Mental Health

involuntary commitment

When a person experiences mental illness or psychological issues that causes him or her to experience impaired judgment, loss of discipline or their hold on reality, he or she may become a danger to themself and other people.  If this person is unwilling to accept treatment, it may be necessary to seek an involuntary commitment to a psychiatric facility, where their mental condition can be assessed and treated.

Legal Statutes Governing Involuntary Commitments

Title 30:4-27 of the New Jersey statutes address the initiation of court proceedings for the involuntary commitment of a person.

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 needs 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.”  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.

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 witness who testifies on a subject matter beyond fact-finder possess sufficient expertise to offer the testimony. Before such witness may testify, the court must establish the witness has the requisite expertise about such specialized knowledge.

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, to involuntarily commit a party, the state must prove a party is afflicted with a mental illness that causes the party 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 them. As a result of the state’s omission, the court could not make the requisite findings. There is not even any evidence the state’s doctor was a psychiatrist.

In addition, even if a doctor is properly qualified, he or she cannot merely testify it is “possible” plaintiff’s mental illness made her a danger to others. That opinion is insufficient to establish by clear and convincing evidence that the plaintiff needs involuntary commitment. To establish his or her illness made him or her a danger to others requires expert testimony couched in terms of reasonable medical probability.

Bringing in the Police for Help

If a person’s behavior has escalated to a point where you believe that there is an 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 his 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 attend outpatient treatment sessions.  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.

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

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.

If you or a 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 you go to a hospital and agree to voluntary commitment, it is important to understand your rights.

You can take someone with you.  Any person with a disability is allowed to bring a medical support person with them to the hospital. You do not have to go to a hospital alone.

Your support person cannot stay with you in the behavioral health portion of the hospital if you choose to remain in the hospital voluntarily, but you can ask that your support person be present by telephone while you are speaking with your doctors and nurses.

If you decide you do not want to stay there anymore, you can ask the hospital to discharge you.  If you are at the hospital voluntarily, you have the right to be discharged after you ask to be.  The hospital is required by law to discharge you within 48 hours, or on the next business day, whichever is first, unless they believe you are a threat to yourself, to others, or to property.  If they want to keep you in a hospital setting, they have to convert your voluntary status to involuntary, which requires them to get a Court Order from a Judge.    If your loved one went to a hospital voluntarily, and 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.

 


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.