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SECOND REGULAR SESSION
HOUSE BILL NO. 2512
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE BYRNES.
6244H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 632, RSMo, by adding thereto nine new sections relating to humane access
to emer gency psychiatric treatment, with penalty provisions.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 632, RSMo, is amended by adding thereto nine new sections, to
2 be known as sections 632.700, 632.701, 632.702, 632.703, 632.704, 632.705, 632.706,
3 632.707, and 632.708, to read as follows:
632.700. Sections 632.700 to 632.708 shall be known as "The Care Befor e
2 Pr edictable Harm Act".
632.701. 1. The general assembly finds that:
2 (1) The closure of long-term psychiatric institutions without adequate
3 community tr eatment has res ulted in individuals with sever e mental illness being
4 untr eated until crisis and too often tr eated only thr ough the criminal justice system;
5 (2) Incar ceration is not tr eatment and for cing individuals to r eceive mental
6 health car e only after arres t is inhumane and inconsistent with the duty of the state to
7 pr ovide car e for vulnerable citizens;
8 (3) Families and caregiv ers ar e fr equently the first to observe deterioration in
9 individuals with sever e mental illness, but curr ent proced ures pre vent early intervention
10 until after imminent danger has occurr ed;
11 (4) Missouri has a compelling interes t in creat ing a humane and timely pathway
12 to evaluation and tr eatment for individuals unable to recogn ize the need for car e, while
13 r especting due process and using the least restrictive means necessary;
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
14 (5) Individuals with sever e mental illness may experience repea ted cycles of
15 homelessness and emergency care res ulting from untrea ted symptoms, which present a
16 pr edictable risk of serious harm; early , evidence-based intervention pr events harm,
17 supports family stability , and redu ces the burden on law enfor cement and emergency
18 medical systems; and
19 (6) Missouri becomes the first state to r eplace the "imminent danger" test with a
20 "pr edictable harm" standard that allows intervention when a cycle of homelessness and
21 psychosis crea tes a clear and pre ventable risk to life.
22 2. It is the intent of the general assembly that trea tment under sections 632.700
23 to 632.708 shall be pr ovided in clinical settings and not thr ough the criminal justice
24 system, that no Missourian should be for ced to enter a jail cell in order to access mental
25 health tr eatment, and that sections 632.700 to 632.708 establish a statewide structur e for
26 early intervention, including assisted outpatient tr eatment, short-term stabilization, and
27 the use of evidence-based long-acting medication when clinically justified.
632.702. As used in sections 632.700 to 632.708, the following terms mean:
2 (1) "Assisted outpatient tr eatment", individualized care ordered by a court that
3 may include therapy , community supports, case management, and medication, including
4 long-acting injectable antipsychotic medication when medically justified;
5 (2) "Danger to self or others", a substantial risk of physical harm to the
6 individual or another person, including inability to pr ovide for basic human needs due
7 to symptoms of mental illness;
8 (3) "Least res trictive", the medically appr opriate tr eatment envir onment that
9 constitutes the minimum necessary intrusion on the individual's liberty while ensuring
10 safety;
11 (4) "Qualified community petitioner":
12 (a) A licensed social worker , case manager , outreac h worker , or hospital social
13 worker who is employed by a homeless services provi der , substance use disorder
14 tr eatment progra m, hospital emergency department, or community mental health
15 center; or
16 (b) A member of a mobile crisis r esponse team, street medicine team, or
17 emergency medical services pr ovider with documented interactions with the individual;
18 (5) "Qualified petitioner", a spouse, par ent, adult child, sibling, legal guardian,
19 or co-r esident car egiver who has prov ided substantial support to the individual for at
20 least six months pr eceding the petition;
21 (6) "Severe mental illness", schizophr enia spectrum disorder , bipolar disorder
22 with psychotic featur es, or other psychiatric disorders res ulting in impair ed insight and
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23 inability to make informed decisions r egarding tr eatment, as documented by a licensed
24 psychiatrist;
25 (7) "Sever e substance use disorder", a substance use disorder as defined in the
26 most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, wher e
27 symptoms r esult in impair ed judgment, inability to rec ognize danger , r epeated
28 overdose, or inability to pr ovide for basic needs including shelter and safety .
