When a person experiences a mental illness and/or disturbance(s) of thought and/or action(s)that cause him or her to experience impaired judgment, loss of discipline or control, and their perceptions of reality are such that he or she may become a danger to himself or herself and other people, something needs to be done. If this person is unwilling to accept treatment, it may be necessary to seek an involuntary referral or commitment to a mental health or psychiatric facility, where their condition can be assessed and treated.
What is Mental Illness and What Help Exists to Address it?
New Jersey defines “mental illness” as “a current, substantial disturbance of thought, mood, perception or orientation which significantly impairs judgment, capacity to control behavior or capacity to recognize reality”. “Mental illness” in New Jersey includes all conditions that result in a level of severe impairment as described above. Mental illness does not include by definition simple alcohol intoxication, a temporary reaction to drugs, or what our state calls “organic brain syndrome or developmental disability” unless the disability results in the severity of impairment described in our statute(s).
Mental impairment and neurological impairment can also qualify as mental illness in NJ. Below are the definitions of mental impairment and neurological impairment that apply to a person under the laws of NJ.
“Mental impairment” means impairment in cognitive, neurological, sensory, or cerebral functioning resulting from causes other than mental illness.
“Neurological Impairment (NI)” means a severe central nervous system disorder.
Involuntary Confinement Requires Severe Mental Illness
Just because someone has a mental illness doesn’t necessarily mean they need to be admitted for inpatient or outpatient evaluation and/or treatment. There must be more. Mental illness requires a reasonable conclusion of imminent “danger” or a “dangerous” condition confronting a person when placement and treatment is being considered for that individual.
The Division of Mental Health operates New Jersey’s state psychiatric hospitals. It is here where in-patient treatment is provided to people with major psychiatric illnesses. There are five hospitals, including Greystone, Trenton State, Ancora, Garrett Gagedorn, and Ann Klein. If a family member or person of significance in your life has been involuntarily committed, they likely have been committed to one of these five institutions or one of several smaller institutions run by the State of New Jersey. Placement to one of these hospitals is called a “civil commitment”. There are six other smaller hospitals, namely Bergen Regional, Buttonwood, Camden County Health Services, Essex County, Runnells, and Meadowview. Each of these six smaller institutions is a voluntary psychiatric facility. If you believe (or have personal knowledge) your loved one has not voluntarily committed himself/herself to the voluntary care of a hospital but suspect an (in)appropriate involuntary civil commitment, or you believe they may be treated with inappropriate medication, call Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com to schedule a confidential appointment with a member of the office to discuss what can be done.
If someone close to you has been institutionally committed or is presently being treated at a community hospital that is planning to transfer him or her to a state psychiatric hospital, we can also help. A person has a legal right to be placed in the least restrictive environment appropriate to his or her condition.
If you are a caregiver, guardian, or power of attorney for a loved one with a mental illness, make an appointment to speak with Fredrick P. Niemann, Esq. or a member of his office as soon as possible to discuss your options for ensuring he or she receive(s) suitable care in the least restrictive environment. If you are a caregiver exhausted by your responsibilities, respite relief may be available to you. Let Hanlon Niemann & Wright assist you with your respite options. You can reach Mr. Niemann and his office toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.
Legal Statutes Governing Involuntary Commitments in NJ
Title 30:4-27 of the New Jersey statutes address involuntary commitments, the process for an involuntary commitment and personal rights of an individual subject to an involuntary commitment, and the initiation of court proceedings for the involuntary commitment of a person.
Bringing in the Police for Help
If a person’s behavior has escalated to a point where you believe that there is immediate danger, call your local police department. If they consider it necessary, the police will arrest the person, and have a certified screening service assess the need to get a court order filed for this person’s involuntary commitment. This court order does not mean that the person will be transferred to a psychiatric facility. Instead, the court order may call for the person to be placed for outpatient and psychiatric treatment(s). A deliberate or unintentional failure to attend these sessions may thereafter cause the person to be committed to a facility for inpatient treatment.
