HB-5810, As Passed House, December 20, 2018

HB-5810, As Passed Senate, December 18, 2018

SENATE SUBSTITUTE FOR

HOUSE BILL NO. 5810

     A bill to amend 1974 PA 258, entitled

"Mental health code,"

by amending sections 100a, 400, 401, 409, 410, 434, 435, 436, 438,

452, 455, 461, 464a, 468, 469a, 472a, 473, 474, 474a, 475, 475a,

477, 478, 482, and 489 (MCL 330.1100a, 330.1400, 330.1401,

330.1409, 330.1410, 330.1434, 330.1435, 330.1436, 330.1438,

330.1452, 330.1455, 330.1461, 330.1464a, 330.1468, 330.1469a,

330.1472a, 330.1473, 330.1474, 330.1474a, 330.1475, 330.1475a,

330.1477, 330.1478, 330.1482, and 330.1489), sections 100a, 401,

434, 435, 438, 452, 455, 461, 468, 469a, 472a, 474, 474a, and 475

as amended by 2016 PA 320, section 400 as amended by 2004 PA 553,

section 409 as amended by 2006 PA 306, section 410 as amended by

2004 PA 556, section 436 as amended by 1995 PA 290, section 464a as

amended by 2014 PA 200, section 473 as amended by 2004 PA 498,

section 475a as added and section 482 as amended by 1996 PA 588,

and section 477 as amended by 1986 PA 117.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

     Sec. 100a. (1) "Abilities" means the qualities, skills, and

competencies of an individual that reflect the individual's talents

and acquired proficiencies.

     (2) "Abuse" means nonaccidental physical or emotional harm to

a recipient, or sexual contact with or sexual penetration of a

recipient as those terms are defined in section 520a of the

Michigan penal code, 1931 PA 328, MCL 750.520a, that is committed

by an employee or volunteer of the department, a community mental

health services program, or a licensed hospital or by an employee

or volunteer of a service provider under contract with the

department, community mental health services program, or licensed

hospital.

     (3) "Adaptive skills" means skills in 1 or more of the

following areas:

     (a) Communication.

     (b) Self-care.

     (c) Home living.

     (d) Social skills.

     (e) Community use.

     (f) Self-direction.

     (g) Health and safety.

     (h) Functional academics.

     (i) Leisure.

     (j) Work.

     (4) "Adult foster care facility" means an adult foster care

facility licensed under the adult foster care facility licensing

act, 1979 PA 218, MCL 400.701 to 400.737.

     (5) "Alcohol and drug abuse counseling" means the act of

counseling, modification of substance use disorder related

behavior, and prevention techniques for individuals with substance

use disorder, their significant others, and individuals who could

potentially develop a substance use disorder.

     (6) "Applicant" means an individual or his or her legal

representative who makes a request for mental health services.

     (7) "Approved service program" means a substance use disorder

services program licensed under part 62 of the public health code,

1978 PA 368, MCL 333.6230 to 333.6251, to provide substance use

disorder treatment and rehabilitation services by the department-

designated community mental health entity and approved by the

federal government to deliver a service or combination of services

for the treatment of incapacitated individuals.

     (8) "Assisted outpatient treatment" or "AOT" means the

categories of outpatient services ordered by the court under

section 468 or 469a. Assisted outpatient treatment may include a

case management plan and case management services to provide care

coordination under the supervision of a psychiatrist and developed

in accordance with person-centered planning under section 712.

Assisted outpatient treatment may also include 1 or more of the

following categories of services: medication; periodic blood tests

or urinalysis to determine compliance with prescribed medications;

individual or group therapy; day or partial day programming

activities; vocational, educational, or self-help training or

activities; assertive community treatment team services; alcohol or

substance use disorder treatment and counseling and periodic tests

for the presence of alcohol or illegal drugs for an individual with

a history of alcohol abuse or substance use disorder; supervision

of living arrangements; and any other services within a local or

unified services plan developed under this act that are prescribed

to treat the individual's mental illness and to assist the

individual in living and functioning in the community or to attempt

to prevent a relapse or deterioration that may reasonably be

predicted to result in suicide, the need for hospitalization, or

serious violent behavior. The medical review and direction included

in an assisted outpatient treatment plan shall be provided under

the supervision of a psychiatrist.

     (9) "Board" means the governing body of a community mental

health services program.

     (10) "Board of commissioners" means a county board of

commissioners.

     (11) "Center" means a facility operated by the department to

admit individuals with developmental disabilities and provide

habilitation and treatment services.

     (12) "Certification" means formal approval of a program by the

department in accordance with standards developed or approved by

the department.

     (13) "Child abuse" and "child neglect" mean those terms as

defined in section 2 of the child protection law, 1975 PA 238, MCL

722.622.

     (14) "Child and adolescent psychiatrist" means 1 or more of

the following:

     (a) A physician who has completed a residency program in child

and adolescent psychiatry approved by the Accreditation Council for

Graduate Medical Education or the American Osteopathic Association,

or who has completed 12 months of child and adolescent psychiatric

rotation and is enrolled in an approved residency program as

described in this subsection.

     (b) A psychiatrist employed by or under contract as a child

and adolescent psychiatrist with the department or a community

mental health services program on March 28, 1996, who has education

and clinical experience in the evaluation and treatment of children

or adolescents with serious emotional disturbance.

     (c) A psychiatrist who has education and clinical experience

in the evaluation and treatment of children or adolescents with

serious emotional disturbance who is approved by the director.

     (15) "Children's diagnostic and treatment service" means a

program operated by or under contract with a community mental

health services program, that provides examination, evaluation, and

referrals for minors, including emergency referrals, that provides

or facilitates treatment for minors, and that has been certified by

the department.

     (16) "Community mental health authority" means a separate

legal public governmental entity created under section 205 to

operate as a community mental health services program.

     (17) "Community mental health organization" means a community

mental health services program that is organized under the urban

cooperation act of 1967, 1967 (Ex Sess) PA 7, MCL 124.501 to

124.512.

     (18) "Community mental health services program" means a

program operated under chapter 2 as a county community mental

health agency, a community mental health authority, or a community

mental health organization.

