Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 39 (2019GS)

Sponsor

Sen. Fillmore, L.

Final action

Governor Signed 3/25/2019

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• defines "assisted outpatient treatment";
• describes the services provided to an individual receiving assisted outpatient treatment;
• describes the process whereby an individual is court ordered to receive assisted outpatient treatment;
• requires a designated examiner to consider assisted outpatient treatment when evaluating a proposed patient for civil commitment; and
• makes technical changes.

Every vote on this bill

Bill text

ASSISTED OUTPATIENT TREATMENT FOR MENTAL
ILLNESS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Lincoln Fillmore
House Sponsor: 
Steve Eliason
LONG TITLE
General Description:
This bill creates a process for the provision of assisted outpatient treatment for an
individual with mental illness.
Highlighted Provisions:
This bill:
▸ defines "assisted outpatient treatment";
▸ describes the services provided to an individual receiving assisted outpatient
treatment;
▸ describes the process whereby an individual is court ordered to receive assisted
outpatient treatment;
▸ requires a designated examiner to consider assisted outpatient treatment when
evaluating a proposed patient for civil commitment; and
▸ makes technical changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
17-43-301
, as last amended by Laws of Utah 2018, Chapters 68 and 407
62A-15-602
, as last amended by Laws of Utah 2018, Chapter 322
62A-15-618
, as renumbered and amended by Laws of Utah 2002, Fifth Special Session,
Chapter 8
62A-15-631
, as last amended by Laws of Utah 2018, Chapter 322
62A-15-703
, as last amended by Laws of Utah 2018, Chapter 322
ENACTS:
31A-22-650
, Utah Code Annotated 1953
62A-15-630.4
, Utah Code Annotated 1953
62A-15-630.5
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
17-43-301
 is amended to read:
17-43-301.
Local mental health authorities -- Responsibilities.
(1) As used in this section:
(a) "Assisted outpatient treatment" means the same as that term is defined in Section
62A-15-602
.
[
(a)
] 
(b)
 "Crisis worker" means the same as that term is defined in Section
62A-15-1301
.
[
(b)
] 
(c)
 "Local mental health crisis line" means the same as that term is defined in
Section 
63C-18-102
.
[
(c)
] 
(d)
 "Mental health therapist" means the same as that term is defined in Section
58-60-102
.
[
(d)
] 
(e)
 "Public funds" means the same as that term is defined in Section 
17-43-303
.
[
(e)
] 
(f)
 "Statewide mental health crisis line" means the same as that term is defined in
Section 
63C-18-102
.
(2) (a) (i) In each county operating under a county executive-council form of
government under Section 
17-52a-203
, the county legislative body is the local mental health
authority, provided however that any contract for plan services shall be administered by the
county executive.
(ii) In each county operating under a council-manager form of government under
Section 
17-52a-204
, the county manager is the local mental health authority.
(iii) In each county other than a county described in Subsection (2)(a)(i) or (ii), the
county legislative body is the local mental health authority.
(b) Within legislative appropriations and county matching funds required by this
section, under the direction of the division, each local mental health authority shall:
(i) provide mental health services to [
persons
] 
individuals
 within the county; and
(ii) cooperate with efforts of the Division of Substance Abuse and Mental Health to
promote integrated programs that address an individual's substance abuse, mental health, and
physical healthcare needs, as described in Section 
62A-15-103
.
(c) Within legislative appropriations and county matching funds required by this
section, each local mental health authority shall cooperate with the efforts of the Department of
Human Services to promote a system of care, as defined in Section 
62A-1-104
, for minors with
or at risk for complex emotional and behavioral needs, as described in Section 
62A-1-111
.
(3) (a) By executing an interlocal agreement under Title 11, Chapter 13, Interlocal
Cooperation Act, two or more counties may join to:
(i) provide mental health prevention and treatment services; or
(ii) create a united local health department that combines substance abuse treatment
services, mental health services, and local health department services in accordance with
Subsection (4).
(b) The legislative bodies of counties joining to provide services may establish
acceptable ways of apportioning the cost of mental health services.
(c) Each agreement for joint mental health services shall:
(i) (A) designate the treasurer of one of the participating counties or another person as
the treasurer for the combined mental health authorities and as the custodian of money
available for the joint services; and
(B) provide that the designated treasurer, or other disbursing officer authorized by the
treasurer, may make payments from the money available for the joint services upon audit of the
appropriate auditing officer or officers representing the participating counties;
(ii) provide for the appointment of an independent auditor or a county auditor of one of
the participating counties as the designated auditing officer for the combined mental health
authorities;
(iii) (A) provide for the appointment of the county or district attorney of one of the
participating counties as the designated legal officer for the combined mental health
authorities; and
(B) authorize the designated legal officer to request and receive the assistance of the
county or district attorneys of the other participating counties in defending or prosecuting
actions within their counties relating to the combined mental health authorities; and
(iv) provide for the adoption of management, clinical, financial, procurement,
personnel, and administrative policies as already established by one of the participating
counties or as approved by the legislative body of each participating county or interlocal board.
(d) An agreement for joint mental health services may provide for:
(i) joint operation of services and facilities or for operation of services and facilities
under contract by one participating local mental health authority for other participating local
mental health authorities; and
(ii) allocation of appointments of members of the mental health advisory council
between or among participating counties.
(4) A county governing body may elect to combine the local mental health authority
with the local substance abuse authority created in Part 2, Local Substance Abuse Authorities,
and the local health department created in Title 26A, Chapter 1, Part 1, Local Health
Department Act, to create a united local health department under Section 
26A-1-105.5
. A local
mental health authority that joins with a united local health department shall comply with this
part.
(5) (a) Each local mental health authority is accountable to the department, the
Department of Health, and the state with regard to the use of state and federal funds received
from those departments for mental health services, regardless of whether the services are
provided by a private contract provider.