The Medical Screening Process If the Police Are Not Called In
If law enforcement has not been involved, yet a medical professional(s) or a mental health screening service deems a person’s behavior to be sufficiently troubling, the person may be detained by a facility, without a court order, for up to 48 hours. Independent screening certificates must be signed by two professionals, one of whom must be a psychiatrist. If there is a need to detain the person for longer than 48 hours, a court order must be obtained. Situations that may cause concern for a person’s mental health often arise from: hospitalization for physical issues, when a patient displays erratic behavior, effects of substance abuse treatment, where a person relapses and experiences mental health issues; and through families reporting evidence of severe mental health issues to the person’s general physician or treatment specialists.
Required Medical Proofs for an Involuntary Commitment
N.J.S.A. 30:4-27.15(a) authorizes a court to continue an individual’s involuntary commitment past a temporary commitment order, so long as “the court finds by clear and convincing evidence that the patient requires continued involuntary commitment”. The statute defines “in need of involuntary commitment to treatment” as “an adult with mental illness, whose mental illness causes the person to be dangerous to self or dangerous to others or property and who is unwilling to accept appropriate treatment voluntarily after it has been offered.” Under N.J.S.A. 30:4-27.2(m), “dangerous to self” is defined as:
{B}y reason of mental illness the person has threatened or attempted suicide or serious bodily harm, or has behaved in such a manner as to indicate that the person is unable to satisfy his need for nourishment, essential medical care or shelter, so that it is probable that substantial bodily injury, serious physical harm or death will result within the reasonably foreseeable future; however, no person shall be deemed to be unable to satisfy his need for nourishment, essential medical care or shelter if he is able to satisfy such needs with the supervision and assistance of others who are willing and available. This determination shall take into account a person’s history, recent behavior and any recent act, threat or serious psychiatric deterioration.
The Legal Process to Obtain an Involuntary Commitment
How Does New Jersey Determine if Someone Needs “Treatment”?
To determine if someone needs inpatient or outpatient treatment provided by our state, reliance upon doctors and psychologists in screening centers is the first step in examining the person to determine if they are a danger to themselves, to property or to others.
How Does New Jersey Determine Who is Dangerous to Himself or Herself?
In New Jersey, someone is “dangerous to themselves” if, because “of mental illness, the person has threatened or attempted suicide or serious bodily harm”, or has behaved in a way that “indicate[s] that the person is unable to satisfy his or her need for nourishment, essential medical care or shelter so that it is probable that substantial bodily injury, serious physical harm or death will result within the reasonably foreseeable future”. If your family member is safe when they are with you, and he or she is not a danger to others, then they are exempted from this definition. To determine if your loved one is not a danger to him or herself, the state says we must “take into account the person’s history, recent behavior, and any recent act, threat or serious psychiatric deterioration.”
How Does New Jersey Determine if Someone is Dangerous to Others?
In New Jersey, someone is “dangerous to others” if, because of their illness, “there is a substantial likelihood that the person will inflict serious bodily harm upon another person” in the reasonably foreseeable future, taking into account “a person’s history, recent behavior, and any recent act, threat or serious psychiatric deterioration.”
How Does New Jersey Determine if Someone is Dangerous to Property?
New Jersey uses the same test as it does to determine if someone is dangerous to others: is there a “substantial likelihood” that the person will “cause serious property damage in the reasonably foreseeable future”, taking into account “a person’s history, recent behavior, and any recent act, threat or serious psychiatric deterioration.”
How Will a Person be Treated if They are a Danger to Self or Others?
If the answer to any of the three questions listed above is yes, treatment is an option. Treatment may be inpatient or outpatient, voluntary or involuntary. Sometimes a person may get assistance instead of treatment because in New Jersey, everyone has the right to be treated in the least restrictive environment.
N.J. Superior Court Rule 4:74-7 details the specific procedure(s) for obtaining an involuntary commitment. Upon commitment to a psychiatric facility, the person is initially held for up to three days. If further assessment is required, he or she can be held for a further period, but the confined person is entitled to a court hearing within 20 days of their entry into the facility, to determine if there is a continued need for commitment. The patient is also entitled to attorney representation, the right to attend the hearing, present evidence, and cross-examine witnesses. The court must be in possession of convincing evidence to warrant extending this period of commitment.
