1. 42 U.S. Code § 9501.Bill of Rights https://www.law.cornell.edu/uscode/text/42/9501 U.S. Code It is the sense of the Congress that each State should review and revise, if necessary, its laws to ensure that mental health patients receive the protection and services they require; and in making such review and revision should take into account the recommendations of the President’s Commission on Mental Health and the following: (1)A person admitted to a program or facility for the purpose of receiving mental health services should be accorded the following: (A)The right to appropriate treatment and related services in a setting and under conditions that-- (i)are the most supportive of such person’s personal liberty; and (ii)restrict such liberty only to the extent necessary consistent with such person’s treatment needs, applicable requirements of law, and applicable judicial orders. (B)The right to an individualized, written, treatment or service plan (such plan to be developed promptly after admission of such person), the right to treatment based on such plan, the right to periodic review and reassessment of treatment and related service needs, and the right to appropriate revision of such plan, including any revision necessary to provide a description of mental health services that may be needed after such person is discharged from such program or facility. (C)The right to ongoing participation, in a manner appropriate to such person’s capabilities, in the planning of mental health services to be provided such person (including the right to participate in the development and periodic revision of the plan described in subparagraph (B)), and, in connection with such participation, the right to be provided with a reasonable explanation, in terms and language appropriate to such person’s condition and ability to understand, of-- (i)such person’s general mental condition and, if such program or facility has provided a physical examination, such person’s general physical condition; (ii)the objectives of treatment; (iii)the nature and significant possible adverse effects of recommended treatments; (iv)the reasons why a particular treatment is considered appropriate; (v)the reasons why access to certain visitors may not be appropriate; and (vi)any appropriate and available alternative treatments, services, and types of providers of mental health services. (D)The right not to receive a mode or course of treatment, established pursuant to the treatment plan, in the absence of such person’s informed, voluntary, written consent to such mode or course of treatment, except treatment-- (i)during an emergency situation if such treatment is pursuant to or documented contemporaneously by the written order of a responsible mental health professional; or (ii)as permitted under applicable law in the case of a person committed by a court to a treatment program or facility. (E)The right not to participate in experimentation in the absence of such person’s informed, voluntary, written consent, the right to appropriate protections in connection with such participation, including the right to a reasonable explanation of the procedure to be followed, the benefits to be expected, the relative advantages of alternative treatments, and the potential discomforts and risks, and the right and opportunity to revoke such consent. (F)The right to freedom from restraint or seclusion, other than as a mode or course of treatment or restraint or seclusion during an emergency situation if such restraint or seclusion is pursuant to or documented contemporaneously by the written order of a responsible mental health professional. (G)The right to a humane treatment environment that affords reasonable protection from harm and appropriate privacy to such person with regard to personal needs. (H)The right to confidentiality of such person’s records. (I)The right to access, upon request, to such person’s mental health care records, except such person may be refused access to-- (i)information in such records provided by a third party under assurance that such information shall remain confidential; and (ii)specific material in such records if the health professional responsible for the mental health services concerned has made a determination in writing that such access would be detrimental to such person’s health, except that such material may be made available to a similarly licensed health professional selected by such person and such health professional may, in the exercise of professional judgment, provide such person with access to any or all parts of such material or otherwise disclose the information contained in such material to such person. (J)The right, in the case of a person admitted on a residential or inpatient care basis, to converse with others privately, to have convenient and reasonable access to the telephone and mails, and to see visitors during regularly scheduled hours, except that, if a mental health professional treating such person determines that denial of access to a particular visitor is necessary for treatment purposes, such mental health professional may, for a specific, limited, and reasonable period of time, deny such access if such mental health professional has ordered such denial in writing and such order has been incorporated in the treatment plan for such person. An order denying such access should include the reasons for such denial. (K)The right to be informed promptly at the time of admission and periodically thereafter, in language and terms appropriate to such person’s condition and ability to understand, of the rights described in this section. (L)The right to assert grievances with respect to infringement of the rights described in this section, including the