(b) Each local mental health authority shall comply, and require compliance by its
contract provider, with all directives issued by the department and the Department of Health
regarding the use and expenditure of state and federal funds received from those departments
for the purpose of providing mental health programs and services. The department and
Department of Health shall ensure that those directives are not duplicative or conflicting, and
shall consult and coordinate with local mental health authorities with regard to programs and
services.
(6) (a) Each local mental health authority shall:
(i) review and evaluate mental health needs and services, including mental health needs
and services for [
persons
]
:
(A) an individual
 incarcerated in a county jail or other county correctional facility; 
and
(B) an individual who is a resident of the county and who is court ordered to receive
assisted outpatient treatment under Section 
62A-15-630.5
;
(ii) in accordance with Subsection (6)(b), annually prepare and submit to the division a
plan approved by the county legislative body for mental health funding and service delivery,
either directly by the local mental health authority or by contract;
(iii) establish and maintain, either directly or by contract, programs licensed under Title
62A, Chapter 2, Licensure of Programs and Facilities;
(iv) appoint, directly or by contract, a full-time or part-time director for mental health
programs and prescribe the director's duties;
(v) provide input and comment on new and revised rules established by the division;
(vi) establish and require contract providers to establish administrative, clinical,
personnel, financial, procurement, and management policies regarding mental health services
and facilities, in accordance with the rules of the division, and state and federal law;
(vii) establish mechanisms allowing for direct citizen input;
(viii) annually contract with the division to provide mental health programs and
services in accordance with the provisions of Title 62A, Chapter 15, Substance Abuse and
Mental Health Act;
(ix) comply with all applicable state and federal statutes, policies, audit requirements,
contract requirements, and any directives resulting from those audits and contract requirements;
(x) provide funding equal to at least 20% of the state funds that it receives to fund
services described in the plan;
(xi) comply with the requirements and procedures of Title 11, Chapter 13, Interlocal
Cooperation Act, Title 17B, Chapter 1, Part 6, Fiscal Procedures for Local Districts, and Title
51, Chapter 2a, Accounting Reports from Political Subdivisions, Interlocal Organizations, and
Other Local Entities Act; and
(xii) take and retain physical custody of minors committed to the physical custody of
local mental health authorities by a judicial proceeding under Title 62A, Chapter 15, Part 7,
Commitment of Persons Under Age 18 to Division of Substance Abuse and Mental Health.
(b) Each plan under Subsection (6)(a)(ii) shall include services for adults, youth, and
children, which shall include:
(i) inpatient care and services;
(ii) residential care and services;
(iii) outpatient care and services;
(iv) 24-hour crisis care and services;
(v) psychotropic medication management;
(vi) psychosocial rehabilitation, including vocational training and skills development;
(vii) case management;
(viii) community supports, including in-home services, housing, family support
services, and respite services;
(ix) consultation and education services, including case consultation, collaboration
with other county service agencies, public education, and public information; and
(x) services to persons incarcerated in a county jail or other county correctional facility.
(7) (a) If a local mental health authority provides for a local mental health crisis line
under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the local
mental health authority shall:
(i) collaborate with the statewide mental health crisis line described in Section
62A-15-1302
;
(ii) ensure that each individual who answers calls to the local mental health crisis line:
(A) is a mental health therapist or a crisis worker; and
(B) meets the standards of care and practice established by the Division of Substance
Abuse and Mental Health, in accordance with Section 
62A-15-1302
; and
(iii) ensure that when necessary, based on the local mental health crisis line's capacity,
calls are immediately routed to the statewide mental health crisis line to ensure that when an
individual calls the local mental health crisis line, regardless of the time, date, or number of
individuals trying to simultaneously access the local mental health crisis line, a mental health
therapist or a crisis worker answers the call without the caller first:
(A) waiting on hold; or
(B) being screened by an individual other than a mental health therapist or crisis
worker.
(b) If a local mental health authority does not provide for a local mental health crisis
line under the plan for 24-hour crisis care and services described in Subsection (6)(b)(iv), the
local mental health authority shall use the statewide mental health crisis line as a local crisis
line resource.
(8) Before disbursing any public funds, each local mental health authority shall require
that each entity that receives any public funds from a local mental health authority agrees in
writing that:
(a) the entity's financial records and other records relevant to the entity's performance
of the services provided to the mental health authority shall be subject to examination by:
(i) the division;
(ii) the local mental health authority director;
(iii) (A) the county treasurer and county or district attorney; or
(B) if two or more counties jointly provide mental health services under an agreement
under Subsection (3), the designated treasurer and the designated legal officer;
(iv) the county legislative body; and
(v) in a county with a county executive that is separate from the county legislative
body, the county executive;
(b) the county auditor may examine and audit the entity's financial and other records
relevant to the entity's performance of the services provided to the local mental health
authority; and
(c) the entity will comply with the provisions of Subsection (5)(b).
(9) A local mental health authority may receive property, grants, gifts, supplies,
materials, contributions, and any benefit derived therefrom, for mental health services. If those
gifts are conditioned upon their use for a specified service or program, they shall be so used.
(10) Public funds received for the provision of services pursuant to the local mental
health plan may not be used for any other purpose except those authorized in the contract
between the local mental health authority and the provider for the provision of plan services.
(11) A local mental health authority shall provide assisted outpatient treatment
services, as described in Section 
62A-15-630.4
, to a resident of the county who has been
ordered under Section 
62A-15-630.5
 to receive assisted outpatient treatment.
Section 2. Section 
31A-22-650
 is enacted to read:
 31A-22-650.
 Insurance coverage for assisted outpatient treatment.
(1) As used in this section, "assisted outpatient treatment" means the same as that term
is defined in Section 
62A-15-602
.
(2) A health insurance provider may not deny an insured the benefits of the insured's
policy solely because the health care that the insured receives is provided under a court order
for assisted outpatient treatment, as provided in Section 
62A-15-630.5
.
Section 3. Section 
62A-15-602
 is amended to read:
62A-15-602.
