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SECOND REGULAR SESSION
HOUSE BILL NO. 3313
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE CA TO N.
7216H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 632, RSMo, by adding thereto eight new sections relating to assisted
outpatient treatment.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 632, RSMo, is amended by adding thereto eight new sections, to
2 be known as sections 632.580, 632.585, 632.590, 632.593, 632.595, 632.600, 632.605, and
3 632.610, to read as follows:
632.580. The definitions set forth in section 632.005 shall apply to sections
2 632.580 to 632.610. In addition, as used in sections 632.580 to 632.610, unless the context
3 clearly requ ires otherwise, the following terms mean:
4 (1) "Assisted outpatient tr eatment", court-ordered involuntary outpatient
5 mental health car e services that are pr ovided by a mental health pro gram under a
6 tr eatment plan developed and monitored by a master's level mental health pr ofessional.
7 Such services may include, but are not limited to:
8 (a) Case management;
9 (b) Medication management;
10 (c) Therapy or counseling;
11 (d) Substance use tr eatment, if applicable;
12 (e) Crisis intervention services; and
13 (f) Assistance with housing, employment, or other community res ources
14 necessary for an individual's stability;
15 (2) "Case manager", a mental health pr ofessional employed by a certified
16 community behavioral health clinic who is assigned to a res pondent to oversee the
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.
17 r espondent's compliance with the outpatient tr eatment plan order ed by the court under
18 sections 632.580 to 632.610;
19 (3) "Community mental health center", the same meaning given to the term in
20 section 205.975;
21 (4) "Compr ehensive mental health services", the same meaning given to the
22 term in section 205.975;
23 (5) "Local public health agency", a county health center board established
24 under chapter 205, a county health department, a combined city and county health
25 department or agency , a multicounty health department or agency , or any other county
26 health authority;
27 (6) "Petition", a petition for assisted outpatient tr eatment filed under section
28 632.585 or for continued assisted outpatient trea tment filed under section 632.600;
29 (7) "Respondent", a person who is alleged in a petition to meet the criteria for
30 assisted outpatient tr eatment in section 632.590;
31 (8) "Service ar ea", the same meaning given to the term in section 205.975.
632.585. 1. A petition for an order authorizing involuntary outpatient tr eatment
2 may be filed by:
3 (1) The dir ector , administrator , or tr eating physician of a mental health pr ogram
4 in which the res pondent is hospitalized;
5 (2) The dir ector , administrator , or tr eating physician of an emergency receivi ng
6 center in which the res pondent is rec eiving services;
7 (3) The appointed guardian or limited guardian of a ward who is the
8 r espondent; or
9 (4) The department of health and senior services, the department of mental
10 health, or any local public health agency located within the judicial circu it in which the
11 petition is filed.
12 2. The petition may be filed in the judicial circu it in which the res pondent is
13 pr esent or r easonably believed to be present or in the judicial circ uit in which the
14 r espondent res ides.
15 3. The petition shall allege under oath, without a notarization r equir ement, that
16 the petitioner has rea son to believe that the res pondent meets the criteria for assisted
17 outpatient trea tment in section 632.590. The petition shall specify factual information
18 on which such belief is based and shall contain the names and addr esses of all persons
19 known to the petitioner who have knowledge of such facts thr ough personal observation.
20 4. No notarization shall be requ ired for a petition or for any affidavits,
21 declarations, or other documents supporting a petition. The petition and any affidavits,
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22 declarations, or other documents supporting the petition shall be subject to the
23 pr ovisions of section 492.060 allowing for declaration under penalty of perjury .
24 5. The pro secuting attorney of the county in which a hearing on a petition takes
25 place shall repr esent the petitioner and file and prosecute in court all petitions. Such
26 duty shall be fulfilled by the county counselor in counties having a county counselor and
27 by the circu it attorney in any city not within a county .
632.590. Following receip t of a petition and completion of the proce dures
2 r equir ed in section 632.593, a court may issue an order requ iring a responde nt to
3 participate in assisted outpatient tr eatment if:
4 (1) The re spondent:
5 (a) Is eighteen years of age or older;
6 (b) Is suffering fro m a mental disorder;
7 (c) W ill not obtain trea tment in the community voluntarily; and
8 (d) Is unable to make an informed decision to seek or to comply with voluntary
9 tr eatment; and
10 (2) Either:
11 (a) Because of the re spondent's fulfillment of the criteria of subdivision (1) of
12 this section, the res pondent req uires tr eatment to prev ent a deterioration in the
13 r espondent's mental disorder that would be likely to res ult in serious harm to the
14 r espondent or others as described in section 632.305; or
15 (b) The res pondent has a history of a lack of compliance with tr eatment for the
16 r espondent's mental disorder , and within the thirty-six months immediately pr eceding
17 the date of the filing of the petition such lack of compliance has either:
18 a. At least twice, been a significant factor in necessitating a civil detention period
19 for tr eatment instituted under section 632.305 or receipt of services in a for ensic or
20 other mental health unit of any state or local corr ectional facility , not including any
21 period during which the res pondent was hospitalized or incar cerated immediately
22 pr eceding the date of the filing of the petition; or
23 b. Resulted in one or mor e acts of serious violent behavior toward self or others
24 or thr eats of, or attempts of, serious physical harm to self or others, not including any
25 period during which the res pondent was hospitalized or incar cerated immediately
26 pr eceding the date of the filing of the petition.