NJ court rules require that a professional witness who testifies and offers an opinion for or against involuntary commitment must possess sufficient expertise to offer the testimony. Before such a witness is able to testify, the court must establish the witness has the requisite expertise and specialized knowledge about mental health.
In addition, when seeking a final order for involuntary commitment, the state’s application must be supported by the oral testimony of a psychiatrist.
As stated above, to involuntarily commit a person, the state must prove the person is afflicted with a mental illness that causes the person to be dangerous to himself, others, or property. Generally, such proof requires medical (expert) testimony. In a recent case, the patient’s attorney did not stipulate that the medical doctor offered by the state was qualified to testify as an expert in this matter. Thus, the state was required to introduce evidence of his qualifications and the court was obligated to make a finding about these qualifications, positive or otherwise. As a result of the state’s omission, the court could not make the requisite findings to impose any involuntary commitment.
In addition, even if a doctor is properly qualified, he or she cannot merely testify it is “possible” plaintiff’s mental illness made him or her a danger to others. That opinion is insufficient to establish by clear and convincing evidence that the plaintiff needs involuntary commitment. To establish that his or her illness made him or her a danger to others requires expert testimony couched in terms of reasonable medical probability.
Watch my video on Families with Minor Children Who Have Special Needs and Disabilities
Watch my video on Drug Addiction and Mental Illness
Understanding How the Civil Commitment Process Works, Both Voluntary and Involuntary
Let’s Learn Three Important Terms Frequently Used in the Civil Commitment Process
Voluntary Commitment is treatment provided on a voluntary basis at a hospital, at a short-term care facility, a psychiatric facility or a special psychiatric hospital, either in an inpatient or outpatient setting. Voluntary means the person understands they are a danger to themselves, to others or to property, and agrees to be admitted to a short-term care facility for stabilization and treatment.
Involuntary Commitment is when an individual whose mental illness “causes the person to be dangerous to self, or dangerous to others or property” and “is unwilling to accept appropriate treatment voluntarily after it has been offered“. Involuntary commitment can be in a hospital, at a short-term care facility, a psychiatric facility or a special psychiatric hospital. It is important to understand that Involuntary Commitments must be reviewed, and approved, by a Superior Court Judge sitting in each county.
Crisis Stabilization means screening, sometimes followed by admission to a hospital, short-term treatment, and monitoring followed by discharge back into the community, discharge into an outpatient program, or transfer into an involuntary commitment. Most crisis stabilization occurs in a short-term admission to a hospital, through an emergency room or a screening center. Once your family member has been screened, they will be transferred to a facility that can provide short-term care. A list of those facilities is available at this link: Mental Health Directory.pdf (state.nj.us)
How the Process Begins
Civil Commitments usually begin when a person is hospitalized or presents to a screening center. If the hospital’s medical staff determines you or a family member are a danger to himself/herself or to others, or to property, the staff can begin civil commitment proceedings. These proceedings take place in the hospital. They usually start when a suspected ill person says they want to leave. That starts a clock, when the hospital must get a court order for a temporary involuntary commitment. How long the hospital has to get this order depends on whether a person has consented to treatment previously or not, but regardless, it is short, 72 hours or less.
The hospital has to have a psychiatrist sign off on the screening, has to have a second psychiatrist sign off on the state’s screening certificate, and has to request a temporary commitment and obtain a court order to keep a person confined beyond that time.
Once someone is “temporarily committed”, they have the right to have another hearing, before a Superior Court Judge, no longer than 20 days after the initial commitment occurs. Until then, the commitment will continue until the Judge agrees the person is no longer a danger, whereupon they will be put on what is known as “CEEP” status, and a social worker will begin looking for an appropriate out-placement for him or her.
The term “CEEP” means a “conditional extension pending placement”. Translated, it means the hospital thinks your family member can leave, but the social worker has not yet determined whether your family member can or should come home or transition to a residential placement setting, or be referred to an outpatient setting.
If someone important to you has been civilly committed, call to make an immediate appointment with Fredrick P. Niemann, Esq., to protect his or her rights.
