HB1718

SECTION 1. The legislature finds that Hawaii's current standard for involuntary hospitalization does not adequately prevent harm either to members of the public or persons suffering from mental illness or substance abuse. By requiring proof that a person is "imminently dangerous to self or others", the law essentially requires the point of danger--and thus potential harm--to have already been reached. Instead, the standard should be more flexible to allow the person to receive treatment before the point of danger has been reached and avoidable harm occurs.

The legislature notes that the National Alliance on Mental Illness, in its December 2016 public policy platform, asserts that states should "adopt broader, more flexible standards that would provide for involuntary commitment and/or court ordered treatment when an individual, due to mental illness is gravely disabled..." in addition to other grounds. The policy platform defines a "gravely disabled" person as one who "is substantially unable...to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety[.]" The policy platform also explains that "requir[ing] proof of dangerousness often produce[s] unsatisfactory outcomes because individuals are allowed to deteriorate needlessly before involuntary commitment and/or court-ordered treatment can be instituted."

The legislature acknowledges that, collectively, Act 221, Session Laws of Hawaii 2013, and Act 114, Session Laws of Hawaii 2016, deleted the term "gravely disabled" from the criteria for involuntary hospitalization and increased dependence on a danger-based definition, in furtherance of a pilot program for assisted community treatment that is now permanent. Mentally ill persons who are gravely disabled may not be imminently dangerous to themselves or others, but still pose a very real danger to themselves or the public and thus should be covered by the law. While the legislature supports the continuation of the assisted community treatment program and its complementary role in treating mental illness and substance abuse on an outpatient basis, the legislature is cognizant that a portion of the mentally ill population, including the chronically homeless, are being deprived of urgent, medically appropriate mental health intervention that is best administered on an inpatient basis.

The purpose of this Act is to protect mentally ill individuals and the public more effectively by amending the definition of "dangerous to self", defining the terms "gravely disabled" and "psychiatric deterioration", broadening the term of "imminently dangerous to self and others", and increasing the maximum period of emergency hospitalization.

SECTION 2. Section 334-1, Hawaii Revised Statutes, is amended to read as follows:

"PART I. GENERAL AND ADMINISTRATIVE PROVISIONS

§334-1 Definitions. As used in this chapter unless otherwise indicated by the context:

"Administrator" means the person in charge of a public or private hospital.

"Admission procedures" mean the various methods for admission of mentally ill persons or of persons habituated to the excessive use of drugs or alcohol to public and private psychiatric facilities.

"Authorized absence" means absence of a patient from a psychiatric facility for any period of time with permission.

"Behavioral health crisis center" means a facility that is specifically designed and staffed to provide care, diagnosis, or treatment for persons who are experiencing a mental illness or substance use disorder crisis.

"Community mental health center" means one or more facilities which alone or in conjunction with other facilities, public or private, are part of a coordinated program providing a variety of mental health services principally for persons residing in a community or communities in or near which the center is located.

"Conservator" shall have the meaning provided in section 560:5-102.

"Court" means any duly constituted court and includes proceedings, hearings of per diem judges as authorized by law.

"Dangerous to others" means likely to do substantial physical or emotional injury on another, as evidenced by a recent act, attempt or threat.

"Dangerous to property" means inflicting, attempting or threatening imminently to inflict damage to any property in a manner which constitutes a crime, as evidenced by a recent act, attempt or threat.

"Dangerous to self" means the person [~~recently has~~]:

(1) [~~Threatened~~] Recently has threatened or attempted suicide or serious bodily harm; or

(2) [Behaved in such a manner as to indicate that the person is unable, without supervision and the assistance of others, to satisfy the need for nourishment, essential medical care, including treatment for a mental illness, shelter or self-protection, so that it is probable that death, substantial bodily injury, or serious physical debilitation or disease will result unless adequate treatment is afforded.]Is gravely disabled.

"Department" means the department of health.

"Director" means the director of health.

"Discharge" means the formal termination on the records of a psychiatric facility of a patient's period of treatment at the facility.

"Gravely disabled" means a condition in which a person is unable, without supervision and the assistance of others, to prevent physical or psychiatric deterioration or to satisfy the need for nourishment, essential medical care including treatment for a mental illness, shelter, or self-protection, so that it is probable that death, substantial bodily injury, or serious physical debilitation or disease will result unless adequate treatment is afforded.

"Guardian" shall have the meaning provided in section 560:5-102.

"Health care operations" means the services and activities conducted by an institution, facility, or agency licensed, certified, or otherwise authorized or permitted by law to provide medical or health services in the ordinary course of business, including case management and care coordination, quality assessment and improvement activities, medical reviews, and administrative activities.

"Health care provider" means an individual or entity licensed, certified, or otherwise authorized or permitted by law to provide medical or health services in the ordinary course of business or practice of a profession.

"Homeless individual" means an individual who is homeless as defined under section 346-361 and who has a serious and persistent mental illness or is otherwise eligible for treatment.

"Imminently dangerous to self or others" means that, without intervention, the person will likely become dangerous to self or dangerous to others within the next [~~forty-five~~] ninety days.