right to have such grievances considered in a fair, timely, and impartial grievance procedure provided for or by the program or facility. (M)Notwithstanding subparagraph (J), the right of access to (including the opportunities and facilities for private communication with) any available-- (i)rights protection service within the program or facility; (ii)rights protection service within the State mental health system designed to be available to such person; and (iii)qualified advocate; for the purpose of receiving assistance to understand, exercise, and protect the rights described in this section and in other provisions of law. (N)The right to exercise the rights described in this section without reprisal, including reprisal in the form of denial of any appropriate, available treatment. (O)The right to referral as appropriate to other providers of mental health services upon discharge. (2) (A)The rights described in this section should be in addition to and not in derogation of any other statutory or constitutional rights. (B)The rights to confidentiality of and access to records as provided in subparagraphs (H) and (I) of paragraph (1) should remain applicable to records pertaining to a person after such person’s discharge from a program or facility. (3) (A)No otherwise eligible person should be denied admission to a program or facility for mental health services as a reprisal for the exercise of the rights described in this section. (B)Nothing in this section should-- (i)obligate an individual mental health or health professional to administer treatment contrary to such professional’s clinical judgment; (ii)prevent any program or facility from discharging any person for whom the provision of appropriate treatment, consistent with the clinical judgment of the mental health professional primarily responsible for such person’s treatment, is or has become impossible as a result of such person’s refusal to consent to such treatment; (iii)require a program or facility to admit any person who, while admitted on prior occasions to such program or facility, has repeatedly frustrated the purposes of such admissions by withholding consent to proposed treatment; or (iv)obligate a program or facility to provide treatment services to any person who is admitted to such program or facility solely for diagnostic or evaluative purposes. (C)In order to assist a person admitted to a program or facility in the exercise or protection of such person’s rights, such person’s attorney or legal representatives should have reasonable access to-- (i)such person; (ii)the areas of the program or facility where such person has received treatment, resided, or had access; and (iii)pursuant to the written authorization of such person, the records and information pertaining to such person’s diagnosis, treatment, and related services described in paragraph (1)(I). (D)Each program and facility should post a notice listing and describing, in language and terms appropriate to the ability of the persons to whom such notice is addressed to understand, the rights described in this section of all persons admitted to such program or facility. Each such notice should conform to the format and content for such notices, and should be posted in all appropriate locations. (4) (A)In the case of a person adjudicated by a court of competent jurisdiction as being incompetent to exercise the right to consent to treatment or experimentation described in subparagraph (D) or (E) of paragraph (1), or the right to confidentiality of or access to records described in subparagraph (H) or (I) of such paragraph, or to provide authorization as described in paragraph (3)(C)(iii), such right may be exercised or such authorization may be provided by the individual appointed by such court as such person’s guardian or representative for the purpose of exercising such right or such authorization. (B)In the case of a person who lacks capacity to exercise the right to consent to treatment or experimentation under subparagraph (D) or (E) of paragraph (1), or the right to confidentiality of or access to records described in subparagraph (H) or (I) of such paragraph, or to provide authorization as described in paragraph (3)(C)(iii), because such person has not attained an age considered sufficiently advanced under State law to permit the exercise of such right or such authorization to be legally binding, such right may be exercised or such authorization may be provided on behalf of such person by a parent or legal guardian of such person. (C)Notwithstanding subparagraphs (A) and (B), in the case of a person admitted to a program or facility for the purpose of receiving mental health services, no individual employed by or receiving any remuneration from such program or facility should act as such person’s guardian or representative. (Pub. L. 96–398, title V, § 501, Oct. 7, 1980, 94 Stat. 1598.) https://dualdiagnosis.org/mental-health-and-addiction/us-legislation/ U.S. Legislation on Mental Health Home The Most Common Co-Occurring Disorders U.S. Legislation on Mental Health Perhaps the most well-known piece of mental health legislation has been the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This law made insurers offer no fewer benefits to an individual for mental health treatment than for physical health treatment. It did not require insurers to offer mental health coverage but it did level the playing field, so to speak. Fewer than four years after it was enacted in 2010, the Obama Administration is widening the scope of coverage by making mental health coverage a requirement for insurers. Using a tiered system, much like insurance plans already do, the amount of coverage will depend on your plan. It also encompasses