C.R.S.
Section 27-65-106
Emergency mental health hold
- screening
- court-ordered evaluation
- discharge instructions
- respondent’s rights
(1)
An emergency mental health hold may be invoked under one of the following conditions:(a)
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When a certified peace officer has probable cause to believe a person has a mental health disorder and, as a result of the mental health disorder, is an imminent danger to the person’s self or others or is gravely disabled, the certified peace officer may take the person into protective custody and transport the person to a facility designated by the commissioner for an emergency mental health hold. If such a facility is not available, the certified peace officer may transport the person to an emergency medical services facility. The certified peace officer may request assistance from a behavioral health crisis response team for assistance in detaining and transporting the person or an emergency medical services provider in transporting the person; or(II)
When an intervening professional reasonably believes that a person appears to have a mental health disorder and, as a result of the mental health disorder, appears to be an imminent danger to the person’s self or others or appears to be gravely disabled, the intervening professional may cause the person to be taken into protective custody and transported to a facility designated by the commissioner for an emergency mental health hold. If such a facility is not available, the certified peace officer may transport the person to an emergency medical services facility. The intervening professional may request assistance from a certified peace officer, a secure transportation provider, or a behavioral health crisis response team for assistance in detaining and transporting the person, or assistance from an emergency medical services provider in transporting the person.(b)
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When a person petitions the court in the county in which the respondent resides or is physically present requesting an evaluation of the respondent’s condition and alleging that the respondent appears to have a mental health disorder and, as a result of the mental health disorder, appears to be a danger to the respondent’s self or others or appears to be gravely disabled.(II)
Any person who files a malicious or false petition for an evaluation of a respondent pursuant to this section is subject to criminal prosecution.(2)
When a person is taken into custody pursuant to subsection (1) of this section, the person must not be detained in a jail, lockup, or other place used for the confinement of persons charged with or convicted of penal offenses. Unless otherwise required by law, a certified peace officer may transport the person to an emergency medical services facility or facility designated by the commissioner even if a warrant has been issued for the person’s arrest if the certified peace officer believes it is in the best interest of the person. The person must not be held on an emergency mental health hold for longer than seventy-two hours after the hold is placed or ordered. Nothing in this section prohibits an emergency medical services facility from involuntarily holding the person in order to stabilize the person as required pursuant to the federal “Emergency Medical Treatment and Labor Act”, 42 U.S.C. sec. 1395dd, or if the treating professional determines that the individual’s physical or mental health disorder impairs the person’s ability to make an informed decision to refuse care and the provider determines that further care is indicated.(3)
When a person is placed on an emergency mental health hold pursuant to subsection (1) of this section and is presented to an emergency medical services facility or a facility designated by the commissioner, the facility shall require a BHA-approved application in writing, stating the circumstances under which the person’s condition was called to the attention of the intervening professional or certified peace officer and further stating sufficient facts, obtained from the intervening professional’s or certified peace officer’s personal observations or obtained from others whom the intervening professional or certified peace officer reasonably believes to be reliable, to establish that the person has a mental health disorder and, as a result of the mental health disorder, is an imminent danger to the person’s self or others or is gravely disabled. The application must indicate when the person was taken into custody and who brought the person’s condition to the attention of the intervening professional or certified peace officer. A copy of the application must be furnished to the person being evaluated, and the application must be retained in accordance with section 27-65-123 (4).(4)
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The petition for a court-ordered evaluation filed pursuant to subsection (1)(b) of this section must contain the following:(I)
The name and address of the petitioner and the petitioner’s interest in the case;(II)
The name of the respondent for whom evaluation is sought, and, if known to the petitioner, the address, age, gender, marital status, occupation, and any animals or dependent children in the respondent’s care;(III)
Allegations of fact indicating that the respondent may have a mental health disorder and, as a result of the mental health disorder, be a danger to the respondent’s self or others or be gravely disabled and showing reasonable grounds to warrant an evaluation;(IV)
The name and address of every person known or believed by the petitioner to be legally responsible for the care, support, and maintenance of the respondent, if available; and(V)
The name, address, and telephone number of the attorney, if any, who has most recently represented the respondent.(b)
Upon receipt of a petition satisfying the requirements of subsection (4)(a) of this section, if the court is not satisfied that probable cause exists to issue an order for an evaluation, the court shall identify a facility designated by the commissioner, an intervening professional, or a certified peace officer to provide screening of the respondent to determine whether probable cause exists to believe the allegations.(c)
Following the screening described in subsection (4)(b) of this section, the facility, intervening professional, or certified peace officer designated by the court shall file a report with the court and may initiate an emergency mental health hold at the time of screening. The report must include a recommendation as to whether probable cause exists to believe that the respondent has a mental health disorder and, as a result of the mental health disorder, is a danger to the respondent’s self or others or is gravely disabled and whether the respondent will voluntarily receive evaluation or treatment. The screening report submitted to the court pursuant to this subsection (4)(c) is confidential in accordance with section 27-65-123 and must be furnished to the respondent or the respondent’s attorney or personal representative.(d)