"Incapacitated person" shall have the meaning provided in section 560:5-102.

"Interested person" means an interested, responsible adult, including but not limited to a public official, the legal guardian, spouse, parent, legal counsel, adult child, or next of kin of a person allegedly mentally ill, mentally deficient or suffering from substance abuse or as otherwise provided in article I of chapter 560.

"Intoxicated person" means a person who is deprived of reasonable self-control because of intake of alcohol or because of any substance which includes in its composition volatile organic solvents.

"Judge" means any judge of the family court or per diem judge appointed by the chief justice as provided in section 604-2.

"Law enforcement officer" has the same meaning as in section 710-1000.

"Licensed physician" means a physician or surgeon licensed by the State to practice medicine, including a physician and surgeon granted a limited and temporary license under section 453-3(1), (2), and (5) or a resident physician and surgeon granted a limited and temporary license under paragraph (4) thereof, or a medical officer of the United States while in this State in the performance of the medical officer's official duties.

"Mental health" means a state of social, psychological, and physical well-being, with capacity to function effectively in a variety of social roles.

"Mentally ill person" means a person having psychiatric disorder or other disease which substantially impairs the person's mental health and necessitates treatment or supervision.

"Patient" means a person under observation, care, or treatment at a psychiatric facility.

"Person suffering from substance abuse" means a person who uses narcotic, stimulant, depressant, or hallucinogenic drugs or alcohol to an extent which interferes with the person's personal, social, family, or economic life.

"Protected person" shall have the meaning provided in section 560:5-102.

"Psychiatric deterioration" means a substantial impairment or an obvious decline of an individual's judgment, reasoning, or ability to control behavior.

"Psychiatric facility" means a public or private hospital or part thereof which provides inpatient or outpatient care, custody, diagnosis, treatment or rehabilitation services for mentally ill persons or for persons habituated to the excessive use of drugs or alcohol or for intoxicated persons.

"Special treatment facility" means a public or private facility which provides a therapeutic residential program for care, diagnosis, treatment or rehabilitation services for emotionally distressed persons, mentally ill persons or persons suffering from substance abuse.

"Therapeutic living program" means a supervised living arrangement that provides mental health or substance abuse services for individuals or families who do not need the structure of a special treatment facility and are transitioning from a more restrictive treatment setting to independent living. The program aids residents in meeting basic needs and provides supportive services through a required service plan.

"Treatment" means the broad range of emergency, out-patient, intermediate, domiciliary, and inpatient services and care, including diagnostic evaluation, medical, psychiatric, psychological, and social service care, vocational rehabilitation, career counseling, and other special services which may be extended to handicapped persons.

"Treatment summary" means a record of information including present history and physical examination, mental status examination, emergency department record, intake evaluation, eligibility determination, current medication list and prescription history, treatment plan, consultant reports, diagnosis and problem lists, recent laboratory and diagnostic testing, clinical or discharge summaries, and discharge instructions, or any combination of such information.

"Unauthorized absence" means absence of a patient from a psychiatric facility for any period of time without permission."

SECTION 3. Section 334-59, Hawaii Revised Statutes, is amended by amending subsections (d) and (e) to read as follows:

"(d) Emergency hospitalization. If the physician, advanced practice registered nurse, or psychologist who performs the emergency examination has reason to believe that the patient is:

(1) Mentally ill or suffering from substance abuse;

(2) Imminently dangerous to self or others; and

(3) In need of care or treatment, or both;

the physician, advanced practice registered nurse, or psychologist may direct that the patient be hospitalized on an emergency basis or cause the patient to be transferred to another psychiatric facility for emergency hospitalization, or both. The patient shall have the right, immediately upon admission, to telephone the patient's guardian [or], a family member [~~including~~], a reciprocal beneficiary, or an adult friend, and an attorney. If the patient declines to exercise that right, the staff of the facility shall inform the adult patient of the right to waive notification to the guardian, family [~~including a~~] member, or reciprocal beneficiary, and shall make reasonable efforts to ensure that the patient's guardian [or], family [~~including a~~], or reciprocal beneficiary[~~, is~~] are notified of the emergency admission, but the patient's family [~~including a~~] or reciprocal beneficiary[,] need not be notified if the patient is an adult and requests that there be no notification. The patient shall be allowed to confer with an attorney in private.

(e) Release from emergency hospitalization. If at any time during the period of emergency hospitalization the responsible physician concludes that the patient no longer meets the criteria for emergency hospitalization the physician shall discharge the patient. If the patient is under criminal charges, the patient shall be returned to the custody of a law enforcement officer. In any event, the patient must be released within [~~forty-eight~~] seventy-two hours of the patient's admission, unless the patient voluntarily agrees to further hospitalization, or a proceeding for court-ordered evaluation or hospitalization, or both, is initiated as provided in section 334-60.3. If that time expires on a Saturday, Sunday, or holiday, the time for initiation is extended to the close of the next court day. Upon initiation of the proceedings the facility shall be authorized to detain the patient until further order of the court."

SECTION 4. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect on July 1, 2024.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	1718
THIRTY-SECOND LEGISLATURE, 2024
STATE OF HAWAII