behavioral health issues and substance abuse or addiction. State Mental Health Legislation One sticking point to this legislation is that coverage can vary based on the state you are living in. According to the National Alliance on Mental Illness, there are certain types of mental health laws, and each state is different. Comprehensive parity provides equal coverage to individuals for mental health issues and substance abuse or addiction. Two states with this law are Connecticut and Vermont. A limited parity means that a plan limits equal coverage based on diagnosed mental health conditions or restricts coverage to a set limit, either financially or in terms of care duration. A broad-based parity law, on the other hand, is a mix between the two. While some limitations to coverage may apply, the coverage itself is encompassing of all mental health conditions. There are a few types of mandates in regards to coverage offerings. These may help you better understand MHPAEA and other parity-related laws. A mandated offering requires an insurance plan to include an option on mental health, in which coverage benefits will be equal to other care. If the plan already offers mental health care treatment, a mandate if offered law states that coverage will be equal to other medical care. And, on the other end of the spectrum, a minimum mandated benefit law does not stress the equality between types of health care coverage. Like mandated care, benefits also fall into the same category. Minimum benefit if offered works similarly to the above mandated benefit only there is not specifically a mandate. If a plan offers health coverage, the minimum benefit need only apply. And such, a minimum benefit is just that – a minimum benefit. Getting Treatment for Mental Health Conditions If you are thinking about treatment for a mental health problem, take time to talk to your insurance company about your coverage. Once you know what your plan benefits are, you can take the next step in finding a treatment facility that is right for you. At FRN, we have premiere clinicians, nurses and physicians. Our staff includes counselors, psychologists, psychiatrists, and specialized treatment professionals who are educated, experienced and genuinely interested in your well-being. Call us today to learn more about the types of treatments we offer, how state legislation affects you and your care, and how we can help. Getting the right treatment for your condition is important, so let us help.
2. Mental Health Rights https://www.mhanational.org/issues/mental-health-rights People living with mental health conditions are people. They have people they love, activities they enjoy, and dreams for their lives. As people, they deserve to be treated with dignity, and under the law they have rights and protections. Unfortunately, it has long been the case that individuals with mental health conditions are among the most abused and discriminated against in our country. From leaving people to languish in overcrowded state hospitals to lobotomies and forced sterilization, the treatment of those with mental health conditions is a dark stain on our history as a nation. While we have come a long way, abuse and discrimination continue to be serious problems today. The shackling or restraining of children, keeping people out of work, and denying access to services are just a few examples of the way we continue to fail the 1 in 5 Americans that has a diagnosable mental health disorder. This is not just a small issue for a small group of people: half of all Americans will experience a diagnosable mental health condition in their lifetime. If it is not us being directly impacted, it is likely that it will be our family members, friends, or loved ones-- whether we know it or not. Beyond struggles in education or employment, we see the loss of human dignity and even human life for the people we love and care about when we do not work to address abuses in the system. For Mental Health America, the fight against abuse and discrimination is essential to our history and continues to guide our work. MHA's symbol, which sits in our national office, is the Bell of Hope cast from the chains and shackles that were used to restrain individuals in old state hospitals. As an organization, MHA is committed to the principles of human and civil rights inherent to the concept of equal justice under the law. This includes the rights of persons with mental health and substance use conditions to: liberty and autonomy, protection from seclusion and restraint, community inclusion access to services, and privacy. Liberty and Autonomy People living with mental health conditions have the right to make decisions about their lives, including their treatment. Just as all Americans, they should be assumed competent to make their own decisions, and a refusal of any type of treatment should not be considered evidence that a person is incompetent. A person's preferences, like those referenced in a psychiatric advanced directive, should be followed and all effort should be made to engage individuals in voluntary services. In rare cases where an individual is considered an imminent danger to self or others, he or she has the right to due process, adequate representation, and appeals should there be civil commitment or involuntary treatmentprocedures. MHA calls for the following policy changes: Advance directives have proven to be useful for maintaining and increasing the autonomy of persons with mental health conditions. MHA urges states to create and enforce laws which permit persons with mental illnesses to designate in writing, while competent, what treatment they should receive should their decisional capacity be impaired at a later date. There