Definitions.
As used in this part, Part 7, Commitment of Persons Under Age 18 to Division of
Substance Abuse and Mental Health, Part 8, Interstate Compact on Mental Health, Part 9, Utah
Forensic Mental Health Facility, Part 10, Declaration for Mental Health Treatment, and Part
12, Essential Treatment and Intervention Act:
(1) "Adult" means an individual 18 years of age or older.
(2) "Approved treatment facility or program" means a treatment provider that meets the
standards described in Subsection 
62A-15-103
(2)(a)(v).
(3) "Assisted outpatient treatment" means involuntary outpatient mental health
treatment ordered under Section 
62A-15-630.5
.
[
(3)
] 
(4)
 "Commitment to the custody of a local mental health authority" means that an
adult is committed to the custody of the local mental health authority that governs the mental
health catchment area where the adult resides or is found.
[
(4)
] 
(5)
 "Community mental health center" means an entity that provides treatment
and services to a resident of a designated geographical area, that operates by or under contract
with a local mental health authority, and that complies with state standards for community
mental health centers.
[
(5)
] 
(6)
 "Designated examiner" means:
(a) a licensed physician, preferably a psychiatrist, who is designated by the division as
specially qualified by training or experience in the diagnosis of mental or related illness; or
(b) a licensed mental health professional designated by the division as specially
qualified by training and who has at least five years' continual experience in the treatment of
mental illness.
[
(6)
] 
(7)
 "Designee" means a physician who has responsibility for medical functions
including admission and discharge, an employee of a local mental health authority, or an
employee of a person that has contracted with a local mental health authority to provide mental
health services under Section 
17-43-304
.
[
(7)
] 
(8)
 "Essential treatment" and "essential treatment and intervention" mean
court-ordered treatment at a local substance abuse authority or an approved treatment facility or
program for the treatment of an adult's substance use disorder.
[
(8)
] 
(9)
 "Harmful sexual conduct" means the following conduct upon an individual
without the individual's consent, including the nonconsensual circumstances described in
Subsections 
76-5-406
(1) through (12):
(a) sexual intercourse;
(b) penetration, however slight, of the genital or anal opening of the individual;
(c) any sexual act involving the genitals or anus of the actor or the individual and the
mouth or anus of either individual, regardless of the gender of either participant; or
(d) any sexual act causing substantial emotional injury or bodily pain.
[
(9)
] 
(10)
 "Institution" means a hospital or a health facility licensed under
 Section
26-21-8
.
[
(10)
] 
(11)
 "Local substance abuse authority" means the same as that term is defined in
Section 
62A-15-102
 and described in Section 
17-43-201
.
[
(11)
] 
(12)
 "Mental health facility" means the Utah State Hospital or other facility that
provides mental health services under contract with the division, a local mental health
authority, a person that contracts with a local mental health authority, or a person that provides
acute inpatient psychiatric services to a patient.
[
(12)
] 
(13)
 "Mental health officer" means an individual who is designated by a local
mental health authority as qualified by training and experience in the recognition and
identification of mental illness, to:
(a) apply for and provide certification for a temporary commitment; or
(b) assist in the arrangement of transportation to a designated mental health facility.
[
(13)
] 
(14)
 "Mental illness" means:
(a) a psychiatric disorder that substantially impairs an individual's mental, emotional,
behavioral, or related functioning; or
(b) the same as that term is defined in:
(i) the current edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association; or
(ii) the current edition of the International Statistical Classification of Diseases and
Related Health Problems.
[
(14)
] 
(15)
 "Patient" means an individual who is:
(a) under commitment to the custody or to the treatment services of a local mental
health authority; or
(b) undergoing essential treatment and intervention.
[
(15)
] 
(16)
 "Physician" means an individual who is:
(a) licensed as a physician under Title 58, Chapter 67, Utah Medical Practice Act; or
(b) licensed as a physician under Title 58, Chapter 68, Utah Osteopathic Medical
Practice Act.
[
(16)
] 
(17)
 "Serious bodily injury" means bodily injury that involves a substantial risk
of death, unconsciousness, extreme physical pain, protracted and obvious disfigurement, or
protracted loss or impairment of the function of a bodily member, organ, or mental faculty.
[
(17)
] 
(18)
 "Substantial danger" means that due to mental illness, an individual is at
serious risk of:
(a) suicide;
(b) serious bodily self-injury;
(c) serious bodily injury because the individual is incapable of providing the basic
necessities of life, including food, clothing, or shelter;
(d) causing or attempting to cause serious bodily injury to another individual; or
(e) engaging in harmful sexual conduct.
[
(18)
] 
(19)
 "Treatment" means psychotherapy, medication, including the administration
of psychotropic medication, or other medical treatments that are generally accepted medical or
psychosocial interventions for the purpose of restoring the patient to an optimal level of
functioning in the least restrictive environment.
Section 4. Section 
62A-15-618
 is amended to read:
62A-15-618.
Designated examiners.
(1) A designated examiner, when evaluating a proposed patient for civil commitment,
shall consider whether:
(a) a proposed patient has been under a court order for assisted outpatient treatment;
(b) the proposed patient complied with the terms of the assisted outpatient treatment
order, if any; and
(c) whether assisted outpatient treatment is sufficient to meet the proposed patient's
needs.
(2)
 Designated examiners shall be allowed a reasonable fee by the county legislative
body of the county in which the proposed patient resides or is found, unless they are otherwise
paid.
Section 5. Section 
62A-15-630.4
 is enacted to read:
 62A-15-630.4.
Assisted outpatient treatment services.
(1) The local mental health authority or its designee shall provide assisted outpatient
treatment, which shall include:
(a) case management; and
(b) an individualized treatment plan, created with input from the proposed patient
when possible.
(2) A court order for assisted outpatient treatment does not create independent
authority to forcibly medicate a patient.
Section 6. Section 
62A-15-630.5
 is enacted to read:
 62A-15-630.5.
