NYAPRS Note: Last Friday, OMH released the attached guidance informing our field, hospitals and other key stakeholders that the current “danger to self’ standards that can authorize involuntary transport and admission to a psychiatric hospital bed includes a “person’s refusal or inability to meet his or her essential need for food, shelter, clothing or health care, provided that such refusal or inability is likely to result in serious harm if there is no immediate hospitalization.”

Whereas this standard has been on the books for some time, NYAPRS and our colleagues are extremely concerned that encouragement to apply these standards more frequently might replace a more appropriate community response with a reflexive admission. In no way do we want to see anyone come to serious harm or loss of life but, at the same time, we want to ensure that the powerful tool of involuntary removal and confinement be used very carefully and judiciously.

Hospital stays must not be seen as a remedy for homelessness in place of appropriate community housing and support models. Just as the state is putting 600 hospital beds in NYC back online, the State and City should be also double the number of low threshold Safe Haven and crisis stabilization beds that are contemplated at this time, possibly using empty hotel space, and triple the number of behavioral health crisis stabilization and step down centers in NYC and in the rest of the state to provide more appropriate alternative settings for large numbers of these individuals. Recovery Options in Buffalo is developed an array of crisis programming under one roof that provides an excellent model (https://behavioralhealthnews.org/the-respite-and-recovery-peer-run-crisis-service-model/).

Increased use of inpatient psychiatric services must also lead to dramatically improved hospital discharge planning practices, ensuring access to the transitional support of a peer bridger and appropriate housing and case management for all.

We must also closely significantly raise the level of trauma informed culturally competent approaches that are used to engage, assess and possibly hospitalize individuals who already have long histories of trauma. Finally, OMH must assume strong responsibility for frequent and ongoing training and close oversight over how counties, providers and hospitals apply these standards.

OMH Expands Involuntary Admission Criteria to Include ‘Perceived Inability to Meet Basic Living Needs’

NYAPRS Report February 22, 2022

Last Friday, the NYS Office of Mental Health expanded criteria for individuals to be involuntarily taken into custody and transferred to a hospital or Comprehensive Psychiatric Emergency Program for evaluation and possible admission.

This has historically applied to individuals who appear to be mentally ill and who are deemed to be conducting themselves in ways that are regarded as demonstrating potential dangerousness to self or to others,

The new guidance now extends involuntary admission criteria to include those who appear to be are posting a serious harm to self and others via their perceived inability to meet basic living needs (which has been often defined as “a failure to obtain necessary food, clothing, shelter or medical care” because of the impairment, even when there is no recent dangerous act.

As a result, they can be involuntary evaluated and hospitalized by:

· Involuntary Admissions on Medical Certification (“2PC”)

o Evaluation by 2 psychiatrists and leading to a period of confinement for up to 60 days (2PC admission)*

· Emergency Admission for Immediate Observation, Care, and Treatment

o Evaluation by 1 physician for an ‘emergency admission to a local psychiatric hospitals for up to 14 days.

o Staff psychiatrist must, within 48 hours after admission, examine the patient and confirm the first MD's finding that the patient meets the Emergency Standard.

· Emergency Admission to a Comprehensive Psychiatric Emergency Program

o They can remain on EA status for up to 72 hours after which they can be converted to formal involuntary admission status

*the patient, a friend or relative, or the Mental Hygiene Legal Service may request a court hearing to contest the involuntary retention at any time during such period.