     (19) "Consent" means a written agreement executed by a

recipient, a minor recipient's parent, or a recipient's legal

representative with authority to execute a consent, or a full or

limited guardian authorized under the estates and protected

individuals code, 1998 PA 386, MCL 700.1101 to 700.8206, with the

authority to consent, or a verbal agreement of a recipient that is

witnessed and documented by an individual other than the individual

providing treatment.

     (20) "County community mental health agency" means an official

county or multicounty agency created under section 210 that

operates as a community mental health services program and that has

not elected to become a community mental health authority or a

community mental health organization.

     (21) "Department" means the department of health and human

services.

     (22) "Department-designated community mental health entity"

means the community mental health authority, community mental

health organization, community mental health services program,

county community mental health agency, or community mental health

regional entity designated by the department to represent a region

of community mental health authorities, community mental health

organizations, community mental health services programs, or county

community mental health agencies.

     (23) "Dependent living setting" means all of the following:

     (a) An adult foster care facility.

     (b) A nursing home licensed under article 17 part 217 of the

public health code, 1978 PA 368, MCL 333.20101 to

333.22260.333.21701 to 333.21799e.

     (c) A home for the aged licensed under article 17 part 213 of

the public health code, 1978 PA 368, MCL 333.20101 to

333.22260.333.21301 to 333.21335.

     (24) "Designated representative" means any of the following:

     (a) A registered nurse or licensed practical nurse licensed or

otherwise authorized under part 172 of the public health code, 1978

PA 368, MCL 333.17201 to 333.17242.

     (b) A paramedic licensed or otherwise authorized under part

209 of the public health code, 1978 PA 368, MCL 333.20901 to

333.20979.

     (c) A physician's assistant licensed or otherwise authorized

under part 170 or 175 of the public health code, 1978 PA 368, MCL

333.17001 to 333.17084 and 333.17501 to 333.17556.

     (d) An individual qualified by education, training, and

experience who performs acts, tasks, or functions under the

supervision of a physician.

     (25) "Developmental disability" means either of the following:

     (a) If applied to an individual older than 5 years of age, a

severe, chronic condition that meets all of the following

requirements:

     (i) Is attributable to a mental or physical impairment or a

combination of mental and physical impairments.

     (ii) Is manifested before the individual is 22 years old.

     (iii) Is likely to continue indefinitely.

     (iv) Results in substantial functional limitations in 3 or

more of the following areas of major life activity:

     (A) Self-care.

     (B) Receptive and expressive language.

     (C) Learning.

     (D) Mobility.

     (E) Self-direction.

     (F) Capacity for independent living.

     (G) Economic self-sufficiency.

     (v) Reflects the individual's need for a combination and

sequence of special, interdisciplinary, or generic care, treatment,

or other services that are of lifelong or extended duration and are

individually planned and coordinated.

     (b) If applied to a minor from birth to 5 years of age, a

substantial developmental delay or a specific congenital or

acquired condition with a high probability of resulting in

developmental disability as defined in subdivision (a) if services

are not provided.

     (26) "Director" means the director of the department or his or

her designee.

     (27) "Discharge" means an absolute, unconditional release of

an individual from a facility by action of the facility or a court.

     (28) "Eligible minor" means an individual less than 18 years

of age who is recommended in the written report of a

multidisciplinary team under rules promulgated by the department of

education to be classified as 1 of the following:

     (a) Severely mentally impaired.

     (b) Severely multiply impaired.

     (c) Autistic impaired and receiving special education services

in a program designed for the autistic impaired under subsection

(1) of R 340.1758 of the Michigan administrative code

Administrative Code or in a program designed for the severely

mentally impaired or severely multiply impaired.

     (29) "Emergency situation" means a situation in which an

individual is experiencing a serious mental illness or a

developmental disability, or a minor is experiencing a serious

emotional disturbance, and 1 of the following applies:

     (a) The individual can reasonably be expected within the near

future to physically injure himself, herself, or another

individual, either intentionally or unintentionally.

     (b) The individual is unable to provide himself or herself

food, clothing, or shelter or to attend to basic physical

activities such as eating, toileting, bathing, grooming, dressing,

or ambulating, and this inability may lead in the near future to

harm to the individual or to another individual.

     (c) The individual has mental illness that has impaired his or

her judgment so that the individual is unable to understand his or

her need for treatment , and that impaired judgment, on the basis

of competent clinical opinion, presents a substantial risk of

significant physical or mental harm to the individual in the near

future or presents a substantial risk of significant physical harm

to others in the near future.and presents a risk of harm.

     (30) "Executive director" means an individual appointed under

section 226 to direct a community mental health services program or

his or her designee.

     Sec. 400. As used in this chapter, unless the context requires

otherwise:

     (a) "Clinical certificate" means the written conclusion and

statements of a physician or a licensed psychologist that an

individual is a person requiring treatment, together with the

information and opinions, in reasonable detail, that underlie the

conclusion, on the form prescribed by the department or on a

substantially similar form.

     (b) "Competent clinical opinion" means the clinical judgment

of a physician, psychiatrist, or licensed psychologist.

     (c) "Court" means the probate court or the court with

responsibility with regard to mental health services for the county

of residence of the subject of a petition, or for the county in

which the subject of a petition was found.

     (d) "Formal voluntary hospitalization" means hospitalization

of an individual based on both of the following:

     (i) The execution of an application for voluntary

hospitalization by the individual or by a patient advocate

designated under the estates and protected individuals code, 1998

PA 386, MCL 700.1101 to 700.8102, 700.8206, to make mental health

treatment decisions for the individual.

     (ii) The hospital director's determination that the individual

is clinically suitable for voluntary hospitalization.

     (e) "Informal voluntary hospitalization" means hospitalization

of an individual based on all of the following:

     (i) The individual's request for hospitalization.

     (ii) The hospital director's determination that the individual

is clinically suitable for voluntary hospitalization.

     (iii) The individual's agreement to accept treatment.

     (f) "Involuntary mental health treatment" means court-ordered

hospitalization, alternative assisted outpatient treatment, or

combined hospitalization and alternative assisted outpatient

treatment as described in section 468. For the purpose of this

chapter, involuntary mental health treatment does not include a

full or limited guardian authorized under the estates and protected

individuals code, 1998 PA 386, MCL 700.1101 to 700.8206, with the

authority to consent to mental health treatment for an individual

found to be a legally incapacitated individual under the estates

and protected individuals code, 1998 PA 386, MCL 700.1101 to

700.8206.