are a growing number of effective treatments for mental health conditions, including psychotropic medications. However, all medications pose some risks and many pose quite serious risks to the health of the persons who take them, particularly when medications are taken for extended periods to treat chronic illnesses. For this reason and because of its commitment to the autonomy and dignity of persons with mental health conditions, MHA strongly agrees that all persons, even persons lawfully convicted and serving a sentence of imprisonment, have a right to refuse medication and that medication may not be imposed involuntarily unless rigorous standards and procedures are met. Coercion occurs during many so-called "voluntary" admissions. Zinermon v. Burch, 494 U.S. 113 (1990). Persons facing involuntary commitment are routinely offered the option of becoming voluntary patients. However, in many treatment facilities, a person who has been voluntarily admitted is not free to leave when she or he chooses. Rather, it is common for mental health laws to permit the facility to detain a person for up to one week after she indicates a desire to leave. MHA urges states to eliminate this form of admission and admit persons to mental health facilities in the same manner as persons are admitted to medical treatment facilities for non-psychiatric illnesses. Seclusion and Restraint People living with mental health conditions have the right to be free from all abuses, including the practices of seclusion and restraint. Shackling, physical restraints, chemical restraints, and seclusion are among the practices used in schools and treatment facilities and throughout the criminal justice system. These practices represent failures in treatment, have no therapeutic value, and expose individuals to added trauma. Seclusion and restraint also play a role in many interactions with law enforcement, where some estimate about half of those killed by police officers has a mental illness. MHA calls for the ultimate abolition of seclusion and restraint and encourages providers, teachers, law enforcement, and consumers to work together to plan alternatives and create cultures that do not use seclusion and restraint. MHA calls for the following policy changes: Psychiatric facilities should encourage people in treatment to develop psychiatric advance directives that specify conditions in which they authorize that seclusion and restraints be used and detail alternative techniques that the person in treatment requests to help reduce his or her agitation and problematic behavior prior to the imposition of seclusion and restraints. Engaging consumers in this activity should take place immediately upon admission or at the next clinically appropriate time because a disproportionately large number of seclusion and restraint events take place in the first few days after a person is admitted to a psychiatric facility. All staff should be trained and demonstrate competence in non-physical intervention and de-escalation techniques to prevent the use of seclusion and restraints and in the safest and least restrictive ways to use seclusion and restraints. These trainings should take place when staff are first hired and continually at regular intervals. Only staff persons who have received this training should be involved in seclusion or restraint of consumers. HHS, SAMHSA, and the Centers for Mental Health Services should develop a curriculum for states to certify trainers to do this work. To reduce and ultimately eliminate the use of seclusion and restraints, the federal government and the states should drastically improve the mechanisms currently available to monitor these activities and the harm caused by them to mental health consumers. As one step to improve monitoring of the use and abuse of seclusion and restraints, MHA calls on the states to publish on their websites data on the use of seclusion and restraints including the number of hours spent in restraint for each public facility and private facility contracting with the state as well as data on any injuries or deaths associated with the use of seclusion and restraint and diversion to correctional facilities. Community Inclusion People living with mental health conditions have the right to live and fully participate in their communities of choice. From denying someone an apartment to kicking kids out of schools, discrimination against people living with mental health conditions often occurs in areas like housing, employment, and education. Community inclusion means not only addressing discriminatory practices that exist but also providing necessary supports that allow people to live and find meaningful roles in their communities. In order to best serve the people they aim to help, services should be driven by wants and experiences of consumers to include things like peer support and self-help tools that fight isolation and promote recovery. Important laws that involve community inclusion include the Americans with Disabilities Act (ADA), Rehabilitation Act, Individuals with Disabilities in Education Act (IDEA), and important Supreme Court cases like Olmstead vs. L.C. To learn more about community inclusion, check out Community Inclusion After Olmstead. MHA calls for the following policy change: Affiliates and advocates have long advocated for deinstitutionalization of state mental hospitals, and many have participated in DOJ audits and remedial activities, implementing Olmstead. The challenge now is to promote more effective community integration, including positive social interactions and support, especially of peers, access to meaningful work, and promotion of spiritual, religious, cultural and recreational opportunities. Part of providing