Whenever it appears, by petition and screening pursuant to this section, to the satisfaction of the court that probable cause exists to believe that the respondent has a mental health disorder and, as a result of the mental health disorder, is a danger to the respondent’s self or others or is gravely disabled and that efforts have been made to secure the cooperation of the respondent but the respondent has refused or failed to accept evaluation voluntarily, the court shall issue an order for evaluation authorizing a certified peace officer or secure transportation provider to take the respondent into custody and transport the respondent to a facility designated by the commissioner for an emergency mental health hold. At the time the respondent is taken into custody, a copy of the petition and the order for evaluation must be given to the respondent and promptly thereafter to the one lay person designated by the respondent and to the person in charge of the facility named in the order or the respondent’s designee. If the respondent refuses to accept a copy of the petition and the order for evaluation, such refusal must be documented in the petition and the order for evaluation.(5)
When a person is transported to an emergency medical services facility or a facility designated by the commissioner, the facility may detain the person under an emergency mental health hold for evaluation for a period not to exceed seventy-two hours from the time the emergency mental health hold was placed or ordered. Nothing in this section prohibits an emergency medical services facility from involuntarily holding the person in order to stabilize the person as required pursuant to the federal “Emergency Medical Treatment and Labor Act”, 42 U.S.C. sec. 1395dd, or if the treating professional determines that the individual’s physical or mental health disorder impairs the person’s ability to make an informed decision to refuse care and the provider determines that further care is indicated. If, in the opinion of the person in charge of the evaluation, the person can be properly cared for without being detained, the person shall be provided services on a voluntary basis. If the person in charge of the evaluation determines the person should be released, the person in charge of the evaluation may terminate the emergency mental health hold.(6)
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Each person detained for an emergency mental health hold pursuant to this section shall receive an evaluation as soon as possible after the person is presented to the facility and shall receive such treatment and care as the person’s condition requires for the full period that the person is held. The evaluation may include an assessment to determine if the person continues to meet the criteria for an emergency mental health hold and requires further mental health care in a facility designated by the commissioner. The evaluation must state whether the person should be released, referred for further care and treatment on a voluntary basis, or certified for short-term treatment pursuant to section 27-65-109.(b)
Each evaluation must be completed using a standardized form approved by the commissioner and may be completed by a professional person; a licensed advanced practice registered nurse with training in psychiatric nursing; or a licensed physician assistant, a licensed clinical social worker, a licensed professional counselor, or a licensed marriage and family therapist who has two years of experience in behavioral health safety and risk assessment working in a health-care setting.(c)
If the person conducting an evaluation pursuant to subsection (6)(a) of this section is not a professional person and the evaluating person recommends the detained person be certified for short-term treatment pursuant to section 27-65-109, the evaluating person shall notify the facility of the recommendation. A certification may only be initiated by a professional person.(7)
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If a person is evaluated at an emergency medical services facility and the evaluating professional determines that the person continues to meet the criteria for an emergency mental health hold pursuant to subsection (1) of this section, the emergency medical services facility shall immediately notify the BHA if the facility cannot locate appropriate placement. Once notified, the BHA shall support the emergency medical services facility in locating an appropriate placement option on an inpatient or outpatient basis, whichever is clinically appropriate.(b)
If an appropriate placement option cannot be located pursuant to subsection (7)(a) of this section and the person continues to meet the criteria for an emergency mental health hold pursuant to subsection (1) of this section and the person has been medically stabilized, the emergency medical services facility may place the person under a subsequent emergency mental health hold. If the facility places the person under a subsequent emergency mental health hold, the facility shall immediately notify the BHA, the person’s lay person, and the court, and the court shall immediately appoint an attorney to represent the person. The facility may notify the court where the person resides by mail. Once the court is notified, the emergency medical services facility is not required to take any further action to provide the person with an attorney unless specified in subsection (10) of this section. The emergency medical services facility shall notify the BHA after each emergency mental health hold is placed. The BHA is responsible for actively assisting the facility in locating appropriate placement for the person. If the person has been recently transferred from an emergency medical services facility to a facility designated by the commissioner and the designated facility is able to demonstrate that the facility is unable to complete the evaluation before the initial emergency mental health hold is set to expire, the designated facility may place the person under a subsequent emergency mental health hold and shall immediately notify the BHA and lay person.(c)
The BHA shall maintain data on the characteristics of each person placed on a subsequent emergency mental health hold pursuant to subsection (7)(b) of this section. The BHA may contract with entities coordinating care or with providers serving within the safety net system developed pursuant to section 27-63-105 to meet the requirements of this subsection (7).(8)