     (g) "Mental illness" means a substantial disorder of thought

or mood that significantly impairs judgment, behavior, capacity to

recognize reality, or ability to cope with the ordinary demands of

life.

     (h) "Preadmission screening unit" means a service component of

a community mental health services program established under

section 409.

     (i) "Private-pay patient" means a patient whose services and

care are paid for from funding sources other than the community

mental health services program, the department, or other state or

county funding.

     (j) "Release" means the transfer of an individual who is

subject to an order of combined hospitalization and alternative

assisted outpatient treatment from 1 treatment program to another

in accordance with his or her individual plan of services.

     (k) "Subject of a petition" means an individual regarding whom

a petition has been filed with the court asserting that the

individual is or is not a person requiring treatment or for whom an

objection to involuntary mental health treatment has been made

under section 484.

     Sec. 401. (1) As used in this chapter, "person requiring

treatment" means (a), (b), or (c): , or (d):

     (a) An individual who has mental illness, and who as a result

of that mental illness can reasonably be expected within the near

future to intentionally or unintentionally seriously physically

injure himself, herself, or another individual, and who has engaged

in an act or acts or made significant threats that are

substantially supportive of the expectation.

     (b) An individual who has mental illness, and who as a result

of that mental illness is unable to attend to those of his or her

basic physical needs such as food, clothing, or shelter that must

be attended to in order for the individual to avoid serious harm in

the near future, and who has demonstrated that inability by failing

to attend to those basic physical needs.

     (c) An individual who has mental illness, whose judgment is so

impaired by that mental illness, that he or she is unable to

understand his or her need for treatment, and whose impaired

judgment, and whose lack of understanding of the need for treatment

has caused him or her to demonstrate an unwillingness to

voluntarily participate in or adhere to treatment that is

necessary, on the basis of competent clinical opinion, to prevent a

relapse or harmful deterioration of his or her condition, and

presents a substantial risk of significant physical or mental harm

to the individual in the near future or presents a substantial risk

of physical harm to or others. in the near future.

     (d) An individual who has mental illness, whose understanding

of the need for treatment is impaired to the point that he or she

is unlikely to voluntarily participate in or adhere to treatment

that has been determined necessary to prevent a relapse or harmful

deterioration of his or her condition, and whose noncompliance with

treatment has been a factor in the individual's placement in a

psychiatric hospital, prison, or jail at least 2 times within the

last 48 months or whose noncompliance with treatment has been a

factor in the individual's committing 1 or more acts, attempts, or

threats of serious violent behavior within the last 48 months. An

individual under this subdivision is only eligible to receive

assisted outpatient treatment.

     (2) An individual whose mental processes have been weakened or

impaired by a dementia, an individual with a primary diagnosis of

epilepsy, or an individual with alcoholism or other drug dependence

is not a person requiring treatment under this chapter unless the

individual also meets the criteria specified in subsection (1). An

individual described in this subsection may be hospitalized under

the informal or formal voluntary hospitalization provisions of this

chapter if he or she is considered clinically suitable for

hospitalization by the hospital director.

Sec. 409. (1) Each community mental health services program

shall establish 1 or more preadmission screening units with 24-hour

availability to provide assessment and screening services for

individuals being considered for admission into hospitals or

alternative assisted outpatient treatment programs. The community

mental health services program shall employ mental health

professionals or licensed bachelor's social workers licensed under

article 15 part 185 of the public health code, 1978 PA 368, MCL

333.16101 to 333.18838, 333.18501 to 333.18518, to provide the

preadmission screening services or contract with another agency

that meets the requirements of this section. Preadmission screening

unit staff shall be supervised by a registered professional nurse

or other mental health professional possessing at least a master's

degree.

     (2) Each community mental health services program shall

provide the address and telephone number of its preadmission

screening unit or units to law enforcement agencies, the

department, the court, and hospital emergency rooms.

     (3) A preadmission screening unit shall assess an individual

being considered for admission into a hospital operated by the

department or under contract with the community mental health

services program. If the individual is clinically suitable for

hospitalization, the preadmission screening unit shall authorize

voluntary admission to the hospital.

     (4) If the preadmission screening unit of the community mental

health services program denies hospitalization, the individual or

the person making the application may request a second opinion from

the executive director. The executive director shall arrange for an

additional evaluation by a psychiatrist, other physician, or

licensed psychologist to be performed within 3 days, excluding

Sundays and legal holidays, after the executive director receives

the request. If the conclusion of the second opinion is different

from the conclusion of the preadmission screening unit, the

executive director, in conjunction with the medical director, shall

make a decision based on all clinical information available. The

executive director's decision shall be confirmed in writing to the

individual who requested the second opinion, and the confirming

document shall include the signatures of the executive director and

medical director or verification that the decision was made in

conjunction with the medical director. If an individual is assessed

and found not to be clinically suitable for hospitalization, the

preadmission screening unit shall provide appropriate referral

services.

     (5) If an individual is assessed and found not to be

clinically suitable for hospitalization, the preadmission screening

unit shall provide information regarding alternative services and

the availability of those services, and make appropriate referrals.

     (6) A preadmission screening unit shall assess and examine, or

refer to a hospital for examination, an individual who is brought

to the unit by a peace officer or ordered by a court to be

examined. If the individual meets the requirements for

hospitalization, the preadmission screening unit shall designate

the hospital to which the individual shall be admitted. The

preadmission screening unit shall consult with the individual and,

if the individual agrees, it shall consult with the individual's

family member of choice, if available, as to the preferred hospital

for admission of the individual.

     (7) If the individual chooses a hospital not under contract

with a community mental health services program, and the hospital

agrees to the admission, the preadmission screening unit shall

refer the individual to the hospital that is requested by the

individual. Any financial obligation for the services provided by

the hospital shall be satisfied from funding sources other than the

community mental health services program, the department, or other

state or county funding.

     Sec. 410. Except as otherwise provided in section 402a, an

individual who requests, applies for, or assents to either informal

or formal voluntary admission to a hospital or outpatient treatment

program operated by the department or a hospital or outpatient

treatment program under contract with a community mental health

services program may be considered for admission by the hospital or

outpatient treatment program only after authorization by a

community mental health services preadmission screening unit.

     Sec. 434. (1) Any individual 18 years of age or over may file

with the court a petition that asserts that an individual is a

person requiring treatment.