services in the most integrated setting is providing services early and effectively so that a person avoids exclusion from the community altogether. A mix of universal and targeted early intervention and prevention services integrated into schools and communities would assure that care would truly be given in the most integrated setting possible. MHA is committed to protecting the gains made under the ADA in reforming state mental health systems. MHA and its affiliates should oppose legislative efforts to undermine Olmstead or to roll back gains made under the ADA for people with mental health conditions. MHA and its affiliates should likewise support proactive legislation in all states to advance community inclusion and integration of services, without waiting for courts to compel states to take action. MHA and its affiliates should ensure that community inclusion is promoted and measured as an outcome by providers, peers, and administrators of mental health care systems. Access to Services People living with mental health conditions have the right to receive the services they want, how and where they want them, with full explanation of insurance benefits, treatment options, and side effects. Insurance plans should provide a full explanation of services covered and implement mental health parity, which means providing coverage for mental health related services comparable to those offered for physical health services. This includes making sure people have choices in both services and providers with access to necessary and effective treatment options. Informed consent and culturally and linguistically competent services empower people to make the best decisions for their health and well-being. Important laws that involve access to services include the Affordable Care Act (ACA) and the Mental Health Parity and Addition Equity Act (MHPAEA). To learn more about rights around access to services, go to Rights of Persons with Mental Health and Substance Use Conditions. To learn more about services issues, check out our Services Issuespage. MHA calls for the following policy changes: MHA believes in full implementation of insurance parity, including freedom from limits based on annual and lifetime expenditures, days or visits, co-payments, or diagnoses. Advocates should work with states attorneys general to set up complaint lines and publicize them widely to ensure parity is being implemented. Individuals have the right to be fully informed of all beneficial treatment options covered and not covered, including related costs, in clear language. Advocates should work to ensure that insurance companies provide comprehensive, accurate information about benefits and services, how to access available services, how to appeal a decision, how to lodge a complaint, and how to get help navigating a service delivery system. MHA supports the right to access medically necessary and effective medication without being subjected to "fail first" policies, discriminatory or excessive co-payments, or time-consuming prior authorization and paperwork processes. In addition to expedited reviews and appeals from one's health plan when the situation is emergent or urgent, individuals have the right to sue the health plan for authorization denials that result in harm to the consumer. Advocates should help individuals appeal denials and work to change discriminatory policies that keep people from accessing the services they want and need. Privacy People living with mental health conditions have the right to privacy and to manage who can see their healthcare information. This includes controlling who sees their health information and the ability to access and supplement their mental health records. Health plans and providers should provide information about privacy and confidentiality protocols. For example, many mental health professionals are required to report child abuse; therefore, an individual should know prior to engaging in treatment that any disclosure of child abuse may potentially result in a report to respective authorities. Information about privacy and information sharing should be given when a person joins a health plan or begins treatment with a new clinician and should be available on an ongoing basis, with the ability to withdraw, narrow, or otherwise modify terms of consent for what is to be shared. Important laws related to privacy include the Health Insurance Portability and Accountability Act (HIPAA) and state duty-to-warn laws. To learn more about privacy, check out Standards for Management of and Access to Consumer Information. MHA calls for the following policy changes: For court orders authorizing disclosure of confidential information for other than criminal purposes, HIPAA requires that the consumer receive formal notice of the request and an opportunity to respond but does not set a standard, which is left to state law. MHA advocates that the judge weigh the need for disclosure against the potential harm to the consumer and to the clinician-consumer relationship and its impact on the treatment process. HIPAA requires that the order limit disclosure to information essential to the demonstrated purpose and provide protection against future public scrutiny, such as by sealing court records. MHA generally opposes special protections of certain health related information because there is no evidence that additional formalities increase privacy, and such special protections compromise integration of care. Examples of "super-confidential" information include: genetic information and information pertaining to school records, substance abuse, mental health conditions, HIV testing, and sexually transmitted diseases, as defined and protected by specific federal and state