Assisted outpatient treatment proceedings.
(1) A responsible individual who has credible knowledge of an adult's mental illness
and the condition or circumstances that have led to the adult's need for assisted outpatient
treatment may file, in the district court in the county where the proposed patient resides or is
found, a written application that includes:
(a) unless the court finds that the information is not reasonably available, the proposed
patient's:
(i) name;
(ii) date of birth; and
(iii) social security number; and
(b) (i) a certificate of a licensed physician or a designated examiner stating that within
the seven-day period immediately preceding the certification, the physician or designated
examiner examined the proposed patient and is of the opinion that the proposed patient has a
mental illness and should be involuntarily committed; or
(ii) a written statement by the applicant that:
(A) the proposed patient has been requested to, but has refused to, submit to an
examination of mental condition by a licensed physician or designated examiner;
(B) is sworn to under oath; and
(C) states the facts upon which the application is based.
(2) (a) Subject to Subsection (2)(b), before issuing a judicial order, the court may
require the applicant to consult with the appropriate local mental health authority, and the court
may direct a mental health professional from that local mental health authority to interview the
applicant and the proposed patient to determine the existing facts and report them to the court.
(b) The consultation described in Subsection (2)(a):
(i) may take place at or before the hearing; and
(ii) is required if the local mental health authority appears at the hearing.
(3) If the proposed patient refuses to submit to an interview described in Subsection
(2)(a) or an examination described in Subsection (8), the court may issue an order, directed to a
mental health officer or peace officer, to immediately place the proposed patient into the
custody of a local mental health authority or in a temporary emergency facility, as provided in
Section 
62A-15-634
, to be detained for the purpose of examination.
(4) Notice of commencement of proceedings for assisted outpatient treatment, setting
forth the allegations of the application and any reported facts, together with a copy of any
official order of detention, shall:
(a) be provided by the court to a proposed patient before, or upon, placement into the
custody of a local mental health authority or, with respect to any proposed patient presently in
the custody of a local mental health authority;
(b) be maintained at the proposed patient's place of detention, if any;
(c) be provided by the court as soon as practicable to the applicant, any legal guardian,
any immediate adult family members, legal counsel for the parties involved, the local mental
health authority or its designee, and any other person whom the proposed patient or the court
shall designate; and
(d) advise that a hearing may be held within the time provided by law.
(5) The district court may, in its discretion, transfer the case to any other district court
within this state, provided that the transfer will not be adverse to the interest of the proposed
patient.
(6) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
of a judicial order, or after commitment of a proposed patient to a local mental health authority
or its designee under court order for detention in order to complete an examination, the court
shall appoint two designated examiners:
(a) who did not sign the assisted outpatient treatment application nor the certification
described in Subsection (1);
(b) one of whom is a licensed physician; and
(c) one of whom may be designated by the proposed patient or the proposed patient's
counsel, if that designated examiner is reasonably available.
(7) The court shall schedule a hearing to be held within 10 calendar days of the day on
which the designated examiners are appointed.
(8) The designated examiners shall:
(a) conduct their examinations separately;
(b) conduct the examinations at the home of the proposed patient, at a hospital or other
medical facility, or at any other suitable place that is not likely to have a harmful effect on the
proposed patient's health;
(c) inform the proposed patient, if not represented by an attorney:
(i) that the proposed patient does not have to say anything;
(ii) of the nature and reasons for the examination;
(iii) that the examination was ordered by the court;
(iv) that any information volunteered could form part of the basis for the proposed
patient to be ordered to receive assisted outpatient treatment; and
(v) that findings resulting from the examination will be made available to the court;
and
(d) within 24 hours of examining the proposed patient, report to the court, orally or in
writing, whether the proposed patient is mentally ill. If the designated examiner reports orally,
the designated examiner shall immediately send a written report to the clerk of the court.
(9) If a designated examiner is unable to complete an examination on the first attempt
because the proposed patient refuses to submit to the examination, the court shall fix a
reasonable compensation to be paid to the examiner.
(10) If the local mental health authority, its designee, or a medical examiner determines
before the court hearing that the conditions justifying the findings leading to an assisted
outpatient treatment hearing no longer exist, the local mental health authority, its designee, or
the medical examiner shall immediately report that determination to the court.
(11) The court may terminate the proceedings and dismiss the application at any time,
including prior to the hearing, if the designated examiners or the local mental health authority
or its designee informs the court that the proposed patient is not mentally ill.
(12) Before the hearing, an opportunity to be represented by counsel shall be afforded
to the proposed patient, and if neither the proposed patient nor others provide counsel, the court
shall appoint counsel and allow counsel sufficient time to consult with the proposed patient
before the hearing. In the case of an indigent proposed patient, the payment of reasonable
attorney fees for counsel, as determined by the court, shall be made by the county in which the
proposed patient resides or is found.
(13) (a) All persons to whom notice is required to be given shall be afforded an
opportunity to appear at the hearing, to testify, and to present and cross-examine witnesses. The
court may, in its discretion, receive the testimony of any other individual. The court may allow
a waiver of the proposed patient's right to appear only for good cause shown, and that cause
shall be made a matter of court record.
(b) The court is authorized to exclude all individuals not necessary for the conduct of
the proceedings and may, upon motion of counsel, require the testimony of each examiner to be
given out of the presence of any other examiners.
(c) The hearing shall be conducted in as informal a manner as may be consistent with
orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
mental health of the proposed patient.
(d) The court shall consider all relevant historical and material information that is
offered, subject to the rules of evidence, including reliable hearsay under Rule 1102, Utah
Rules of Evidence.
(e) (i) A local mental health authority or its designee, or the physician in charge of the
proposed patient's care shall, at the time of the hearing, provide the court with the following
information:
(A) the detention order, if any;
(B) admission notes, if any;
(C) the diagnosis, if any;
(D) doctor's orders, if any;
(E) progress notes, if any;
(F) nursing notes, if any; and
(G) medication records, if any.