     (2) The petition shall contain the facts that are the basis

for the assertion, the names and addresses, if known, of any

witnesses to the facts, and, if known, the name and address of the

nearest relative or guardian, or, if none, a friend, if known, of

the individual.

     (3) Except as provided in subsection (7), the petition shall

be accompanied by the clinical certificate of a physician or a

licensed psychologist, unless after reasonable effort the

petitioner could not secure an examination. If a clinical

certificate does not accompany the petition, an affidavit setting

the petitioner shall set forth the reasons an examination could not

be secured shall also be filed. within the petition. The petition

may also be accompanied by a second clinical certificate. If 2

clinical certificates accompany the petition, at least 1 clinical

certificate shall must have been executed by a psychiatrist.

     (4) Except as otherwise provided in subsection (7) and section

455, a clinical certificate that accompanies a petition shall must

have been executed within 72 hours before the filing of the

petition, and after personal examination of the individual.

     (5) If the individual is found not to be a person requiring

treatment under this section, the petition and any clinical

certificate shall be maintained by the court as a confidential

record to prevent disclosure to any person who is not specifically

authorized under this chapter to receive notice of the petition or

clinical certificate.

     (6) The petition described in this section may assert that the

subject of the petition should receive assisted outpatient

treatment in accordance with section 468(2)(e).468(2)(d).

     (7) A petition that does not seek hospitalization but only

requests that the subject of the petition receive assisted

outpatient treatment is not subject to subsection (3) or (4).

     Sec. 435. (1) If the petition is accompanied by 1 clinical

certificate, the court shall order the individual to be examined by

a psychiatrist.

     (2) If the petition is not accompanied by a clinical

certificate, and if the court is satisfied a reasonable effort was

made to secure an examination, the court shall order the individual

to be examined by a psychiatrist and either a physician or a

licensed psychologist.

     (3) The individual may be received and detained at the place

of examination as long as necessary to complete the examination or

examinations, but not more than 24 hours.

     (4) After an examination ordered under subsection (1), the

examining psychiatrist shall either transmit a clinical certificate

to the court or report to the court that execution of a clinical

certificate is not warranted. After each examination ordered under

subsection (2), the examining psychiatrist, or the examining

physician or licensed psychologist, as applicable, shall either

transmit a clinical certificate to the court or report to the court

that execution of a clinical certificate is not warranted.

     (5) If 1 examination was ordered and the examining

psychiatrist reports that execution of a clinical certificate is

not warranted, or if 2 examinations were ordered and 1 of the

examining physicians or the licensed psychologist reports that

execution of a clinical certificate is not warranted, the court

shall dismiss the petition or order the individual to be examined

by a psychiatrist, or if a psychiatrist is not available, by a

physician or licensed psychologist. If a third examination report

states that execution of a clinical certificate is not warranted,

the court shall dismiss the petition.

     (6) This section does not apply to a petition filed under

section 434(6).434(7).

     Sec. 436. (1) If it appears to the court that the individual

will not comply with an order of examination under section 435, the

court may order a peace officer to take the individual into

protective custody and transport him or her to a preadmission

screening unit or hospital designated by the community mental

health services program or to another suitable place for the

ordered examination or examinations.

     (2) A court order for a peace officer to take an individual

into protective custody and transport the individual as described

in subsection (1) must be executed within 10 days after the court

enters the order. If the order is not executed within 10 days after

the court enters the order, the law enforcement agency must report

to the court the reason the order was not executed within the

prescribed time period.

     (3) Following the filing of a petition for assisted outpatient

treatment, if it comes to the court's attention that the individual

will not make himself or herself available for an evaluation, the

court may order law enforcement to transport the individual for the

mental health evaluation and to take the individual to the

designated preadmission screening unit or hospital. The court must

be satisfied that reasonable effort was made to secure an

examination before the court orders a peace officer to transport

the individual for an evaluation. At the time the individual

arrives at the preadmission screening unit or hospital, the

preadmission screening unit or hospital must complete an assessment

that includes an examination upon the arrival of the individual and

release the individual following the conclusion of the examination

unless the medical professional who examines the individual finds

the need for immediate hospitalization. If immediate

hospitalization is necessary, the director must file a petition,

accompanied by 2 clinical certificates, with the probate court

within 24 hours after the medical professional's finding. The

petition must request involuntary hospitalization and may request a

combination of hospitalization and assisted outpatient treatment.

The court must set a hearing in accordance with section 452(1).

     Sec. 438. If it appears to the court that the individual

requires immediate assessment because the individual presents a

substantial risk of significant physical or mental harm to himself

or herself in the near future or presents a substantial risk of

significant physical harm to others in the near future, the court

may order the individual hospitalized and may order a peace officer

to take the individual into protective custody and transport the

individual to a preadmission screening unit designated by the

community mental health services program. If the preadmission

screening unit authorizes hospitalization, the peace officer shall

transport the individual to a hospital designated by the community

mental health services program, unless other arrangements are

provided by the preadmission screening unit. If the examinations

and clinical certificates of the psychiatrist, and the physician or

the licensed psychologist, are not completed within 24 hours after

hospitalization, the individual shall be released.

     Sec. 452. (1) The court shall fix a date for every hearing

convened under this chapter. Except as provided in subsection (2),

the hearing shall be convened promptly, but not more than 7 days

after the court's receipt of any of the following:

     (a) A petition for a determination that an individual is a

person requiring treatment, a clinical certificate executed by a

physician or a licensed psychologist, and a clinical certificate

executed by a psychiatrist.

     (b) A petition for a determination that an individual

continues to be a person requiring treatment and a clinical

certificate executed by a psychiatrist.

     (c) A petition for discharge filed under section 484.

     (d) A demand or notification that a hearing that has been

temporarily deferred under section 455(6) be convened.

     (2) A hearing for a petition under section 434(6) 434(7) shall

be convened not more than 28 days after the filing of the petition,

unless the petition was filed while the subject of the petition was

an inpatient at a psychiatric hospital, in which case the hearing

shall be convened within 7 days of the filing of the petition.

     Sec. 455. (1) The subject of a petition has the right to be

present at all hearings. This right may be waived by a waiver of

attendance signed by the subject of a petition, witnessed by his or

her legal counsel, and filed with the court or it may be waived in

open court at a scheduled hearing. The subject's right to be

present at a hearing is considered waived by the subject's failure

to attend the hearing after receiving notice required by section

453 and any applicable court rule, providing the subject has had an

opportunity to consult with counsel as required under section 454.