Legal Documents That Will Help Individuals That Are Assisting Others with Mental Illness
The Benefits of an Advance Directive for Mental Health
An Advance Directive for Mental Health, or a Psychiatric Advance Directive, is an available document to use with your health care providers about what kinds of mental health treatment a person will or will not be allowed to provide if a psychotic episode occurs. This legal document “speaks” for a person if they become mentally ill and incapable of making mental health and related decisions. These documents are private – no one must know about it or its contents unless the signator wants it disclosed conditionally or unconditionally. A properly drafted Advance Directive for Mental Health enables an attorney to speak with and advocate for him or her if they are hospitalized involuntarily and will enable the person to exercise as much control as possible over treatment. For more information about Advance Directives for Mental Health, contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com to make an appointment to draft an advance directive for mental health to take back control over your treatment.
The Importance of a Durable Power of Attorney
A Power of Attorney (POA) is a powerful and important document that allows a person to appoint another person to be his/her legal advocate and representative. If a person with the disability is (in general) of sound mind, it is imperative they sign a Power of Attorney naming the person they choose as their agent. The POA is revocable at any time that the person with the disability chooses, but the holder of the POA can use the POA to gain physical access to a confined person if they are institutionalized and in a psychiatric hospital.
To learn more about a Power of Attorney, please visit our dedicated Power of Attorney web page which explains in thorough detail how a Power of Attorney can benefit you and a person who is relying upon your efforts. Click here: https://www.hnwlaw.com/elder-law/durable-power-of-attorney/
Please watch my video on Power of Attorney to Protect Someone from Mental Illness, Abuse, or Addiction
Accessing Services and Public Benefits for Minors and Adults with Mental Illness
Not all disabilities are physical. Individuals with a mental illness are entitled to services from the State of New Jersey through the Division of Mental Health and Addiction Services.
For both minors and adults, the first step to securing services for them is getting them Medicaid. If the mental illness was diagnosed before the age of 22, then we can assist you with SSI and Medicaid based upon a parent’s work history. If the diagnosis was not made until after age 22, and the person has a work history, our focus becomes getting the person qualified under social security disability. Getting SSI or SSDI eligibility can be a difficult and time-consuming process but the end results are almost always well worth it.
If your loved one has been diagnosed with a psychiatric illness, this is a particularly difficult time. People are going into crisis more quickly, and now it is more dangerous than usual to go to a hospital for treatment.
If your loved one goes to a hospital and agrees to a voluntary commitment, it is important he or she (and you) understands their rights.
He or she can take someone with them. Any person with a disability is allowed to bring a medical support person with them to the hospital. Your loved one does not have to go to a hospital alone.
As a support person you cannot stay in the behavioral health portion of the hospital but if you choose to remain in the hospital voluntarily, you can ask that you be kept in contact by telephone while your loved one is speaking with your doctors and nurses.
If your loved one decides he or she does not want to stay there anymore, they (or you) can ask the hospital to allow for discharge. If the person is at the hospital voluntarily, he/she has the right to be discharged after being asked to be. The hospital is required by law to discharge a person within 48 hours, or on the next business day, whichever is first, unless they believe a person is a threat to themselves, to others, or to property. If they want to keep a person in a hospital setting, they have to convert the voluntary status to involuntary, which requires them to get a Court Order from a Judge. If your loved one went to a hospital voluntarily, wants to be discharged, or does not wish to be treated with specific medications or therapies, contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com. Please ask us about our video conferencing or telephone consultations if you are unable to come to our office.
Identifying Your Priorities Prior to Death
For many, the most important thing for the family is securing a safe place for their loved one to live after they are gone. To secure housing, we almost always need Medicaid first, and NJ Family Care can be a good place to start if a person has not previously qualified for access to Medicaid.
Services range from family counseling “Acute Care Family Support” (educating family members about the housing and personal services process) to mental health and substance abuse treatment programs, homelessness prevention, integrated case management, “Intensive Outpatient Treatment Support Services”, the “Program of Assertive Community Treatment”, to voluntary and involuntary commitments.
New Jersey Wants to Help Disabled Persons Get on Their Feet
It is important that the family connect with the Division of Vocational Rehabilitation Services (DVRS) to investigate possible work-related opportunities. There are supportive employers in the state that can be networked.
It is important for a family to understand that individuals with mental illness cannot usually access services from DDD. This is because most individuals with mental illness do not have an intellectual disability as defined under Federal and State law.