(ii) The information described in Subsection (13)(e)(i) shall also be provided to the
proposed patient's counsel:
(A) at the time of the hearing; and
(B) at any time prior to the hearing, upon request.
(14) The court shall order a proposed patient to assisted outpatient treatment if, upon
completion of the hearing and consideration of the information presented, the court finds by
clear and convincing evidence that:
(a) the proposed patient has a mental illness;
(b) there is no appropriate less-restrictive alternative to a court order for assisted
outpatient treatment; and
(c) (i) the proposed patient lacks the ability to engage in a rational decision-making
process regarding the acceptance of mental health treatment, as demonstrated by evidence of
inability to weigh the possible risks of accepting or rejecting treatment; or
(ii) the proposed patient needs assisted outpatient treatment in order to prevent relapse
or deterioration that is likely to result in the proposed patient posing a substantial danger to self
or others.
(15) The court may order the applicant or a close relative of the patient to be the
patient's personal representative, as described in 45 C.F.R. Sec. 164.502(g), for purposes of the
patient's mental health treatment.
(16) In the absence of the findings described in Subsection (14), the court, after the
hearing, shall dismiss the proceedings.
(17) (a) The assisted outpatient treatment order shall designate the period for which the
patient shall be treated, which may not exceed six months without a review hearing.
(b) An individual identified under Subsection (4) may request a review hearing at any
time while the assisted outpatient treatment order is in effect.
(c) At a review hearing, the court may extend the duration of an assisted outpatient
treatment order by up to six months, if:
(i) the court finds by clear and convincing evidence that the patient meets the
conditions described in Subsection (14); or
(ii) (A) the patient does not appear at the review hearing; and
(B) notice of the review hearing was provided to the patient's last known address by the
applicant described in Subsection (1) or by a local mental health authority.
(d) The court shall maintain a current list of all patients under its order of assisted
outpatient treatment.
(e) At least two weeks prior to the expiration of the designated period of any assisted
outpatient treatment order still in effect, the court that entered the original order shall inform
the appropriate local mental health authority or its designee.
(18) Costs of all proceedings under this section shall be paid by the county in which the
proposed patient resides or is found.
(19) A court may not hold an individual in contempt for failure to comply with an
assisted outpatient treatment order.
(20) As provided in Section 
31A-22-650
, a health insurance provider may not deny an
insured the benefits of the insured's policy solely because the health care that the insured
receives is provided under a court order for assisted outpatient treatment.
Section 7. Section 
62A-15-631
 is amended to read:
62A-15-631.
Involuntary commitment under court order -- Examination --
Hearing -- Power of court -- Findings required -- Costs.
(1) A responsible [
person
] 
individual
 who has [
reason to know
] 
credible knowledge
 of
an adult's mental illness and the condition or circumstances that have led to the adult's need to
be involuntarily committed may initiate an involuntary commitment court proceeding by filing,
in the district court in the county where the proposed patient resides or is found, a written
application that includes:
(a) unless the court finds that the information is not reasonably available, the proposed
patient's:
(i) name;
(ii) date of birth; and
(iii) social security number; [
and
]
(b) (i) a certificate of a licensed physician or a designated examiner stating that within
the seven-day period immediately preceding the certification, the physician or designated
examiner examined the proposed patient and is of the opinion that the proposed patient has a
mental illness and should be involuntarily committed; or
(ii) a written statement by the applicant that:
(A) the proposed patient has been requested to, but has refused to, submit to an
examination of mental condition by a licensed physician or designated examiner;
(B) is sworn to under oath; and
(C) states the facts upon which the application is based[
.
]
; and
(c) a statement whether the proposed patient has previously been under an assisted
outpatient treatment order, if known by the applicant.
(2) (a) Subject to Subsection (2)(b), before issuing a judicial order, the court may
require the applicant to consult with the appropriate local mental health authority, and the court
may direct a mental health professional from that local mental health authority to interview the
applicant and the proposed patient to determine the existing facts and report them to the court.
(b) The consultation described in Subsection (2)(a):
(i) may take place at or before the hearing; and
(ii) is required if the local mental health authority appears at the hearing.
(3) If the court finds from the application, from any other statements under oath, or
from any reports from a mental health professional that there is a reasonable basis to believe
that the proposed patient has a mental illness that poses a substantial danger to self or others
requiring involuntary commitment pending examination and hearing; or, if the proposed patient
has refused to submit to an interview with a mental health professional as directed by the court
or to go to a treatment facility voluntarily, the court may issue an order, directed to a mental
health officer or peace officer, to immediately place the proposed patient in the custody of a
local mental health authority or in a temporary emergency facility as provided in Section
62A-15-634
 to be detained for the purpose of examination.
(4) Notice of commencement of proceedings for involuntary commitment, setting forth
the allegations of the application and any reported facts, together with a copy of any official
order of detention, shall be provided by the court to a proposed patient before, or upon,
placement in the custody of a local mental health authority or, with respect to any proposed
patient presently in the custody of a local mental health authority whose status is being changed
from voluntary to involuntary, upon the filing of an application for that purpose with the court. 
A copy of that order of detention shall be maintained at the place of detention.
(5) Notice of commencement of those proceedings shall be provided by the court as
soon as practicable to the applicant, any legal guardian, any immediate adult family members,
legal counsel for the parties involved, the local mental health authority or its designee, and any
other persons whom the proposed patient or the court shall designate. That notice shall advise
those persons that a hearing may be held within the time provided by law. If the proposed
patient has refused to permit release of information necessary for provisions of notice under
this subsection, the extent of notice shall be determined by the court.
(6) Proceedings for commitment of an individual under the age of 18 years to a local
mental health authority may be commenced in accordance with Part 7, Commitment of Persons
Under Age 18 to Division of Substance Abuse and Mental Health.
(7) The district court may, in its discretion, transfer the case to any other district court
within this state, provided that the transfer will not be adverse to the interest of the proposed
patient.