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The facility shall provide each person detained for an emergency mental health hold discharge instructions. The discharge instructions must be completed for every person, regardless of the person’s discharge status, before the person is released. If the detained person refuses to accept the discharge instructions, the refusal must be documented in the person’s medical record. At a minimum, the discharge instructions must include:(I)
A summary of why the person was detained or evaluated for an emergency mental health hold; detailed information as to why the evaluating professional determined the person no longer meets the criteria for an emergency mental health hold or certification pursuant to section 27-65-109; and whether the person may receive services on a voluntary basis pursuant to subsection (6) of this section;(II)
If the person’s medications were changed or the person was newly prescribed medications during the emergency mental health hold, a clinically appropriate supply of medications, as determined by the judgment of a licensed health-care provider, for the person until the person can access another provider or follow-up appointment;(III)
A safety plan for the person and, if applicable, the person’s lay person where indicated by the person’s mental health disorder or mental or emotional state;(IV)
Notification to the person’s primary care provider, if applicable;(V)
A referral to appropriate services, if such services exist in the community, if the person is discharged without food, housing, or economic security. Any referrals and linkages must be documented in the person’s medical record.(VI)
The phone number to call or text the Colorado crisis services hotline and information on the availability of peer support services;(VII)
Information on how to establish a psychiatric advance directive if one is not presented;(VIII)
Medications that were changed during the emergency mental health hold, including any medications that the person was taking or that were previously prescribed upon admission, and which medications, if any, were changed or discontinued at the time of discharge;(IX)
A list of any screening or diagnostic tests conducted during the emergency mental health hold, if requested;(X)
A summary of therapeutic treatments provided during the emergency mental health hold, if requested;(XI)
Any laboratory work, including blood samples or imaging that was completed or attempted, if requested;(XII)
The person’s vital signs upon discharge from the emergency mental health hold, if requested;(XIII)
A copy of any psychiatric advance directive presented to the facility, if applicable; and(XIV)
How to contact the discharging facility if needed.(b)
The facility shall document in the person’s medical record whether the person accepted the discharge instructions. The facility shall provide the discharge instructions to the person’s parent or legal guardian if the person is under eighteen years of age, and to the person’s lay person, when possible.(c)
Upon discharge, the facility shall discuss with the person, the person’s parent or legal guardian, or the person’s lay person the statewide care coordination infrastructure established in section 27-60-204 to facilitate a follow-up appointment for the person within seven calendar days after the discharge. Facilities shall comply with this subsection (8)(c) when the statewide care coordination infrastructure created in section 27-60-204 is fully operational, as determined by the BHA. The BHA shall immediately notify facilities when the statewide care coordination infrastructure is available to assist persons with discharge.(d)
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The facility shall, at a minimum, attempt to follow up with the person, the person’s parent or legal guardian, or the person’s lay person at least forty-eight hours after discharge. The facility is encouraged to utilize peer support professionals, as defined in section 27-60-108 (2)(b), when performing follow-up care with individuals and in developing a continuing care plan pursuant to subsection (8)(a)(I) of this section. The facility may facilitate follow-up care through contracts with community-based behavioral health providers or the Colorado behavioral health crisis hotline. If the facility facilitates follow-up care through a third-party contract, the facility shall obtain authorization from the person to provide follow-up care.(II)
If the person is enrolled in medicaid, the facility is not required to meet the requirements of this subsection (8)(d) and instead, the facility shall notify the person’s relevant managed care entity, as defined in section 25.5-5-403, of the person’s discharge and need for ongoing follow-up care prior to the person’s discharge.(III)
If the facility contracts with a safety net provider, as defined in section 27-50-101, to provide behavioral health services to a person on or following an emergency mental health hold, the facility shall work with the safety net provider in order to meet the requirements of this subsection (8)(d).(e)
The facility shall encourage the person to designate a family member, friend, or other person as a lay person to participate in the person’s discharge planning and shall notify the person that the person is able to rescind the authorization of a lay person at any time. If the person designates a lay person and has provided necessary authorization, the facility shall attempt to involve the lay person in the person’s discharge planning. The facility shall notify the lay person that the person is being discharged or transferred.(9)
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On or before July 1, 2024, and each July 1 thereafter, each emergency medical services facility that has evaluated a person pursuant to this section shall provide an annual report to the BHA that includes only disaggregated and nonidentifying information concerning persons who were treated at an emergency medical services facility pursuant to this section. The report must comply with section 24-1-136 (9) and is exempt from section 24-1-136 (11)(a)(I). The report must contain the following:(I)
The names and counties of the facilities;(II)
The total number of persons treated pursuant to this section, including a summary of demographic information;(III)
A summary regarding the different reasons for which persons were treated pursuant to this section; and(IV)
A summary of the disposition of persons transferred to a designated facility.(b)
