq.) for persons who are in need of involuntary commitment because of a mental illness. Applying this standard, the bill would provide for involuntary commitment to a residential substance use disorders treatment facility if a person has a substance use disorder that causes the person to be dangerous to self, others, or property in the reasonably foreseeable future, is unwilling to accept appropriate treatment voluntarily after it has been offered, and needs care at the facility because other services are not appropriate or available to meet the person's treatment needs.

The bill defines the term "substance use disorder" as it is defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. The term includes, but is not limited to, alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, and stimulants.

The bill expands the current law concerning mental health screening services to provide for these services to offer assessments to determine which services for substance use disorders are appropriate for a person and where those services may be most appropriately provided. The screening services are to provide emergency and consensual treatment to the person receiving the assessment, and may transport or detain the person up to 24 hours for providing the treatment and assessment. Screeners are to gather information about the person's history and available services for a person with a substance use disorder. If a psychiatrist concludes that the person is in need of involuntary commitment to treatment for a substance use disorder, the psychiatrist completes a "screening certificate," which is one of the documents needed to submit to a court to initiate court proceedings for involuntary commitment. Screeners are also permitted to make "screening outreach visits" if, based on clinically relevant information, the person may need involuntary commitment but is unwilling to come to the screening service for assessment.

Additionally, law enforcement officers are authorized to take custody of, and bring a person to, a screening service based on criteria enumerated in the bill. The officers, screening service staff, and their employers are provided with immunity from civil and criminal liability.

The bill provides the same procedural protections available under current law governing involuntary commitment for a mental illness. A person may be involuntarily admitted to a residential substance use disorders treatment facility only by referral from a screening service or by temporary court order. The facility may detain involuntarily admitted persons by referral from a screening service, without a court order, for no more than 72 hours from when the screening certificate was executed. Court proceedings for involuntary commitment are initiated by submitting to the court the screening certificate and a "clinical certificate," which is to be executed by a psychiatrist on the patient's treatment team.

If not referred by a screening service, involuntary commitment may be initiated by submitting two clinical certificates, at least one of which is prepared by a psychiatrist. A person who is a relative, or any other person who signs a clinical certificate for a motive other than care, treatment, and confinement of the person would be guilty of a crime of the fourth degree.

The bill provides certain patient rights which include: having examinations provided in the primary means of communication of the person or the aid of an interpreter; receiving verbal explanations of the reason for admission; and the right to be represented by an attorney.

Within 20 days of initial commitment, the person is entitled to a court hearing, which is to be transcribed. At this hearing, if the court finds by clear and convincing evidence that the patient needs continued involuntary commitment to treatment for a substance use disorder, it is to issue an order authorizing the commitment.

Additionally, if the court finds by clear and convincing evidence that the patient needs continued involuntary commitment to treatment for a substance use disorder and has a co-occurring mental illness, the court is to issue an order authorizing the involuntary commitment of the patient pursuant to the law governing civil commitment for mental illness.

If the court finds the patient does not need continued involuntary commitment, the court would so order and a patient is to be discharged, with a discharge plan, within 48 hours of the court's verbal order or by the end of the next working day.

At least 10 days prior to a hearing, notice is to be provided to the patient, the patient's guardian if any, the patient's next-of-kin, the patient's attorney, the chief executive officer or other individual who has custody of the patient, and any other individual specified by the court.

A committed patient is to be provided with periodic court reviews of the need for involuntary commitment. The court is to conduct the first review hearing 30 days from the date of the first hearing, and every 30 days thereafter. Additional review hearings may be scheduled but, except in extraordinary circumstances, not more often than once every 21 days.

The bill also provides for administrative and conditional discharges from commitment. A treatment team at a residential substance use disorders treatment facility is to administratively discharge a patient if the team determines the patient no longer needs commitment. A discharge plan is to be developed, and the patient is to have the opportunity to participate in its development. A facility licensed to provide substance use disorder treatment on an outpatient basis is also designated to participate in developing the plan, and the designated facility is to provide follow-up care to the patient.

Lastly, the court may discharge a patient subject to conditions if the court finds that: the patient's history indicates a high risk of repeated admissions due to failure to comply with discharge plans; or there is a substantial likelihood that by reason of a substance use disorder the patient will be dangerous to self, others, or property if the patient does not receive other services that render involuntary commitment to treatment unnecessary.