(8) Within 24 hours, excluding Saturdays, Sundays, and legal holidays, of the issuance
of a judicial order, or after commitment of a proposed patient to a local mental health authority
or its designee under court order for detention or examination, the court shall appoint two
designated examiners:
(a) who did not sign the civil commitment application nor the civil commitment
certification under Subsection (1);
(b) one of whom is a licensed physician; and
(c) one of whom may be designated by the proposed patient or the proposed patient's
counsel, if that designated examiner is reasonably available.
(9) The court shall schedule a hearing to be held within 10 calendar days of the day on
which the designated examiners are appointed.
(10) The designated examiners shall:
(a) conduct their examinations separately;
(b) conduct the examinations at the home of the proposed patient, at a hospital or other
medical facility, or at any other suitable place that is not likely to have a harmful effect on the
proposed patient's health;
(c) inform the proposed patient, if not represented by an attorney:
(i) that the proposed patient does not have to say anything;
(ii) of the nature and reasons for the examination;
(iii) that the examination was ordered by the court;
(iv) that any information volunteered could form part of the basis for the proposed
patient's involuntary commitment; and
(v) that findings resulting from the examination will be made available to the court;
and
(d) within 24 hours of examining the proposed patient, report to the court, orally or in
writing, whether the proposed patient is mentally ill, has agreed to voluntary commitment, as
described in Section 
62A-15-625
, or has acceptable programs available to the proposed patient
without court proceedings. If the designated examiner reports orally, the designated examiner
shall immediately send a written report to the clerk of the court.
(11) If a designated examiner is unable to complete an examination on the first attempt
because the proposed patient refuses to submit to the examination, the court shall fix a
reasonable compensation to be paid to the examiner.
(12) If the local mental health authority, its designee, or a medical examiner determines
before the court hearing that the conditions justifying the findings leading to a commitment
hearing no longer exist, the local mental health authority, its designee, or the medical examiner
shall immediately report that determination to the court.
(13) The court may terminate the proceedings and dismiss the application at any time,
including prior to the hearing, if the designated examiners or the local mental health authority
or its designee informs the court that the proposed patient:
(a) is not mentally ill;
(b) has agreed to voluntary commitment, as described in Section 
62A-15-625
; or
(c) has acceptable options for treatment programs that are available without court
proceedings.
(14) Before the hearing, an opportunity to be represented by counsel shall be afforded
to [
every
] 
the
 proposed patient, and if neither the proposed patient nor others provide counsel,
the court shall appoint counsel and allow counsel sufficient time to consult with the proposed
patient before the hearing. In the case of an indigent proposed patient, the payment of
reasonable attorney fees for counsel, as determined by the court, shall be made by the county in
which the proposed patient resides or is found.
(15) (a) The proposed patient, the applicant, and all other persons to whom notice is
required to be given shall be afforded an opportunity to appear at the hearing, to testify, and to
present and cross-examine witnesses. The court may, in its discretion, receive the testimony of
any other person. The court may allow a waiver of the proposed patient's right to appear only
for good cause shown, and that cause shall be made a matter of court record.
(b) The court is authorized to exclude all persons not necessary for the conduct of the
proceedings and may, upon motion of counsel, require the testimony of each examiner to be
given out of the presence of any other examiners.
(c) The hearing shall be conducted in as informal a manner as may be consistent with
orderly procedure, and in a physical setting that is not likely to have a harmful effect on the
mental health of the proposed patient.
(d) The court shall consider all relevant historical and material information that is
offered, subject to the rules of evidence, including reliable hearsay under Rule 1102, Utah
Rules of Evidence.
(e) (i) A local mental health authority or its designee, or the physician in charge of the
proposed patient's care shall, at the time of the hearing, provide the court with the following
information:
(A) the detention order;
(B) admission notes;
(C) the diagnosis;
(D) any doctors' orders;
(E) progress notes;
(F) nursing notes; [
and
]
(G) medication records pertaining to the current commitment[
.
]
; and
(H) whether the proposed patient has previously been civilly committed or under an
order for assisted outpatient treatment.
(ii) That information shall also be supplied to the proposed patient's counsel at the time
of the hearing, and at any time prior to the hearing upon request.
(16) The court shall order commitment of a proposed patient who is 18 years of age or
older to a local mental health authority if, upon completion of the hearing and consideration of
the information presented in accordance with Subsection (15)(d), the court finds by clear and
convincing evidence that:
(a) the proposed patient has a mental illness;
(b) because of the proposed patient's mental illness the proposed patient poses a
substantial danger to self or others;
(c) the proposed patient lacks the ability to engage in a rational decision-making
process regarding the acceptance of mental treatment as demonstrated by evidence of inability
to weigh the possible risks of accepting or rejecting treatment;
(d) there is no appropriate less-restrictive alternative to a court order of commitment;
and
(e) the local mental health authority can provide the proposed patient with treatment
that is adequate and appropriate to the proposed patient's conditions and needs. In the absence
of the required findings of the court after the hearing, the court shall dismiss the proceedings.
(17) (a) The order of commitment shall designate the period for which the patient shall
be treated. When the patient is not under an order of commitment at the time of the hearing,
that period may not exceed six months without benefit of a review hearing. Upon such a
review hearing, to be commenced prior to the expiration of the previous order, an order for
commitment may be for an indeterminate period, if the court finds by clear and convincing
evidence that the required conditions in Subsection (16) will last for an indeterminate period.
(b) The court shall maintain a current list of all patients under its order of commitment. 
That list shall be reviewed to determine those patients who have been under an order of
commitment for the designated period. At least two weeks prior to the expiration of the
designated period of any order of commitment still in effect, the court that entered the original
order shall inform the appropriate local mental health authority or its designee. The local
mental health authority or its designee shall immediately reexamine the reasons upon which the
order of commitment was based. If the local mental health authority or its designee determines
that the conditions justifying that commitment no longer exist, it shall discharge the patient
from involuntary commitment and immediately report the discharge to the court. Otherwise,
the court shall immediately appoint two designated examiners and proceed under Subsections
(8) through (14).
