INVOLUNTARY OUTPATIENT COMMITMENT PROGRAM (IOPC) BRIEF SYNOPSIS OF THE PROGRAM: Involuntary Outpatient Commitment program (IOPC) - The involuntary outpatient commitment program is a civil court ordered program designed for individuals who are chronically not voluntarily compliant with psychiatric treatment. Referrals for this program are typically from inpatient hospital facilities to the IOPC court liaison. This program provides psychiatric and intensive comprehensive case management services, as well as, weekly staffings with the judge to individuals ordered for treatment by the Bexar County Probate Court. The IOPC court liaison monitors client s progress and compliance with treatment and civil court order. The assigned court liaison reports to the court on the client s condition and attends all court staffings and dockets. TEAM & CASELOAD RATIO: The team consists of: One court liaison, two SP 4 case managers, one SP 3 & 4 case manager and one SP 3 case manager. Court liaison- supervises all active IOPC consumer s to make sure they are complying w/court order treatment and are receiving MH services indicated on their court order. SP 4 case managers have a caseload of 1:10 SP 3 case managers have a caseload of 1:15 1
ELIGIBILITY: - clients who have a history of noncompliance with psychiatric treatment - clients who have a history of repeated hospitalizations - clients who have a history of repeated incarcerations - clients who are frequent 911 callers - clients are typically priority population (bipolar, schizophrenia, schizoaffective, MDD) EXCLUSIONARY: Sexual offenses & 3 G felony offenses (decided case by case) ADMISSION PROCESS: - referral is made to IOPC court liaison by hospital (private and county), Bexar County Jail or the court - court liaison goes to facility and screens the client and to collect collateral information (demographics, psychosocial information sheet(s), psychiatric evaluation, medication list) - court liaison staffs case with IOPC treatment team psychiatrist and both decide if consumer is appropriate for IOPC - referring entity is contacted by court liaison to discuss acceptance or inappropriate for IOPC program - if case is appropriate then paperwork is initiated but if not appropriate then no further action is required LENGTH OF COMMITMENTS: - Temporary- IOPC is only valid for 90 days - Extended- IOPC is valid for 1 year (proposed patient must have received court ordered inpatient mental health services under Title 7, Subtitle C, Health & safety Code, or under section 5, Article 46.02, Code of Criminal procedure, for at least 60 consecutive days during the preceding 12 months; and proposed patient s condition is likely to continue more than 90 days.) 2
PAPERWORK NEEDED FOR IOPC TO BE INITIATED: The court MUST have 2 notarized medical certificates from 2 different psychiatrists certifying and documenting that the proposed patient requires intensive outpatient treatment and supervision & reasons why patient is unable to voluntarily participate in treatment. STEP BY STEP PROCESS FROM PRE-IOPC TO IOPC COURT ORDER: The court liaison files the following paperwork to initiate IOPC paperwork process (9 pages in total): - Completes CHCS fax cover sheet and request date for case to be placed on the SASH commitment hearing docket. - Completes CHCS IOPC Request form (consumer s name, cause number; if known, date of 1 st certificate, date of 2 nd certificate, date application completed. Special Notes, date faxed to clerks office, date originals will be delivered to court) - Completes Information sheet (sheet with proposed patient s demographics, sheriff s information and patient location must be filled out, so that mental health deputies will know where to serve proposed patient and it MUST indicate service only at bottom left hand corner of sheet otherwise proposed patient will be detained (taken into custody) by mental health deputies) - Completes Application for Court Ordered Outpatient Mental Health Services (fill in blank spaces on application, indicate if proposed patient is pending any criminal charges, fills in sections 1: (acts committed by proposed patient that indicate he/she will not receive or cannot) & 2: clinical condition makes it impossible for proposed patient to make a rational and informed decision about submitting to outpatient treatment voluntarily) - Physician s Certification of Medical Examination for Out-Patient Treatment of Mental Illness is completed by two doctors. Both MUST be signed, dated and notarized. - IOPC packet is then faxed to the Bexar County Clerk s office (Juanita/Clara @ 335-2869). - Once all paperwork is faxed then Bexar County Clerk s office is contacted to confirm fax (Juanita:335-2492/ Clara: 335-2491) *****NOTE: All application MUST be submitted by NOON Wednesday to set commitment hearing for the following Tuesday SASH commitment hearing docket. ******** 3