632.593. 1. At the time of filing the petition, the court clerk shall set a date and
2 time for the hearing, which shall take place within two judicial days of the filing of the
3 petition. An attorney shall be appointed to rep res ent the res pondent as r equir ed under
4 section 632.450 fr om the r egister of attorneys described in section 632.415. An attorney
5 so appointed shall be entitled to attorney's fees to the same extent as allowed under
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6 section 632.415. The clerk shall prompt ly notify the res pondent, the r espondent's
7 attorney , the petitioner , and the petitioner's attorney of the date and time for the
8 hearing. The court shall not grant continuances except upon a showing of good and
9 sufficient cause.
10 2. The hearing shall be conducted in as informal a manner as may be consistent
11 with orderly proced ure and in a physical setting not likely to have a harmful effect on
12 the res pondent. The res pondent shall have the following rights in addition to those
13 specified elsewher e:
14 (1) T o be r epresent ed by an attorney;
15 (2) T o present evidence on his or her own behalf;
16 (3) T o cros s-examine witnesses who testify against him or her;
17 (4) T o rem ain silent;
18 (5) T o view and copy all petitions and reports in the court file of his or her case;
19 (6) T o have the hearing open or closed to the public as he or she elects;
20 (7) T o be proceed ed against according to the rules of evidence applicable to civil
21 judicial pro ceedings; and
22 (8) T o have the hearing befor e a jury if r equested by the r espondent or his or her
23 attorney .
24 3. The res pondent shall be pr esent at the hearing unless the r espondent's
25 physical condition is such that he or she cannot be pr esent in the courtroom or if the
26 court determines that the r espondent's conduct in the courtr oom is so disruptive that
27 the pro ceedings cannot reas onably continue.
28 4. The burden of pr oof at the hearing shall be by clear and convincing evidence
29 and shall be upon the petitioner .
30 5. If the matter is tried before a jury , the jury shall determine and shall be
31 instructed only upon the issue of whether the responde nt meets the criteria for assisted
32 outpatient tr eatment in section 632.590. The rem aining pro cedure s for the jury trial
33 shall be as in other civil matters.
34 6. The r espondent shall not be req uired to file an answer or other r esponsive
35 pleading.
36 7. At the conclusion of the hearing, if the court or jury finds, based upon clear
37 and convincing evidence, that the res pondent meets the criteria for assisted outpatient
38 tr eatment in section 632.590, and the court finds that a mental health pr ogram
39 appr opriate to handle the r espondent's condition has agreed to accept the res pondent,
40 the court shall issue an order requ iring the r espondent to participate in assisted
41 outpatient tr eatment with the mental health pro gram for a period not to exceed two
42 years.
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43 8. At the conclusion of the hearing, if the court or jury does not find by clear and
44 convincing evidence that the res pondent meets the criteria for assisted outpatient
45 tr eatment in section 632.590, the court shall dismiss the petition.
46 9. An order requ iring the res pondent to participate in assisted outpatient
47 tr eatment based on satisfaction of the pr ovisions of subparagraph a. of paragraph (b) of
48 subdivision (2) of section 632.590 shall not be issued unless the court has consider ed, or
49 the jury has been instructed to consider , at least the following factors:
50 (1) The res pondent's ability to access finances in order to obtain food or
51 medicine;
52 (2) The res pondent's ability to obtain tr eatment for the res pondent's medical
53 condition;
54 (3) The res pondent's ability to access necessary reso urces in the community
55 without assistance;
56 (4) The degr ee to which ther e are risks to the r espondent's safety;
57 (5) The likelihood that the r espondent will decompensate without immediate
58 car e or tr eatment;
59 (6) The res pondent's pr evious attempts to inflict physical injury on self or
60 others;
61 (7) The res pondent's history of behavioral health tr eatment in the community;
62 (8) The re spondent's patterns of decompensation in the past;
63 (9) The re spondent's risk of being victimized or harmed by others; and
64 (10) The r espondent's access to the means to inflict harm on self or others.
65 10. Nothing in this section shall prev ent the court or jury fr om considering any
66 other factor not described in this section.
67 1 1. If req uested by the res pondent, the court shall appoint an available licensed
68 physician or licensed psychologist to examine the res pondent and testify at the
69 r espondent's requ est. If the res pondent or the r espondent's attorney so requ ests, the
70 court shall not appoint a licensed physician or licensed psychologist who is an employee
71 of any entity in which the r espondent is hospitalized or r eceiving services or who is an
72 employee of any entity that filed the petition. The appointment proced ures in section
73 632.420 shall apply to any appointment under this subsection.