(c) The local mental health authority or its designee responsible for the care of a patient
under an order of commitment for an indeterminate period shall, at six-month intervals,
reexamine the reasons upon which the order of indeterminate commitment was based. If the
local mental health authority or its designee determines that the conditions justifying that
commitment no longer exist, that local mental health authority or its designee shall discharge
the patient from its custody and immediately report the discharge to the court. If the local
mental health authority or its designee determines that the conditions justifying that
commitment continue to exist, the local mental health authority or its designee shall send a
written report of those findings to the court. The patient and the patient's counsel of record
shall be notified in writing that the involuntary commitment will be continued, the reasons for
that decision, and that the patient has the right to a review hearing by making a request to the
court. Upon receiving the request, the court shall immediately appoint two designated
examiners and proceed under Subsections (8) through (14).
(18) Any patient committed as a result of an original hearing or a patient's legally
designated representative who is aggrieved by the findings, conclusions, and order of the court
entered in the original hearing has the right to a new hearing upon a petition filed with the court
within 30 days of the entry of the court order. The petition must allege error or mistake in the
findings, in which case the court shall appoint three impartial designated examiners previously
unrelated to the case to conduct an additional examination of the patient. The new hearing
shall, in all other respects, be conducted in the manner otherwise permitted.
(19) Costs of all proceedings under this section shall be paid by the county in which the
proposed patient resides or is found.
Section 8. Section 
62A-15-703
 is amended to read:
62A-15-703.
Residential and inpatient settings -- Commitment proceeding --
Child in physical custody of local mental health authority.
(1) A child may receive services from a local mental health authority in an inpatient or
residential setting only after a commitment proceeding, for the purpose of transferring physical
custody, has been conducted in accordance with the requirements of this section.
(2) That commitment proceeding shall be initiated by a petition for commitment, and
shall be a careful, diagnostic inquiry, conducted by a neutral and detached fact finder, pursuant
to the procedures and requirements of this section. If the findings described in Subsection (4)
exist, the proceeding shall result in the transfer of physical custody to the appropriate local
mental health authority, and the child may be placed in an inpatient or residential setting.
(3) The neutral and detached fact finder who conducts the inquiry:
(a) shall be a designated examiner, as defined in Section 
62A-15-602
; and
(b) may not profit, financially or otherwise, from the commitment or physical
placement of the child in that setting.
(4) Upon determination by a fact finder that the following circumstances clearly exist,
the fact finder may order that the child be committed to the physical custody of a local mental
health authority:
(a) the child has a mental illness, as defined in [
Subsection
] 
Section
62A-15-602
[
(13)
];
(b) the child demonstrates a reasonable fear of the risk of substantial danger to self or
others;
(c) the child will benefit from care and treatment by the local mental health authority;
and
(d) there is no appropriate less-restrictive alternative.
(5) (a) The commitment proceeding before the neutral and detached fact finder shall be
conducted in as informal manner as possible and in a physical setting that is not likely to have a
harmful effect on the child.
(b) The child, the child's parent or legal guardian, the petitioner, and a representative of
the appropriate local mental health authority:
(i) shall receive informal notice of the date and time of the proceeding; and
(ii) may appear and address the petition for commitment.
(c) The neutral and detached fact finder may, in the fact finder's discretion, receive the
testimony of any other person.
(d) The fact finder may allow a child to waive the child's right to be present at the
commitment proceeding, for good cause shown. If that right is waived, the purpose of the
waiver shall be made a matter of record at the proceeding.
(e) At the time of the commitment proceeding, the appropriate local mental health
authority, its designee, or the psychiatrist who has been in charge of the child's care prior to the
commitment proceeding, shall provide the neutral and detached fact finder with the following
information, as it relates to the period of current admission:
(i) the petition for commitment;
(ii) the admission notes;
(iii) the child's diagnosis;
(iv) physicians' orders;
(v) progress notes;
(vi) nursing notes; and
(vii) medication records.
(f) The information described in Subsection (5)(e) shall also be provided to the child's
parent or legal guardian upon written request.
(g) (i) The neutral and detached fact finder's decision of commitment shall state the
duration of the commitment. Any commitment to the physical custody of a local mental health
authority may not exceed 180 days. Prior to expiration of the commitment, and if further
commitment is sought, a hearing shall be conducted in the same manner as the initial
commitment proceeding, in accordance with the requirements of this section.
(ii) At the conclusion of the hearing and subsequently in writing, when a decision for
commitment is made, the neutral and detached fact finder shall inform the child and the child's
parent or legal guardian of that decision and of the reasons for ordering commitment.
(iii) The neutral and detached fact finder shall state in writing the basis of the decision,
with specific reference to each of the criteria described in Subsection (4), as a matter of record.
(6) A child may be temporarily committed for a maximum of 72 hours, excluding
Saturdays, Sundays, and legal holidays, to the physical custody of a local mental health
authority in accordance with the procedures described in Section 
62A-15-629
 and upon
satisfaction of the risk factors described in Subsection (4). A child who is temporarily
committed shall be released at the expiration of the 72 hours unless the procedures and findings
required by this section for the commitment of a child are satisfied.
(7) A local mental health authority shall have physical custody of each child committed
to it under this section. The parent or legal guardian of a child committed to the physical
custody of a local mental health authority under this section, retains legal custody of the child,
unless legal custody has been otherwise modified by a court of competent jurisdiction. In cases
when the Division of Child and Family Services or the Division of Juvenile Justice Services
has legal custody of a child, that division shall retain legal custody for purposes of this part.