IOPC COURT ORDERED CLIENT REQUIREMENTS: The client is required to do the following once court ordered onto IOPC program: - Comply w/psychiatric treatment (meet with the doctor for scheduled appointments) - Take psychiatric medications, as prescribed by the psychiatrist - Meet w/the assigned case manager (s) 1-4 times per week depending on the assigned service package - Meet w/judge Kazen once a week for the first few weeks upon discharge from the hospital and newly court ordered onto IOPC program - Meet w/iopc court liaison 1-2 times a month to make sure that consumer is complying w/iopc court order and to make sure that consumer is receiving services he/she is court ordered to receive. STAFFINGS: IOPC staffings are based upon the therapeutic courts model, which is an alternative justice model in which a collaborative court team made up of a supervising judge, district attorney, defense counsel, probation officer and/or substance abuse or mental health treatment provider oversees and closely monitors participants. - IOPC staffings w/judge Kazen are held every Wednesday 9:30am- 1:30 pm. - 16 consumers are scheduled for IOPC staffings - The team staffs consumer s case and discusses compliance/non-compliance with psychiatric treatment, social services (housing, dental, clothing etc), guardianship, probation, parole & completion of program prior to consumer coming for his/her staffing. - The consumer comes into staffing and reports any questions, concerns or issues that may be affecting consumer s compliance w/psychiatric treatment. Consumer is provided w/guidance and support, as well as, assistance with his/her needs. - Judge and IOPC court liaison determine when consumer will need to return for next staffings (1-4 weeks). 4
NON-COMPLIANCE: If consumer becomes non-compliant w/iopc court order or treatment the IOPC court liaison: - staffs case with case manager and/or treatment team to discuss the issue (s). - meets with consumer to discuss issues resulting in noncompliance and ways to reengage consumer into treatment and compliance w/iopc court order. - If issue is not resolved then consumer is scheduled for the next scheduled IOPC staffing w/judge Kazen. ORDER OF DETENTION: If consumer is mentally ill and meets criteria in section 574-034 for court ordered mental health services and as a result of that illness meets the following additional criteria: (A) is likely to cause serious harm to self. (B) is likely to cause harm to others. (C) is suffering severe and abnormal mental, emotional or physical distress, is experiencing substantial mental or physical deterioration of the proposed patients inability, except, for reasons of indigence, to provide for his/her basic needs, including food, clothing, health, or safety; and is unable to make a rational and informed decision as to whether or not to submit to treatment. Process for order of detention: The court liaison files the following paperwork to initiate application for order of detention (5 pages in total): - Completes CHCS fax cover sheet and request date for case to be placed on the SASH probable cause hearing docket. - Completes Information sheet (sheet with proposed patient s demographics, sheriff s information and patient location must be filled out, so that mental health deputies will know where to pick up and detain (take into custody) by mental health deputies; facility information section MUST be filled out: acceptance to private facility, facility and accepting administrator, so that mental health deputies will know where to transport patient) *NOTE: If the San Antonio State Hospital (SASH) is on diversion then it will be the court liaison s responsibility to find alternative hospitalization arrangements 5