The court may exclude the subject from a hearing if the subject's

behavior at the hearing makes it impossible to conduct the hearing.

The court shall enter on the record its reasons for excluding the

subject of a petition from the hearing. The subject's presence may

be waived by the court if there is testimony by a physician or

licensed psychologist who has recently observed the subject that

the subject's attendance would expose him or her to serious risk of

physical harm.

     (2) The subject of the petition under section 434, after

consultation with counsel, may stipulate to the entry of any order

for treatment.

     (3) The subject of a petition under section 434 who is

hospitalized pending the court hearing, within 72 hours after the

petition and clinical certificates have been filed with the court,

shall meet with legal counsel, a treatment team member assigned by

the hospital director, a person assigned by the executive director

of the responsible community mental health services program or

other program as designated by the department, and, if possible, a

person designated by the subject of the petition, in order to be

informed of all of the following:

     (a) The proposed plan of treatment in the hospital.

     (b) The nature and possible consequences of commitment

procedures.

     (c) The proposed plan of treatment in the community consisting

of either an alternative to hospitalization or a combination of

hospitalization and alternative assisted outpatient treatment with

hospitalization not to exceed 60 days.

     (d) The right to request that the hearing be temporarily

deferred, with a continuing right to demand a hearing during the

deferral period. The deferral period shall be 60 days if the

individual chooses to remain hospitalized, or 90 180 days if the

individual chooses alternative outpatient treatment or a

combination of hospitalization and alternative treatment.

outpatient treatment.

     (4) The person designated by the subject of the petition under

subsection (3) may be any person who is willing and able to attend

the meeting, including a representative of an advocacy group or the

recipient rights adviser of the hospital.

     (5) The hospital in which the subject of a petition under

section 434 is hospitalized shall notify the participants of the

meeting required by subsection (3).

     (6) The subject of a petition under section 434 who is

hospitalized pending the court hearing may file with the court a

request to temporarily defer the hearing for not longer than 60

days if the individual chooses to remain hospitalized, or 90 180

days if the individual chooses alternative outpatient treatment or

a combination of hospitalization and alternative outpatient

treatment. The request shall include a stipulation that the

individual agrees to remain hospitalized and to accept treatment as

may be prescribed for the deferral period, or to accept and follow

the proposed plan of treatment as described in subsection (3)(c)

for the deferral period, or to accept and follow the proposed plan

for outpatient treatment, and further agrees that at any time the

individual may refuse treatment and demand a hearing under section

452. The request to temporarily defer the hearing shall be on a

form provided by the department and signed by the individual in the

presence of his or her legal counsel and shall be filed with the

court by legal counsel.

     (7) Upon receipt of the request and stipulation under

subsection (6), the court shall temporarily defer the hearing.

During the deferral period, both the original petition and the

clinical certificates remain valid. If the hearing is convened, the

court may require additional clinical certificates and information

from the provider. The court shall retain continuing jurisdiction

during the deferral period.

     (8) Upon receipt of a copy of the request to temporarily defer

the hearing under subsection (6), if the individual has agreed to

remain hospitalized, the hospital director shall treat the

individual as a formal voluntary patient without requiring the

individual to sign formal voluntary admission forms. If the

individual, at any time during the period in which the hearing is

being deferred, refuses the prescribed treatment or requests a

hearing, either in writing or orally, treatment shall cease, the

hospitalized individual shall remain hospitalized with the status

of the subject of a petition under section 434, and the court shall

be notified to convene a hearing under section 452(1)(d).

     (9) Upon receipt of a copy of the request to temporarily defer

the hearing under subsection (6), if the individual has agreed to

participate in an alternative to hospitalization in the community,

the hospital director shall release the individual from the

hospital to the alternative outpatient treatment provider. If the

individual, at any time during the deferral period, refuses the

prescribed treatment or requests a hearing, either in writing or

orally, treatment shall cease and the court shall be notified to

convene a hearing under section 452(1)(d). Upon notification, the

court shall, if necessary, order a peace officer to transport the

individual to the hospital where the individual shall remain until

the hearing is convened. The individual shall be given the status

of the subject of a petition under section 434.

     (10) If the individual has remained hospitalized and if, not

earlier than 14 days nor later than 7 days before the expiration of

the deferral period, the hospital director believes that the

condition of the individual is such that he or she continues to

require treatment, and believes that the individual will not agree

to sign a formal voluntary admission request or is considered by

the hospital not to be suitable for voluntary admission, the

hospital director shall notify the court to convene a hearing under

section 452(1)(d).

     (11) If the individual is participating in an alternative to

hospitalization in the community as described in subsection (3)(c)

and if, not earlier than 14 days nor later than 7 days before the

expiration of the deferral period, the executive director of the

community mental health services program responsible for the

treatment that is an alternative to hospitalization believes that

the condition of the individual is such that he or she continues to

require treatment, and believes that the individual will not agree

to accept treatment voluntarily or is considered by the alternative

outpatient treatment program provider not suitable for voluntary

treatment, the executive director shall notify the court to convene

a hearing under section 452(1)(d).

     Sec. 461. (1) Except as otherwise provided in this section, an

An individual may not be found to require treatment unless at least

1 physician or licensed psychologist who has personally examined

that individual testifies in person or by written deposition at the

hearing.

     (2) For a petition filed under section 434(6) that was not

accompanied by, or that has not subsequently been supplemented by,

a psychiatrist's clinical certificate, 434(7), that does not seek

hospitalization before the hearing, an individual may not be found

to require treatment unless a psychiatrist who has personally

examined that individual testifies. A psychiatrist's testimony is

not necessary if a psychiatrist signs the petition. If a

psychiatrist signs the petition, at least 1 physician or licensed

psychologist and 1 psychiatrist who have has personally examined

that individual must testify. in person or by written deposition at

the hearing.The requirement for testimony may be waived by the

subject of the petition. If the testimony given in person is

waived, a clinical certificate completed by a physician, licensed

psychologist, or psychiatrist must be presented to the court before

or at the initial hearing.

     (3) The examinations required under this section for a

petition filed under section 434(6) 434(7) shall be arranged by the

court and the local community mental health services program or

other entity as designated by the department.