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Any information disaggregated and provided to the BHA pursuant to this subsection (9) is privileged and confidential. Such information must not be made available to the public except in an aggregate format that cannot be used to identify an individual facility. The information is not subject to civil subpoena and is not discoverable or admissible in any civil, criminal, or administrative proceeding against an emergency medical services facility or health-care professional. The information must be used only to assess statewide behavioral health services needs and to plan for sufficient levels of statewide behavioral health services. In collecting the data pursuant to the requirements of this subsection (9), the BHA shall protect the confidentiality of patient records, in accordance with state and federal laws, and shall not disclose any public identifying or proprietary information of any hospital, hospital administrator, health-care professional, or employee of a health-care facility.(II)
Subsection (9)(b)(I) of this section does not apply to information that is otherwise available from a source outside of the data collection activities required pursuant to subsection (9)(a) of this section.(10)
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A person detained for an emergency mental health hold pursuant to this section has the following rights:(I)
To be told the reason for the person’s detainment and the limitations of the person’s detainment, including a description of the person’s right to refuse medication, unless the person requires emergency medications, and that the detainment does not mean all treatment during detainment is mandatory;(II)
To request a change to voluntary status;(III)
To be treated fairly, with respect and recognition of the person’s dignity and individuality, by all employees of the facility with whom the person comes in contact;(IV)
To not be discriminated against on the basis of age, race, ethnicity, religion, culture, spoken language, physical or mental disability, socioeconomic status, sex, sexual orientation, gender identity, or gender expression;(V)
To retain and consult with an attorney at any time; except that, unless specified in subsection (7)(b) of this section, the facility is not required to retain an attorney on behalf of the person but must allow the person to contact an attorney;(VI)
To continue the practice of religion;(VII)
Within twenty-four hours after the person’s request, to see and receive the services of a patient representative who has no direct or indirect clinical, administrative, or financial responsibility for the person;(VIII)
To have reasonable access to telephones or other communication devices and to make and to receive calls or communications in private. Facility staff shall not open, delay, intercept, read, or censor mail or other communications or use mail or other communications as a method to enforce compliance with facility staff.(IX)
To wear the person’s own clothes, keep and use the person’s own personal possessions, and keep and be allowed to spend a reasonable sum of the person’s own money. A facility may temporarily restrict a person’s access to personal clothing or personal possessions, until a safety assessment is completed. If the facility restricts a person’s access to personal clothing or personal possessions, the facility shall have a discussion with the person about why the person’s personal clothing or personal possessions are being restricted. A licensed medical professional or a licensed behavioral health professional shall conduct a safety assessment as soon as possible. The licensed professional shall document in the person’s medical record the specific reasons why it is not safe for the person to possess the person’s personal clothing or personal possessions. The facility shall periodically conduct additional safety assessments to determine whether the person may possess the person’s personal clothing or personal possessions, with the goal of restoring the person’s rights established pursuant to this section.(X)
To keep and use the person’s cell phone, unless access to the cell phone causes the person to destabilize or creates a danger to the person’s self or others, as determined by a provider, facility staff member, or security personnel involved in the person’s care;(XI)
To have the person’s information and records disclosed to family members and a lay person pursuant to section 27-65-123;(XII)
To have the person’s treatment records remain confidential, except as required by law;(XIII)
To not be fingerprinted, unless required by law;(XIV)
To not be photographed, except upon admission for identification and administrative purposes. Any photographs must be confidential and must not be released by the facility except pursuant to a court order. Nonmedical photographs must not be taken or used without appropriate consent or authorization.(XV)
To have appropriate access to adequate water, hygiene products, and food and to have the person’s nutritional needs met in a manner that is consistent with recognized dietary practices;(XVI)
To have personal privacy to the extent possible during the course of treatment; and(XVII)
To have the ability to meet with visitors in accordance with the facility’s current visitor guidelines.(b)
A person’s rights under this subsection (10) may only be denied if access to the item, program, or service causes the person to destabilize or creates a danger to the person’s self or others, as determined by a licenced provider involved in the person’s care. Denial of any right must be entered into the person’s treatment record and must be made available, upon request, to the person, the person’s legal guardian, or the person’s attorney.(c)
A facility shall not intentionally retaliate or discriminate against a detained person or employee for contacting or providing information to any official or to an employee of any state protection and advocacy agency or for initiating, participating in, or testifying in a grievance procedure or in an action for any remedy authorized pursuant to this section. Any facility that violates this subsection (10) commits an unclassified misdemeanor and shall be fined not more than one thousand dollars.(d)
Any person whose rights are denied or violated pursuant to this section has the right to file a complaint against the facility with the behavioral health administration and the department of public health and environment.
Source:
Section 27-65-106 — Emergency mental health hold - screening - court-ordered evaluation - discharge instructions - respondent’s rights, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-27.pdf (accessed Oct. 20, 2023).
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