Social Security Disability Insurance Benefits & Supplemental Security Income
Some people living with a mental health condition find that there are periods of time when working becomes too difficult, and they can no longer sustain employment. Fortunately, there are two national programs run by the Social Security Administration (SSA) that provide monthly income and health insurance for people unable to work. Here is some information on both programs:
Social Security Disability Insurance Benefits (SSDI)
To qualify for SSDI, you must have an impairment that prevents you from working for at least 12 months and you must have worked and paid into the Social Security program (payroll taxes or FICA) for at least five of the last ten years.
In 2014, the average SSDI monthly benefit was $1,165. However, the amount you receive is directly related to the amount of FICA taxes you have already paid into the FICA system over your working years.
Supplemental Security Income (SSI)
SSI has two programs, one for adults and one for children (up to age 18).
Children: To quality for SSI benefits, children must have an impairment that has lasted or is expected to last for at least 12 months and that causes “marked and severe functional limitations.” The child’s family must have very low income and resources. When the child turns 18, SSA will make a determination regarding whether or not he or she is eligible for SSI adult benefits.
Adults: To qualify for SSI benefits, you must have an impairment that prevents you from working on a regular and sustained basis. In addition, you must have very low income, resources and assets; to be exact, you cannot have more than $2,000 in assets. Spousal rules are in place as well; if you are married, your spouse must also have very low income, resources and assets. A couple may not have more than $3,000 in assets.
In 2015, the federal payment was $733/month for an individual and $1,100/month for a couple. However, the amount depends on several factors, including your living arrangements.
Disability Claims Process
Most Social Security applications are processed through a local SSA office. An attorney with disability claims experience or a Social Security claims representative can help you prepare your application and file it for you. Payment for disability representation is limited by law—no more than 25% of any retroactive SSI or SSDI payments you receive when you are awarded disability, but no more than $6,000—whichever is the lesser amount. Many professionals will agree to only get paid if you win your case.
SSA has detailed information on how disabilities are evaluated, so make sure to read the SSA criteria for your condition. Go to Disability Evaluation Under Social Security. If your condition is not listed, or if you don’t meet all the criteria, try looking at the standards for qualification under other disabilities. Because SSA does not use the same diagnostic system as medical professionals, you might qualify for benefits under a condition other than that which you have been medically diagnosed with.
Typically, it will take three to five months to get a decision on your application. If approved, the SSA will begin paying benefits immediately. Both SSI and SSDI applicants may receive back pay or retroactive benefits based on when the claim was filed, and the date established as the onset of your disability.
Appealing Your Denied Claim
The majority of claims are denied, and most people file an appeal. You may file an appeal and have a hearing before an administrative judge. Many people whose applications were denied are often awarded benefits by these judges. You might wish to consult a Social Security disability benefits attorney or other professional to guide you through the complex hearings and appeals process. It usually takes about 22 months from the time you apply for benefits until you get a hearing.
SSA has important information about appealing decisions on your disability claim or the amount of your payment at Understanding the SSI Appeals Process and SSA Disability Appeal.
Services Provided by the NJ Division of Mental Health and Addiction Services
NJ has a number of contracts with public and private ambulatory care services which provide mental health services including assessment, emergency and referral services to mentally ill persons located within a specified geographical areas. Individuals are screened for consideration of both mental illness and dangerous physical health issues.
What Screening Services Are Available
• Screeners are available to come to a person’s home, provided a family member is there to allow entry.
• Screeners will evaluate anyone requiring involuntary commitment even if it is to a location (community hospital) not designated as a “screening center.
• To locate a county screening center: http://www.state,nj.us/humanservices/dmhas/home/hotlines/MH_Screenin g_Centers.pdf
Involuntary Outpatient Commitment (IOC)
NJ also has in place Involuntary Outpatient Commitment (IOC) programs to coordinate community-based mental health services to individuals, who are court-ordered into mental health treatment. IOC programs enroll individuals who have been assessed by mental health professionals and adjudicated by a court as meeting the legal standard for involuntary outpatient treatment. IOC programs offer court-ordered outpatient mental health treatment; Assistance with linking with community-based mental health services; Monitoring of adherence to the court-ordered plan; Ongoing assessment of clinical progress; Interface with the judiciary including transportation to court hearings and contact with the presiding judge, as needed.
