New legislation changes process for patients on MHHs

For the first time in decades, Colorado has passed legislation that reforms the process by which hospitals can place and maintain patients on involuntary commitments, known as mental-health holds.

A mental-health hold is a legal document that allows a hospital to detain a patient for the assessment or treatment of a mental-health condition, for up to 72 hours. Patients who are deemed to be a danger to themselves or others or have become gravely disabled due to mental illness meet the criterial for an MHH.

The new statute went into effect on Jan. 1, but because of what some involved in the implementation are calling murky direction from the state’s new Behavioral Health Administration office and a gross underestimation of the time it would take to build new hospital-based policies and educate clinicians about the changes, the state is allowing a six-month launch window. Hospitals won’t be surveyed regarding their compliance with CRS 27-65 until July 1.

So we have some time, but the window is closing. Physicians at all Colorado hospitals who care for patients on mental-health holds will notice changes in workflow and documentation, starting in March.

“For the last year, Peaks Region Behavioral Health managers and I have been working with the Behavioral Health Administration to better understand the impact of these statute changes and together we have developed procedures that align our practices with the new requirements,” said Melissa Rapp, LCSW, Behavioral Health program manager for Intermountain Peaks.

Here’s what’s new:

Patient belongings: Physicians can restrict patients’ access to their cell phone, clothing or other items temporarily, until a safety assessment is completed. At that time, patient belongings must be returned unless it’s determined an item might cause them to destabilize. Each item must be considered individually and the decision to return or restrict any property must be documented in the patient chart.

Patient advocate: A patient advocate or representative must be provided within 24 hours, if requested.

Vacating a mental-health hold: Psychologists, PAs and psychiatry NPs now also can sign the order to vacate a mental-health hold, but the order must still be co-signed by the attending physician.

Discharge instructions: There are now 16 required discharge-instruction elements for patients detained on a mental-health hold, including the development of a safety plan and a referral to a follow-up program through crisis services. The patient must actively participate in the development of these plans. Please consult with your local Behavioral Health team for specific details.

Subsequent mental-health holds: Because of a state-wide shortfall of appropriate behavioral health centers and programs, patients who continue to demonstrate the need for placement on an MHH at the 72-hour mark – and for whom no safe placement has been found – can be placed on another hold by their attending physician. Behavioral Health must be consulted and a new form, referred to as the M-1.1, must be completed.

Here’s what’s updated:

The state’s Emergency Mental Health Hold application, referred to as the M-1, has been updated to comply with the new law and must be signed, dated and timed by the physician. A new form that guides physicians through the process of following state law, referred to as the M-1.5, also must be completed. You can find that form and guidance for your reference by clicking here. Please consult with your local Behavioral Health team for specific details.

“Legislation regarding mental-health holds, particularly in the area of patient rights, was in dire need of modernization. No law that governs the quality of healthcare we provide should languish for decades,” said Rapp. “This new law is well intentioned and it’s a meaningful step in the right direction.”

“It also will impact daily operations, and I invite feedback and partnership between physicians and Behavioral Health teams as we all work through these changes.”

Rapp has developed a brief presentation with Q&A regarding the new legislation and changes in hospital policy. Physicians who would like to schedule Rapp to present at their department meetings can contact her at melissa.rapp@imail.org.