laws and regulations. MHA does support the HIPAA exemption for psychotherapy notes, as defined in 42 CFR 164.501. Individuals should have the right to release HIPAA-protected information to their designated healthcare proxies and in their psychiatric advance directives, and should routinely do so. State law presumptions could help consumers to avoid HIPAA impediments to sharing information as they wish. https://www.treatmentadvocacycenter.org/component/content/article/183-in-a-crisis/1596-know-the-laws-in-your-state In a current emergency, see Someone I Know Is in Crisis. Open this link on your smartphone for mobile psychiatric crisis information. To secure treatment during or following a psychiatric crisis, it is essential to know the civil commitment laws and standards that determine eligibility for intervention where the individual in crisis lives. Three forms of involuntary treatment are authorized by civil commitment laws in 46 states and the District of Columbia. Two forms are available in Connecticut, Maryland, Massachusetts and Tennessee, where court-ordered outpatient treatment has not yet been adopted. Emergency hospitalization for evaluation is a crisis response in which a patient is admitted to a treatment facility for psychiatric evaluation, typically for a short period of fixed time (e.g., 72 hours). "Psychiatric hold" or "pick-up" and other terms may be used to describe the process. Inpatient civil commitment is a process in which a judge orders hospital treatment for a person who continues to meet the state’s civil commitment criteria after the emergency evaluation period. Inpatient commitment is practiced in all states, but the standards that qualify an individual for it vary from state to state. “Involuntary hospitalization” or another term may be used to describe the practice. Outpatient civil commitment or “assisted outpatient treatment (AOT)“ is a treatment option in which a judge orders a qualifying person with symptoms of mental illness to adhere to a mental health treatment plan while living in the community. AOT laws have been passed in 46 states, but the standards for its use vary from state to state. “Outpatient commitment,” “involuntary outpatient commitment,” “mandated outpatient treatment” and other terms may be used to describe the practice. Use the map on this page to navigate to information about the laws in your state. To find out who can initiate court-ordered psychiatric intervention, see "Initiating Court-Ordered Assisted Treatment: Inpatient, Outpatient and Emergency Hospitalization Standards by State."
Mental Health Commitment Laws: A Survey of the States February 2014 Every Western nation, and every US state, has established civil commitment laws and criteria that govern when the condition of an individual with acute or chronic psychiatric symptoms warrants a court order to mandate mental health treatment in a hospital or, where enabling statutes exist, as a condition of living in the community. Among other provisions, these laws address how long and under what criteria patients can remain hospitalized for psychiatric treatment against their wishes; whether the state can require patients to adhere to court-ordered treatment after hospital discharge; and how much deterioration must occur before a patient can be re-hospitalized involuntarily. Mental Health Commitment Laws: A Survey of the States comprehensively examined the laws each state was using in 2014 to determine who within the state’s population might qualify for court-ordered treatment and for what duration. Each state was graded on the adequacy of its statutes to facilitate short-term emergency hospitalization; longer-term commitment to a psychiatric hospital; and, where applicable, provisions for the less-restrictive option of court-ordered treatment (often called “assisted outpatient treatment” or “AOT”) in the community. Top Takeaway Civil commitment laws may be universal, but the quality of the laws that govern them and their implantation are not. The quality of the civil commitment laws in the vast majority of states remains far below what is necessary to provide a readily accessible path to treatment and recovery for individuals with the most severe mental illness who are unable to seek care for themselves. Fast Facts Only 14 states earned a cumulative grade of “B” or better for the quality of their civil commitment laws. 17 states earned a cumulative grade of “D” or “F” for the quality of their laws. Only 18 states were found to recognize the need for treatment as a basis for civil commitment to a hospital, and several of those were found to have less than ideal standards. No state earned a grade of “A” on the use of its civil commitment laws. Recommendations Universal adoption of need-for-treatment standards to provide a legally viable means of intervening in psychiatric deterioration prior to the onset of dangerousness or grave disability Enactment of AOT laws by the states that have not yet passed them Universal adoption of emergency hospitalization standards that create no additional barriers to treatment Provision of sufficient inpatient psychiatric treatment beds for individuals in need of treatment to meet the standard of 50 beds per 100,000 in population Since the Study New Mexico in 2016 enacted legislation authorizing AOT in the state, leaving only four states without outpatient commitment laws (Connecticut, Maryland, Massachusetts, Tennessee). Congress in 2016 appropriated $15 million to fund new AOT programs, increasing interest and use of the program. States continued to review and reform provisions of their civil commitment laws, generally moving to increase access to treatment for individuals with acute or chronic serious mental illness.