(8) The cost of caring for and maintaining a child in the physical custody of a local
mental health authority shall be assessed to and paid by the child's parents, according to their
ability to pay. For purposes of this section, the Division of Child and Family Services or the
Division of Juvenile Justice Services shall be financially responsible, in addition to the child's
parents, if the child is in the legal custody of either of those divisions at the time the child is
committed to the physical custody of a local mental health authority under this section, unless
Medicaid regulation or contract provisions specify otherwise. The Office of Recovery Services
shall assist those divisions in collecting the costs assessed pursuant to this section.
(9) Whenever application is made for commitment of a minor to a local mental health
authority under any provision of this section by a person other than the child's parent or
guardian, the local mental health authority or its designee shall notify the child's parent or
guardian. The parents shall be provided sufficient time to prepare and appear at any scheduled
proceeding.
(10) (a) Each child committed pursuant to this section is entitled to an appeal within 30
days after any order for commitment. The appeal may be brought on the child's own petition or
on petition of the child's parent or legal guardian, to the juvenile court in the district where the
child resides or is currently physically located. With regard to a child in the custody of the
Division of Child and Family Services or the Division of Juvenile Justice Services, the attorney
general's office shall handle the appeal, otherwise the appropriate county attorney's office is
responsible for appeals brought pursuant to this Subsection (10)(a).
(b) Upon receipt of the petition for appeal, the court shall appoint a designated
examiner previously unrelated to the case, to conduct an examination of the child in accordance
with the criteria described in Subsection (4), and file a written report with the court. The court
shall then conduct an appeal hearing to determine whether the findings described in Subsection
(4) exist by clear and convincing evidence.
(c) Prior to the time of the appeal hearing, the appropriate local mental health authority,
its designee, or the mental health professional who has been in charge of the child's care prior
to commitment, shall provide the court and the designated examiner for the appeal hearing with
the following information, as it relates to the period of current admission:
(i) the original petition for commitment;
(ii) admission notes;
(iii) diagnosis;
(iv) physicians' orders;
(v) progress notes;
(vi) nursing notes; and
(vii) medication records.
(d) Both the neutral and detached fact finder and the designated examiner appointed for
the appeal hearing shall be provided with an opportunity to review the most current
information described in Subsection (10)(c) prior to the appeal hearing.
(e) The child, the child's parent or legal guardian, the person who submitted the
original petition for commitment, and a representative of the appropriate local mental health
authority shall be notified by the court of the date and time of the appeal hearing. Those
persons shall be afforded an opportunity to appear at the hearing. In reaching its decision, the
court shall review the record and findings of the neutral and detached fact finder, the report of
the designated examiner appointed pursuant to Subsection (10)(b), and may, in its discretion,
allow or require the testimony of the neutral and detached fact finder, the designated examiner,
the child, the child's parent or legal guardian, the person who brought the initial petition for
commitment, or any other person whose testimony the court deems relevant. The court may
allow the child to waive the right to appear at the appeal hearing, for good cause shown. If that
waiver is granted, the purpose shall be made a part of the court's record.
(11) Each local mental health authority has an affirmative duty to conduct periodic
evaluations of the mental health and treatment progress of every child committed to its physical
custody under this section, and to release any child who has sufficiently improved so that the
criteria justifying commitment no longer exist.
(12) (a) A local mental health authority or its designee, in conjunction with the child's
current treating mental health professional may release an improved child to a less restrictive
environment, as they determine appropriate. Whenever the local mental health authority or its
designee, and the child's current treating mental health professional, determine that the
conditions justifying commitment no longer exist, the child shall be discharged and released to
the child's parent or legal guardian. With regard to a child who is in the physical custody of the
State Hospital, the treating psychiatrist or clinical director of the State Hospital shall be the
child's current treating mental health professional.
(b) A local mental health authority or its designee, in conjunction with the child's
current treating mental health professional, is authorized to issue a written order for the
immediate placement of a child not previously released from an order of commitment into a
more restrictive environment, if the local authority or its designee and the child's current
treating mental health professional has reason to believe that the less restrictive environment in
which the child has been placed is exacerbating the child's mental illness, or increasing the risk
of harm to self or others.
(c) The written order described in Subsection (12)(b) shall include the reasons for
placement in a more restrictive environment and shall authorize any peace officer to take the
child into physical custody and transport the child to a facility designated by the appropriate
local mental health authority in conjunction with the child's current treating mental health
professional. Prior to admission to the more restrictive environment, copies of the order shall
be personally delivered to the child, the child's parent or legal guardian, the administrator of the
more restrictive environment, or the administrator's designee, and the child's former treatment
provider or facility.
(d) If the child has been in a less restrictive environment for more than 30 days and is
aggrieved by the change to a more restrictive environment, the child or the child's
representative may request a review within 30 days of the change, by a neutral and detached
fact finder as described in Subsection (3). The fact finder shall determine whether:
(i) the less restrictive environment in which the child has been placed is exacerbating
the child's mental illness or increasing the risk of harm to self or others; or
(ii) the less restrictive environment in which the child has been placed is not
exacerbating the child's mental illness or increasing the risk of harm to self or others, in which
case the fact finder shall designate that the child remain in the less restrictive environment.
(e) Nothing in this section prevents a local mental health authority or its designee, in
conjunction with the child's current mental health professional, from discharging a child from
commitment or from placing a child in an environment that is less restrictive than that
designated by the neutral and detached fact finder.
(13) Each local mental health authority or its designee, in conjunction with the child's
current treating mental health professional shall discharge any child who, in the opinion of that
local authority, or its designee, and the child's current treating mental health professional, no
longer meets the criteria specified in Subsection (4), except as provided by Section 
78A-6-120
. 
The local authority and the mental health professional shall assure that any further supportive
services required to meet the child's needs upon release will be provided.
(14) Even though a child has been committed to the physical custody of a local mental
health authority under this section, the child is still entitled to additional due process
proceedings, in accordance with Section 
62A-15-704
, before any treatment that may affect a
constitutionally protected liberty or privacy interest is administered. Those treatments include,
but are not limited to, antipsychotic medication, electroshock therapy, and psychosurgery.