     (4) A written deposition may be introduced as evidence at the

hearing only if the attorney for the subject of the petition was

given the opportunity to be present during the taking of the

deposition and to cross-examine the deponent. This testimony or

deposition may be waived by the subject of a petition. An

individual may be found to require treatment even if the petitioner

does not testify, as long as there is competent evidence from which

the relevant criteria in section 401 can be established.

     Sec. 464a. (1) Upon entry of a court order directing that an

individual be involuntarily hospitalized under this chapter or that

an individual involuntarily undergo a program of alternative

treatment or a program of combined hospitalization and alternative

assisted outpatient treatment under this chapter, the court shall

immediately order the department of state police to enter the court

order into the law enforcement information network. The department

of state police shall remove the court order from the law

enforcement information network only upon receipt of a subsequent

court order for that removal.

     (2) The department of state police shall immediately enter an

order described in subsection (1) into the law enforcement

information network or shall immediately remove an order from the

law enforcement information network as ordered by the court under

this section.

     (3) This section does not apply to an order of involuntary

treatment for substance use disorder under chapter 2A.

     Sec. 468. (1) For a petition filed under section 434, if the

court finds that an individual is not a person requiring treatment,

the court shall enter a finding to that effect and, if the person

has been hospitalized before the hearing, shall order that the

person be discharged immediately.

     (2) For a petition filed under section 434, if an individual

is found to be a person requiring treatment, the court shall do 1

of the following:

     (a) Order the individual hospitalized in a hospital

recommended by the community mental health services program or

other entity as designated by the department.

     (b) Order the individual hospitalized in a private or veterans

administration hospital at the request of the individual or his or

her family, if private or federal funds are to be utilized and if

the hospital agrees. If the individual is hospitalized in a private

or Veterans Administration hospital under this subdivision, any

financial obligation for the hospitalization shall be satisfied

from funding sources other than the community mental health

services program, the department, or other state or county funding.

     (c) Order the individual to undergo a program of treatment

that is an alternative to hospitalization and that is recommended

by the community mental health services program or other entity as

designated by the department.

(c) (d) Order the individual to undergo a program of combined

hospitalization and alternative treatment or hospitalization and

assisted outpatient treatment, as recommended by the community

mental health services program or other entity as designated by the

department.

(d) (e) Order the individual to receive assisted outpatient

treatment through a community mental health services program, or

other entity as designated by the department, capable of providing

the necessary treatment and services to assist the individual to

live and function in the community as specified in the order. The

court may include a case management plan and case management

services and 1 or more of the following:

     (i) Medication.

     (ii) Blood or urinalysis tests to determine compliance with or

effectiveness of prescribed medication.

     (iii) Individual or group therapy, or both.

     (iv) Day or partial day programs.

     (v) Educational or vocational training.

     (vi) Supervised living.

     (vii) Assisted Assertive community treatment team services.

     (viii) Substance use disorder treatment.

     (ix) Substance use disorder testing for individuals with a

history of alcohol or substance use and for whom that testing is

necessary to assist the court in ordering treatment designed to

prevent deterioration. A court order for substance use testing is

subject to review hearing once every 180 days.

     (x) Any other services prescribed to treat the individual's

mental illness and either to assist the individual in living and

functioning in the community or to help prevent a relapse or

deterioration that may reasonably be predicted to result in suicide

or the need for hospitalization.

     (3) In developing an assisted outpatient treatment plan, a

psychiatrist shall supervise the preparation and implementation of

the assisted outpatient treatment plan. The assisted outpatient

treatment plan shall be completed within 30 days after entry of the

court's order of assisted outpatient treatment and a copy shall be

forwarded to the probate court for filing within 3 days after

completion of the plan to be maintained in the court file.

(4) (3) In developing an assisted outpatient treatment order,

the court shall consider any preference or medication experience

reported by the individual or his or her designated representative,

whether or not the individual has an existing individual plan of

services under section 712, and any direction included in a durable

power of attorney or advance directive that exists.

(5) (4) Before an order of assisted outpatient treatment

expires, if the individual has not previously designated a patient

advocate or executed a durable power of attorney or an advance

directive, the responsible community mental health services program

or other entity as designated by the department shall ascertain

whether the individual desires to establish a durable power of

attorney or an advance directive. If so, the community mental

health services program or other entity as designated by the

department shall direct the individual to the appropriate community

resource for assistance in developing a durable power of attorney

or an advance directive.

(6) (5) If an order for assisted outpatient treatment

conflicts with the provisions of an existing durable power of

attorney, advance directive, or individual plan of services

developed under section 712, the assisted outpatient treatment

order shall be reviewed for possible adjustment by a psychiatrist

not previously involved with developing the assisted outpatient

treatment order. If an order for assisted outpatient treatment

conflicts with the provisions of an existing advance directive,

durable power of attorney, or individual plan of services developed

under section 712, the court shall state the court's findings on

the record or in writing if the court takes the matter under

advisement, including the reason for the conflict.

     Sec. 469a. (1) Except for a petition filed as described under

section 434(6), 434(7), before ordering a course of treatment for

an individual found to be a person requiring treatment, the court

shall review a report on alternatives to hospitalization that was

prepared under section 453a not more than 15 days before the court

issues the order. After reviewing the report, the court shall do

all of the following:

     (a) Determine whether a treatment program that is an

alternative to hospitalization or that follows an initial period of

hospitalization is adequate to meet the individual's treatment

needs and is sufficient to prevent harm that the individual may

inflict upon himself or herself or upon others within the near

future.

     (b) Determine whether there is an agency or mental health

professional available to supervise the individual's alternative

treatment program.

     (c) Inquire as to the individual's desires regarding

alternatives to hospitalization.

     (2) If the court determines that there is a treatment program

that is an alternative to hospitalization that is adequate to meet

the individual's treatment needs and prevent harm that the

individual may inflict upon himself or herself or upon others

within the near future and that an agency or mental health

professional is available to supervise the program, the court shall

issue an order for alternative assisted outpatient treatment or

combined hospitalization and alternative assisted outpatient

treatment in accordance with section 472a. The order shall state

the community mental health services program or, if private

arrangements have been made for the reimbursement of mental health

treatment services in an alternative setting, the name of the

mental health agency or professional that is directed to supervise

the individual's alternative assisted outpatient treatment program.