74 12. The physician-patient privilege r ecognized by section 491.060 and the
75 psychologist-patient privilege recogn ized by section 337.055 shall be deemed waived in
76 pr oceedings under sections 632.580 to 632.610. The fact that such privileges have been
77 waived in accordance with this section shall not by itself waive the privileges in any
78 other pr oceeding, civil or criminal. The waiver of the privileges shall extend only to that
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79 evidence that is dir ectly material and rel evant to the pr oceedings under sections 632.580
80 to 632.610.
81 13. Appeals fr om court orders under this section may be made as described in
82 section 632.430.
83 14. Assisted outpatient tr eatment shall not be deemed outpatient detention for
84 purposes of this chapter , and no pr ovision of this chapter rel ating to the r equir ements
85 for inpatient or outpatient detention pr oceedings shall apply to assisted outpatient
86 tr eatment under sections 632.580 to 632.610 unless such pro vision has been specifically
87 incorporated into sections 632.580 to 632.610 by ref erence or otherwise.
632.595. 1. The court shall assign a case manager fr om a certified community
2 behavioral health clinic to each res pondent order ed to participate in assisted outpatient
3 tr eatment.
4 2. The case manager and the res pondent shall report to the court at least once
5 every ninety days. The court may , at its discr etion, req uest mor e fr equent appearances.
6 The case manager shall immediately r eport to the court a substantial failur e of the
7 r espondent or the mental health pro gram pr oviding the assisted outpatient trea tment to
8 comply with the conditions of the assisted outpatient tr eatment.
632.600. 1. The court order for assisted outpatient tr eatment shall expir e at the
2 end of the period specified in the order unless a petition for an extension has been filed.
3 If any person or entity authorized to file a petition under section 632.585 determines
4 that a res pondent req uire s further involuntary assisted outpatient tr eatment, the person
5 or entity shall file a petition for continued assisted outpatient tr eatment before the
6 expiration of the involuntary assisted outpatient tr eatment order ed by the court.
7 2. The pr ocedur e for obtaining an extension shall be the same as for obtaining
8 the original order , except that the thirty-six-month time period provi ded in paragraph
9 (b) of subdivision (2) of section 632.590 shall not be applicable in determining the
10 appr opriateness of an extension.
632.605. 1. During the period of an order for assisted outpatient trea tment, if
2 the mental health pr ogram or mental health pr ofessional who is prov iding the
3 r espondent's assisted outpatient tr eatment determines that the r espondent is not
4 complying with the court order , the mental health pr ogram or mental health
5 pr ofessional shall notify the court immediately .
6 2. If it comes to the attention of the court that a r espondent subject to an order of
7 assisted outpatient tr eatment is not complying with the order , the court may req uire one
8 or mor e of the following, without a hearing:
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9 (1) That the r espondent be taken for evaluation to a community mental health
10 center prov iding compreh ensive mental health services to individuals r esiding in the
11 service ar ea in which the res pondent res ides;
12 (2) That the r espondent be hospitalized in a psychiatric hospital for a period of
13 not mor e than ten days; and
14 (3) Upon reco mmendation by the community mental health center pr oviding
15 compr ehensive mental health services to individuals res iding in the service ar ea in which
16 the r espondent res ides, that the individual be hospitalized for a period of mor e than ten
17 days, but not longer than the duration of the order for assisted outpatient tr eatment, or
18 not longer than ninety days, whichever is less.
19 3. The court may dir ect peace officers to transport the re spondent to a
20 designated facility or a community mental health center , as applicable, and the court
21 may specify conditions under which the res pondent may ret urn to assisted outpatient
22 tr eatment before the order expir es. Reimbursement for transportation costs shall be
23 allowed as pr ovided under section 632.312.
24 4. A res pondent hospitalized without a hearing as pr ovided in subsection 2 of
25 this section may object to the hospitalization. Upon transfer of the res pondent to the
26 hospital, the hospital shall notify the res pondent of his or her right to object under this
27 section. Upon receip t of an objection to the hospitalization, the court shall schedule a
28 hearing for a determination that the individual r equir es hospitalization. The
29 r espondent shall have all rights specified in section 632.593 at the hearing. The court
30 shall order the res pondent discharged from hospitalization unless the court or jury
31 finds, based upon clear and convincing evidence, that the r espondent r equire s
32 hospitalization as a r esult of the res pondent's failur e to comply with the order for
33 assisted outpatient tr eatment.
632.610. The office of state courts administrator shall submit an annual rep ort to
2 the general assembly summarizing:
3 (1) The number of individuals subject to orders for assisted outpatient
4 tr eatment;
5 (2) Statistics on compliance and noncompliance rates with assisted outpatient
6 tr eatment; and
7 (3) Any impact that assisted outpatient tr eatment has on hospitalization and
8 incar ceration rates.
✔
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