Other Available Options When Confronting Mental Health Issues
New Jersey residents may be eligible for different kinds of programs, treatment or assistance. To determine what is appropriate, the first step is screening.
Screening means the process our state uses to determine if a person is mentally ill and/or dangerous. This usually takes place at one of the “screening centers” where crisis stabilization can occur.
Supportive employment means employment with an employer who understands their employee has a disability. It is a competitive work environment for someone whose severe disability requires them to have intensive, extended support in order to perform their job functions.
Residential services and supportive housing are exactly what they sound like: residential placements for individuals with a mental illness, who may not be able to live safely on their own.
Programs in Assertive Community Treatment (“PACT”) is integrated rehabilitation, treatment, and support services for people living in the community with a serious mental illness. Services may include prescription management, education, career counseling, job seeking skills training, or other kinds of ongoing support. Services may vary by county and provider.
Residential Placement for Person with Mental Illness
Getting a “good” residential placement takes a long time. Think multiple years. So, the earlier you start the process the better. You need to see us as soon as possible.
Having read all or a portion of this site, you likely have questions. At Hanlon Niemann & Wright, we are here to answer those questions and to help you. If we can be of assistance, please reach out to Fredrick P. Niemann, Esq., toll-free at (855) 376-5291 or you can email him at fniemann@hnlawfirm.com. He is very easy to talk to and all discussions are strictly confidential.
Early Intervention Support Services (EISS)
There are early intervention services available throughout the state. These short-term, mental health services are for adults who are experiencing significant emotional or psychiatric distress and are in need of immediate intervention. Early Intervention Support Services offer crisis intervention and crisis stabilization services in a setting that is an alternative to hospital-based emergency room treatment. Outreach (non-office-based) services are available.
Individuals are often enrolled in this program after presenting in an emergency room (ER) with psychological symptoms but do not require hospitalization. EISS allows individuals to schedule an intake session at a community mental health clinic; clinics that often have lengthy waitlists, so it’s an efficient way to “get in line”.
Integrated Case Management Service- ICMS
These services for mental health issues are provided predominantly off-site in the individual’s community environment. Personalized, collaborative, and flexible outreach services are designed to engage and support individuals 18 years of age or older who are severely and persistently mentally ill, and facilitate access to needed mental health, medical, social, educational, vocational, housing, and other services and resources.
• Each county has slightly different eligibility requirements, but all require 2 psychiatric hospitalizations of the individual in the past 18 months.
• The duration of service and stay is typically less than 6 months.
Most times, the placement comes from a social worker during the discharge placement session at the psychiatric hospital.
Program of Assertive Community Treatment-PACT
This program is for the most repetitive and disturbed individual in need of constant help. The program offers comprehensive, integrated rehabilitation, treatment and support services to individuals with serious and persistent mental illness, who have experienced repeated involuntary hospitalizations. The professionals in this program offer highly individualized services, conduct the majority of their contacts in community settings and are available for psychiatric crises 24 hours a day/7 days a week. Service intensity is flexible and regularly adjusted to the needs of the individual and is offered for an unlimited time period.
• Individuals are referred by discharge planners at psychiatric hospitals for individuals who are compliant with treatment/psychiatrist.
• A Psychiatrist/Psychiatric Nurse practitioner routinely visits consumers in place of residence and provides medication monitoring.
Intensive Support Team – RIST
RIST programs support consumers with severe and persistent mental illness and co-occurring consumers to live independently in the community. The treatment team provides on-site support in the consumer’s apartment and in the general community. This program is for individuals who were hospitalized in long-term psychiatric hospitals.
Please contact Fredrick P. Niemann, Esq. today. He can be reached toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.
New Jersey Mental Health Assistance Attorney Serving These Counties:
Monmouth County, Ocean County, Essex County, Cape May County, Camden County, Mercer County, Middlesex County,
Bergen County, Morris County, Burlington County, Union County, Somerset County, Hudson County, Passaic County
Fredrick P. Niemann Esq.