The order may provide that if an individual refuses to comply with

a psychiatrist's order to return to the hospital, a peace officer

shall take the individual into protective custody and transport the

individual to the hospital selected.

     (3) If the court orders assisted outpatient treatment as the

alternative to hospitalization, the order shall be consistent with

the provisions of section 468(2)(e).468(2)(d).

     Sec. 472a. (1) Upon the filing of a petition under section 434

and a finding that an individual is a person requiring treatment,

the court shall issue an initial order of involuntary mental health

treatment that shall be limited in duration as follows:

     (a) An initial order of hospitalization shall not exceed 60

days.

     (b) Except as provided in subdivision (d), an initial order of

alternative treatment shall not exceed 90 days.

     (c) Except as provided in subdivision (e), an initial order of

combined hospitalization and alternative treatment shall not exceed

90 days. The hospitalization portion of the initial order shall not

exceed 60 days.

(b) (d) An initial order of assisted outpatient treatment

shall not exceed 180 days.

(c) (e) An initial order of combined hospitalization and

assisted outpatient treatment shall not exceed 180 days. The

hospitalization portion of the initial order shall not exceed 60

days.

     (2) Upon the receipt of a petition under section 473 before

the expiration of an initial order under subsection (1) and a

finding that the individual continues to be a person requiring

treatment, the court shall issue a second order for involuntary

mental health treatment that shall be limited in duration as

follows:

     (a) A second order of hospitalization shall not exceed 90

days.

     (b) A second order of alternative treatment or assisted

outpatient treatment shall not exceed 1 year.

     (c) A second order of combined hospitalization and alternative

treatment or hospitalization and assisted outpatient treatment

shall not exceed 1 year. The hospitalization portion of the second

order shall not exceed 90 days.

     (3) Upon the receipt of a petition under section 473 before

the expiration of a second order under subsection (2) and a finding

that the individual continues to be a person requiring treatment,

the court shall issue a continuing order for involuntary mental

health treatment that shall be limited in duration as follows:

     (a) A continuing order of hospitalization shall not exceed 1

year.

     (b) A continuing order of alternative treatment or assisted

outpatient treatment shall not exceed 1 year.

     (c) A continuing order of combined hospitalization and

alternative treatment or hospitalization and assisted outpatient

treatment shall not exceed 1 year. The hospitalization portion of a

continuing order for combined hospitalization and alternative

treatment or hospitalization and assisted outpatient treatment

shall not exceed 90 days.

     (4) Upon the receipt of a petition under section 473 before

the expiration of a continuing order of involuntary mental health

treatment, including a continuing order issued under section 485a

or a 1-year order of hospitalization issued under former section

472, and a finding that the individual continues to be a person

requiring treatment, the court shall issue another continuing order

for involuntary mental health treatment as provided in subsection

(3) for a period not to exceed 1 year. The court shall continue to

issue consecutive 1-year continuing orders for involuntary mental

health treatment under this section until a continuing order

expires without a petition having been filed under section 473 or

the court finds that the individual is not a person requiring

treatment.

     (5) If a petition for an order of involuntary mental health

treatment is not brought under section 473 at least 14 days before

the expiration of an order of involuntary mental health treatment

as described in subsections (2) to (4), a person who believes that

an individual continues to be a person requiring treatment may file

a petition under section 434 for an initial order of involuntary

mental health treatment as described in subsection (1).

     Sec. 473. Not less than 14 days before the expiration of an

initial, second, or continuing order of involuntary mental health

treatment issued under section 472a or section 485a, a hospital

director or an agency or mental health professional supervising an

individual's alternative treatment or assisted outpatient treatment

shall file a petition for a second or continuing order of

involuntary mental health treatment if the hospital director or

supervisor believes the individual continues to be a person

requiring treatment and that the individual is likely to refuse

treatment on a voluntary basis when the order expires. The petition

shall contain a statement setting forth the reasons for the

hospital director's or supervisor's or their joint determination

that the individual continues to be a person requiring treatment, a

statement describing the treatment program provided to the

individual, the results of that course of treatment, and a clinical

estimate as to the time further treatment will be required. The

petition shall be accompanied by a clinical certificate executed by

a psychiatrist.

     Sec. 474. (1) If an individual is subject to a combined order

of hospitalization and either alternative treatment or assisted

outpatient treatment, the decision to release the individual from

the hospital to the alternative treatment program or assisted

outpatient treatment program shall be a clinical decision made by a

psychiatrist designated by the hospital director in consultation

with the director of the alternative treatment program or the

assisted outpatient treatment program. If the hospital is operated

by or under contract with the department or a community mental

health services program and private payment arrangements have not

been made, the decision shall be made in consultation with the

treatment team designated by the executive director of the

community mental health services program. If an individual is

subject to an order of assisted outpatient treatment, the decision

to release the individual from the assisted outpatient treatment

program shall be a clinical decision made by a psychiatrist

designated by the director of the assisted outpatient treatment

program. Notice of the return of the individual to the alternative

treatment program or to the assisted outpatient treatment program

shall be provided to the court with a statement from a psychiatrist

explaining the belief that the individual is clinically appropriate

for alternative treatment or assisted outpatient treatment. At

least 5 days before releasing an individual from the hospital to

the alternative treatment program or assisted outpatient treatment

program, the hospital director shall notify the agency or mental

health professional that is responsible to supervise the

individual's alternative treatment program or assisted outpatient

treatment program that the individual is about to be released. The

hospital shall share relevant information about the individual with

the supervising agency or professional for the purpose of providing

continuity of treatment.

     (2) If there is a disagreement between the hospital and the

executive director regarding the decision to release the individual

to the alternative treatment program or assisted outpatient

treatment program, either party may appeal in writing to the

department director within 24 hours of the decision. The department

director shall designate the psychiatrist responsible for clinical

affairs in the department, or his or her designee, who shall also

be a psychiatrist, to consider the appropriateness of the release

and make a decision within 48 hours after receipt of the written

appeal. Either party may appeal the decision of the department to

the court in writing within 24 hours after the department's

decision.

     (3) If private arrangements have been made for the

reimbursement of mental health treatment services in an alternative

setting and there is a disagreement between the hospital and the

director of the alternative treatment program or assisted

outpatient treatment program regarding the decision to release the

individual, either party may petition the court for a determination

of whether the individual should be released from the hospital to

the alternative treatment program or assisted outpatient treatment

program.