632.703. 1. A qualified petitioner or qualified community petitioner may file a
2 verified petition for emergency psychiatric evaluation with the circ uit court in the
3 county wher e the individual res ides.
4 2. The petition shall include:
5 (1) (a) Facts indicating the pr esence of sever e mental illness; or
6 (b) Facts indicating the pr esence of sever e substance use disorder;
7 (2) Facts that pr esent a pred ictable risk of serious harm due to homelessness
8 caused by untr eated addiction, including:
9 (a) Repeated exposure to unsafe conditions; or
10 (b) A pattern of cycling between homelessness, emergency medical intervention,
11 and untrea ted addiction that pr esents a significant risk of harm due to impair ed
12 judgment or inability to rec ognize danger;
13 (3) Facts supporting a finding of danger to self or others or a pr edictable harm
14 pattern;
15 (4) Known history of tr eatment or hospitalization; and
16 (5) Supporting documentation, if available.
17 3. The court shall review the petition within twenty-four hours of filing.
18 4. If the court finds that the individual meets the criteria under this section, the
19 court may order the individual to undergo a ninety-six-hour psychiatric evaluation
20 under section 632.305.
632.704. 1. An evaluation order ed under section 632.703 shall be conducted by a
2 licensed psychiatrist and shall include approp riate medical testing to rule out
3 underlying medical or physiological conditions that may mimic psychiatric disorders.
4 2. During the period of emergency detention and evaluation under sections
5 632.700 to 632.708, the tr eating psychiatrist may administer medically appr opriate
6 antipsychotic medication, including long-acting injectable antipsychotic medication,
7 only if the psychiatrist determines and documents in the medical record that:
8 (1) The individual present s an imminent danger to self or others, or is gravely
9 disabled as a res ult of symptoms of sever e mental illness;
10 (2) The medication is necessary to preve nt pred ictable serious harm, including
11 cir cumstances in which the individual:
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12 (a) Is thr eatening to cause harm to self or others; or
13 (b) Has a history of being unhoused during dangerous cir cumstances, or a
14 pattern of cycling between homelessness and emergency car e, which present s a
15 significant risk of harm to self due to impair ed judgment, inability to pr ovide for basic
16 needs, or inability to recogn ize danger;
17 (3) The medication repr esents the least res trictive clinical alternative available to
18 ensur e safety; and
19 (4) The individual lacks the capacity to make an informed decision r egarding
20 tr eatment at the time of administration.
21 3. For purposes of paragraph (b) of subdivision (2) of subsection 2 of this section,
22 "significant risk of harm" includes conditions wher e the individual's judgment is
23 impair ed by symptoms of sever e mental illness such that the individual:
24 (1) Is unable to rec ognize unsafe or life-thre atening circums tances;
25 (2) Is unable to pro vide for basic needs including shelter , clothing, or protecti on
26 fr om the elements;
27 (3) Is unable to seek medical care or safety without assistance; or
28 (4) Has r epeatedly ref used tr eatment, r esulting in a cycle of homelessness and
29 emergency intervention due to untreat ed symptoms.
30 4. Medication administered under this section shall be r ecorded in the
31 individual's medical reco rd, including:
32 (1) Clinical findings supporting dangerousness or grave disability;
33 (2) Attempts made to obtain voluntary consent;
34 (3) The basis for determining incapacity;
35 (4) The name and dosage of the medication administer ed; and
36 (5) The clinical rationale for the selection of a long-acting injectable formulation,
37 if used.
38 5. The administration of medication under this section shall not extend beyond
39 the ninety-six-hour emergency detention period, except pursuant to a tr eatment order
40 issued under section 632.705.
