The Kalamazoo Community Mental Health and Substance Abuse Services are designed to provide assistance for the individual with a mental health or substance abuse problem. The Kalamazoo Community Mental Health and Substance Abuse Services - Access Center, is located at 418 W. Kalamazoo Avenue, Kalamazoo, Michigan 49007 (1-888-373-6200 (toll free) or (269) 373-6000) (http://www.kazoocmh.org).
Voluntary and Involuntary Hospitalization:
It is always preferable for someone to be hospitalized voluntarily, if possible. Anticipating crisis situations and developing a plan ahead of time may facilitate voluntary hospitalization. Even after an application or petition for involuntary hospitalization has been initiated, formal commitment can be avoided if the person agrees to cooperate with the treatment plan proposed at the deferral meeting held soon after admission to the hospital.
In order for a person to be involuntarily hospitalized, they must meet the Michigan Mental Health Code definition of a "person requiring treatment." A person may be seriously mentally ill and still not fit that definition. The Probate Court, based on statements made by the person initiating the proceedings and by either two physicians or one physician and one clinical psychologist, makes the determination as to whether the individual is a person requiring treatment.
A recent amendment to the Mental Health Code ("Kevin's Law, 2004) allows involuntary outpatient treatment for a person who "as a result of mental illness, is unlikely to voluntarily participate in treatment" and in addition specifies that, "For a judge to order treatment, an individual must have been hospitalized, jailed, imprisoned, or have acted violently within the previous two years."
The Michigan Mental Health Code defines mental illness as "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." Mental illness alone, however, is not sufficient to justify involuntary hospitalization. The Mental Health Code defines "person requiring treatment" as follows:
330.1401 "Person requiring treatment" defined; exception. Sec. 1401.
(1) As used in this chapter, "person requiring treatment" means (a), (b), or (c):
- 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 or another individual, and who has engaged in an act or acts or made significant threats that are substantially supportive of the expectation.
- 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.
- An individual who has mental illness, whose judgment is so impaired that he or she is unable to understand his/her need for treatment and whose continued behavior as the result of this mental illness can reasonably be expected, on the basis of competent medical opinion, to result in significant physical harm to himself or herself or others. This individual shall receive involuntary mental health treatment initially only under the provisions of section 434 through 438 of this act.
(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 the hospital director considers him or her clinically suitable for hospitalization.
Any person 18 years or older may file a petition/application which asserts that an individual is a person requiring treatment. This may be a family member, friend, mental health worker, police officer, or any adult who has direct knowledge on which to base their assertion that the person requires treatment.
Admission by Application
A relative, mental health worker, police officer or other person may take a person who appears to be mentally ill to a physician, hospital or pre-admission screening unit of the Kalamazoo Community Mental Health and Substance Abuse Services - Access Center at 418 W. Kalamazoo Avenue, Kalamazoo, Michigan 49007 for assessment. A Petition/Application for Hospitalization referred to as (Application) for this method of admission must be completed.
The form requires examples of recent behaviors which have been directly observed by the person filling out the form, and why the individual needs to be hospitalized. (See Section 401 criteria.) The form must also include the names and addresses of witnesses and the name and address of the person's nearest relative, guardian or friend. The form may be obtained through Probate Court or at the Kalamazoo Community Mental Health and Substance Abuse Services - Access Center at 418 W. Kalamazoo Avenue, Kalamazoo, Michigan 49007 (1-888-373-6200 (toll free) or 269-373-6000.
A physician or clinical psychologist will examine the individual. If the doctor finds that the individual meets the criteria for admission, he/she will fill out a Clinical Certificate stating that the person examined required treatment. The individual will then be admitted to a hospital and a psychiatrist will complete a second assessment and Clinical Certificate.
If the mental health professional that conducts the preadmission screening denies hospitalization, the relative or other involved person may request a second opinion and an additional evaluation will be performed as soon as possible.
Within 72 hours of admission, excluding Sundays and holidays, the individual will have a deferral meeting in the hospital and be assigned representation by a lawyer. The patient may also designate a friend or relative to attend. At this meeting, a representative from the Kalamazoo Community Mental Health and Substance Abuse Services Access Center and one from the hospital will present a proposed treatment plan. If the person agrees to cooperate with this plan, he/she is accepted as a voluntary patient. However, if at any time during the course of treatment the person refuses to accept the agreed-on treatment, the hospital may notify the Probate Court and a court hearing will be held on the original application.
The hearing will be held within 7 days of the date that all necessary forms are received by the Probate Court. It will be necessary for the individual who signed the application to be in court in order to testify about the person's behavior.
Admission by Petition
A Petition/Application for Hospitalization referred to as (Petition) for this method of admission, must be completed. See section on Admission by Application for further details.)
The main difference between the Application procedure and by filing by Petition, the Petition/Application for Hospitalization is filed directly with the Probate Court. However, in Kalamazoo, all admissions by Petition must be screened prior to the filing with the Court by Kalamazoo Community Mental Health and Substance Abuse Services Access Center. A Clinical Certificate should accompany the Petition/Application for Hospitalization, but if it is not possible to obtain one, the Probate Court can order (by police transport if necessary) the person to be examined by a psychiatrist and either another physician or a clinical psychologist. If the person is found to be a person requiring treatment, there will be a deferral meeting. Then, a court hearing will be held within 7 days after the Probate Court receives the necessary forms, if the person does not agree to defer the hearing and accept the treatment plan as outlined in the individual's plan of service.
Admission to a hospital by petition is of course limited to the availability of a judge, which in most communities means weekdays between 8:00 a.m. and 5:00 p.m.
Since the interpretation of "potentially dangerous to self or others" and "unable to care for basic physical needs such as food, clothing or shelter" varies, it may be difficult to obtain admission to the hospital even in an obvious emergency. Families may need to be assertive. Respect the fact that, as family, you know your relative better than anyone and are your relative's strongest advocate. Do not hesitate to continue to pursue what you believe to be in his/her best interest. It may help to have someone along who has experience with commitment procedures. The National Alliance for Mental Illness (NAMI) at 517-485-4049 or http://namimi.org may provide assistance. A police officer who has responded to a crisis can be helpful by assisting in getting the individual to the hospital and being a witness at the court hearing.
If you fill out the application, and later when you testify at the hearing, it is important to be specific and give concrete examples of ways the behavior is dangerous to the mentally ill person or others. Avoid "second hand" information. Don't diagnose (e.g., "he acts paranoid; hallucinates; appears depressed"). In your statement, try to demonstrate the risk at the present time. Some examples of how to describe the situation are: "She sits in a darkened room all day and won't eat anything except coffee. She leaves notes around the house saying she doesn't want to go on living. Here is such a note." Or, "He threw a jar of mayonnaise at me, and if I had not ducked I could been seriously hurt. He has done similar things to other family members." "He threw a chair at his sister." "He drives his car recklessly, endangering people, backing out of the driveway without looking, hitting fences and curbs."
Initiating procedures for involuntary treatment can be extremely difficult for families, who love their relative and respect his/her right to self-determination. A family member's role in making application is, in effect, simply describing the behavior that they believe indicates the need for and right to treatment. The Mental Health Code exists to protect an individual's rights. The Probate Court, taking into consideration the information provided by mental health professionals, ultimately makes the decision as to whether the person requires treatment.