Private hospitals don t honor orders of detention except NIX Specialty does case by case. However, court liaison will need to negotiate with accepting private facility to see if accepting doctor will keep patient in their facility until SASH bed is secured or just until patient is stabilized at the facility. - Completes Application for Temporary Detention (fill in blank spaces on application, indicate if proposed patient is pending any criminal charges, fills in applicable sections (A): likely to cause harm to self, (B): Likely to cause harm to others, or (C): is suffering severe and abnormal mental, emotional or physical distress, is experiencing substantial mental or physical deterioration of the proposed patients inability, except, for reasons of indigence, to provide for his/her basic needs, including food, clothing, health, or safety; and is unable to make a rational and informed decision as to whether or not to submit to treatment. Application MUST be signed, dated and notarized. - Application for Order of Detention packet is then faxed to the Bexar County Clerk s office (Juanita/Clara @ 335-2869). - Once all paperwork is faxed then Bexar County Clerk s office is contacted to confirm fax (Juanita:335-2492/ Clara: 335-2491) HEARINGS (PROBABLE CAUSE/COMMITMENT): What is a PROBABLE CAUSE hearing? 574.025. PROBABLE CAUSE HEARING. (a) A hearing must be held to determine if: (1) there is probable cause to believe that a proposed patient under a protective custody order presents a substantial risk of serious harm to himself or others to the extent that he cannot be at liberty pending the hearing on court-ordered mental health services; and (2) a physician has stated his opinion and the detailed reasons for his opinion that the proposed patient is mentally ill. What is a COMMITMENT hearing? 574.036. ORDER OF CARE OR COMMITMENT. (a) The judge shall dismiss the jury, if any, after a hearing in which a person is found to be mentally ill and to meet the criteria for court-ordered temporary or extended mental health services. (b) The judge may hear additional evidence relating to alternative settings for care before entering an order relating to the setting for the care the person will receive. 6
(c) The judge shall consider in determining the setting for care the recommendation for the most appropriate treatment alternative filed under Section 574.012. (d) The judge shall order the mental health services provided in the least restrictive appropriate setting available. (e) The judge may enter an order: (1) committing the person to a mental health facility for inpatient care if the trier of fact finds that the person meets the commitment criteria prescribed by Section 574.034(a) or 574.035(a); or (2) committing the person to outpatient mental health services if the trier of fact finds that the person meets the commitment criteria prescribed by Section 574.034(b) or 574.035(b). IOPC RENEWALS and DISCHARGE PROCESS CRITERIA: The court liaison staffs case with the IOPC treatment team at the 45 th day for 90 day commitments and the 9 th month for 1 year commitments to determine if IOPC will be extended (IOPC application will be re-initiated) or be allowed to run it s course and expire. 574.085. DISCHARGE ON EXPIRATION OF COURT ORDER. The facility administrator of a facility to which a patient was committed or from which a patient was required to receive temporary or extended inpatient or outpatient mental health services shall discharge the patient when the court order expires. If patient has met criteria for discharge then the assigned case manger makes arrangements to transfer patient to voluntary psychiatric treatment within CHCS outpatient clinics or out in the community to see a private psychiatrist. END OF MONTH COURT REPORTS: The court liaison is responsible for providing the court with an already designated court report, at the end of the month on each person who is actively on the IOPC program. Reports are due by the end of the second week of the following month. These reports consist of: - Issues of non-compliance/compliance - Housing issues - Medication issues - Plan to extend or not extend IOPC - Any major issues regarding compliance with treatment (family, financial, legal) 7
IOPC AT STORY LANE UPON SASH/HOSPITAL DISCHARGE: 1. CHCS SASH liaison will have scheduled aftercare appt. with Andrea or Michael prior to consumer s discharge from SASH. Or, private hospital has made intake appointment with Eligibility and Enrollment on Brooklyn Street so appointment is scheduled for case manager to complete treatment plan. 2. David (CSSP) will pick up designated patients from SASH and bring them in to meet with Allison (reimbursement) to begin SSI benefits, schedule SSI appt., update financials or initiate carelink processes. 3. David (CSSP) will take consumer to have picture taken by Teresa Holder @ S. Presa, so that, we can have a picture on the IOPC team roster. 4. David (CSSP) will take consumer on a mini tour of Story lane and introduce patients to story lane staff 5. David (CSSP) will take consumer to their designated place of residence once tour is complete. 8