41 6. As soon as practicable after admission, the individual shall be advised of the
42 right to counsel and to communicate with an attorney , family member , or guardian.
43 7. Medication administered under this section shall not be used as punishment,
44 for convenience of staff, or as a substitute for appr opriate therapeutic interventions.
45 8. The evaluating psychiatrist shall submit a written repor t to the court stating
46 whether the individual:
47 (1) Has a sever e mental illness;
48 (2) Pr esents a danger to self or others or a predi ctable harm pattern;
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49 (3) Requires tr eatment to preven t deterioration; and
50 (4) Cannot be safely trea ted thr ough less re strictive means.
632.705. 1. The court shall hold a hearing within seven days of receivi ng the
2 evaluation.
3 2. The individual subject to the petition shall have the right to counsel, to pre sent
4 evidence, to call witnesses, and to obtain an independent psychiatric evaluation.
5 3. Upon clear and convincing evidence that the individual meets the criteria
6 described in section 632.704, the court may order assisted outpatient tr eatment for a
7 period not to exceed one hundred eighty days.
8 4. A tr eatment order issued under this section may include:
9 (1) Community mental health services;
10 (2) Therapy and case management;
11 (3) Substance use disorder tr eatment;
12 (4) Supportive housing placement; and
13 (5) Administration of long-acting injectable antipsychotic medication, when
14 medically justified and documented in the clinical record .
15 5. A tre atment order issued under this section shall be the least restrictive means
16 necessary to addr ess the individual's condition. The order may be r enewed only upon a
17 new hearing and findings under this section.
18 6. A tr eatment order issued under this section shall identify the community
19 tr eatment pr ovider or clinic r esponsible for administering court-order ed services,
20 including long-acting injectable medication when medically justified, and such provi der
21 or clinic shall administer tr eatment in accordance with section 632.706.
632.706. 1. The department of mental health shall establish a statewide network
2 of community mental health clinics authorized to administer court-ordered psychiatric
3 tr eatment under sections 632.700 to 632.708, including the administration of long-acting
4 injectable antipsychotic medication.
5 2. A clinic participating in the statewide network shall not ref use to administer
6 court-order ed long-acting injectable antipsychotic medication, if the individual lacks
7 capacity to consent at the time of administration and the medication is medically
8 justified and r epresent s the least res trictive means available to preven t pred ictable
9 serious harm.
10 3. A clinic administering tr eatment under this section shall be immune fr om civil
11 liability for actions taken in good faith pursuant to a valid court order and in
12 compliance with the standards established by the department of mental health under
13 this section.
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14 4. Refusal of a clinic to comply with court-order ed trea tment under this section
15 shall be gr ounds for rem oval fr om the statewide network and may res ult in suspension
16 or withholding of state funds.
17 5. The department shall adopt standardized clinical pro tocols governing the
18 administration of court-ordered medication under this section, including documentation
19 and post-administration monitoring.
632.707. 1. False material statements in a petition under section 632.703 shall be
2 punishable as perjury under section 575.040.
3 2. Any person who knowingly interfer es with the execution of a valid court order
4 issued under sections 632.700 to 632.708 shall be guilty of a class B misdemeanor .
632.708. The department of mental health shall submit an annual report to the
2 general assembly summarizing implementation of sections 632.700 to 632.708,
3 including:
4 (1) The number of petitions filed;
5 (2) The number of emergency evaluations order ed;
6 (3) The number of court-order ed assisted outpatient tr eatment plans issued and
7 r enewed;
8 (4) The number of long-acting injectable administrations performed under court
9 order;
10 (5) Outcomes demonstrating reduction s in repea ted emergency interventions;
11 and
12 (6) Data demonstrating the number of cases in which intervention pr evented
13 pr edictable serious harm, including hospitalization, incar ceration, or death due to
14 exposur e, starvation, or violence.
✔
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