     (4) The court shall make a decision within 48 hours after

receipt of a written appeal under subsection (2) or a petition

under subsection (3). The court shall consider information provided

by both parties and may appoint a psychiatrist to provide an

independent clinical examination.

     Sec. 474a. During the period of an order of combined

hospitalization and alternative assisted outpatient treatment or

combined hospitalization and assisted outpatient treatment,

hospitalization may be used as clinically appropriate and when

ordered by a psychiatrist, for up to the maximum period for

hospitalization specified in the order. Subject to section 475, the

decision to hospitalize the individual shall be made by the

director of the alternative treatment program or assisted

outpatient treatment program, who shall notify the court when the

individual is hospitalized. The notice to the court shall include a

statement from a psychiatrist explaining the need for

hospitalization.

     Sec. 475. (1) During the period of an order for alternative

assisted outpatient treatment or combined hospitalization and

alternative assisted outpatient treatment, if the agency or mental

health professional who is supervising an individual's alternative

assisted outpatient treatment program determines that the

individual is not complying with the court order or that the

alternative assisted outpatient treatment has not been or will not

be sufficient to prevent harm that the individual may inflict on

himself or herself or upon others, then the supervising agency or

mental health professional shall notify the court immediately. If

the individual believes that the alternative assisted outpatient

treatment program is not appropriate, the individual may notify the

court of that fact.

     (2) If it comes to the attention of the court that an

individual subject to an order of alternative assisted outpatient

treatment or combined hospitalization and alternative assisted

outpatient treatment is not complying with the order, that the

alternative assisted outpatient treatment has not been or will not

be sufficient to prevent harm to the individual or to others, or

that the individual believes that the alternative assisted

outpatient treatment program is not appropriate, the court may do

either of the following without a hearing and based upon the record

and other available information:

     (a) Consider other alternatives to hospitalization and modify

the order to direct the individual to undergo another program of

alternative assisted outpatient treatment for the duration of the

order.

     (b) Modify the order to direct the individual to undergo

hospitalization or combined hospitalization and alternative

assisted outpatient treatment. The duration of the hospitalization,

including the number of days the individual has already been

hospitalized if the order being modified is a combined order, shall

not exceed 60 days for an initial order or 90 days for a second or

continuing order. The modified order may provide that if the

individual refuses to comply with the psychiatrist's order to

return to the hospital, a peace officer shall take the individual

into protective custody and transport the individual to the

hospital selected.

     (3) During the period of an order for assisted outpatient

treatment or a combination of hospitalization and assisted

outpatient treatment, if the agency or mental health professional

who is supervising an individual's assisted outpatient treatment

determines that the individual is not complying with the court

order, the supervising agency or mental health professional shall

notify the court immediately.

     (4) If it comes to the attention of the court that an

individual subject to an order of assisted outpatient treatment or

a combination of hospitalization and assisted outpatient treatment

is not complying with the order, the court may require 1 or more of

the following, without a hearing:

     (a) That the individual be taken to the preadmission screening

unit established by the community mental health services program

serving the community in which the individual resides.

     (b) That the individual be hospitalized for a period of not

more than 10 days.

     (c) Upon recommendation by the community mental health

services program serving the community in which the individual

resides, that the individual be hospitalized for a period of more

than 10 days, but not longer than the duration of the order for

assisted outpatient treatment or a combination of hospitalization

and assisted outpatient treatment, or not longer than 90 days,

whichever is less.

     (5) The court may direct peace officers to transport the

individual to a designated facility or a preadmission screening

unit, as applicable, and the court may specify conditions under

which the individual may return to assisted outpatient treatment

before the order expires.

     (6) An individual hospitalized without a hearing as provided

in subsection (4) may object to the hospitalization according to

the provisions of section 475a.

     Sec. 475a. (1) If an individual is hospitalized without a

hearing after placement in an alternative assisted outpatient

treatment program, the individual has a right to object to the

hospitalization. Upon transfer of the individual to the hospital,

the hospital shall notify the individual of his or her right to

object under this section.

     (2) Upon receipt of an objection to a hospitalization under

section subsection (1), the court shall schedule a hearing for a

determination that the individual requires hospitalization.

     Sec. 477. (1) A person responsible for providing treatment to

an individual ordered to undergo a program of alternative assisted

outpatient treatment or a program of combined hospitalization and

alternative assisted outpatient treatment may terminate the

treatment to the individual if the provider of the treatment

considers the individual clinically suitable for termination of

treatment, and shall terminate the treatment when the individual's

mental condition is such that he or she no longer meets the

criteria of a person requiring treatment.

     (2) Upon termination of alternative assisted outpatient

treatment or combined hospitalization and alternative assisted

outpatient treatment, the court shall be notified by the provider

of the treatment.

     Sec. 478. If, upon the discharge of a patient hospitalized by

court order or the termination of alternative assisted outpatient

treatment to an individual receiving alternative assisted

outpatient treatment pursuant to under this chapter, it is

determined that the individual would benefit from the receipt of

further treatment, the hospital or provider of alternative assisted

outpatient treatment shall offer him or her appropriate treatment

on a voluntary basis, or shall aid him or her to obtain treatment

from another source.

     Sec. 482. Each individual subject to a 1-year order of

involuntary mental health treatment has the right to adequate and

prompt review of his or her current status as a person requiring

treatment. Six months from the date of a 1-year order of

involuntary mental health treatment, the executive director of the

community mental health services program responsible for treatment

or, if private arrangements for the reimbursement of mental health

treatment services have been made, the hospital director or

director of the alternative assisted outpatient treatment program

shall assign a physician or licensed psychologist to review the

individual's clinical status as a person requiring treatment.

     Sec. 489. (1) No determination that a person requires

treatment, no order of court authorizing hospitalization or

alternative assisted outpatient treatment, nor any form of

admission to a hospital shall give gives rise to a presumption of,

constitute constitutes a finding of, or operate operates as an

adjudication of legal incompetence.

     (2) No order of commitment under any previous statute of this

state, shall, in the absence of a concomitant appointment of a

guardian, constitute constitutes a finding of or operate operates

as an adjudication of legal incompetence.

     Enacting section 1. This amendatory act takes effect 90 days

after the date it is enacted into law.