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Emergency Detention – State Mental Health Act (1.2.1)

Emergency Detention – State Mental Health Act (1.2.1) - Policies, Clinical, UW Health Clinical, Administrative, Legally Driven Care

1.2.1


UW HEALTH CLINICAL POLICY 1
Policy Title: Emergency Detention – State Mental Health Act
Policy Number: 1.2.1
Category: UW Health
Type: Inpatient
Effective Date: October 26, 2015

I. PURPOSE

To outline Wisconsin law regarding emergency detention and establish procedures for its implementation by
UW Health staff.

II. DEFINITIONS

Emergency Detention is a legal procedure w hereby either a law enforcement off icer may take an individual
into custody, or the treatment director of inpatient psychiatry (or designee) may detain a voluntary patient
against his/her w ill, w here there is a substantial risk of harm to the patient/individual or to others due to the
patient/individual’s mental illness, drug dependence or developmental disability, and certain statutory criteria
listed below are met.

A. Minimal Legal Requirements for Law Enforcement Officer’s Emergency Detention – Statutory Criteria:
i. The off icer must have cause to believe that the individual is mentally ill, drug dependent or
developmentally disabled, and
ii. The off icer’s belief must be based on his/her observance (or a reliable report to the off icer of an
observance) of a recent overt act or attempt or threat to act or omission by the individual that falls
into one of the follow ing four categories:
a. The individual has show n by recent threats of or attempts at suicide or serious bodily harm
that there is a substantial probability of physical harm to him or herself.
b. The individual has show n by recent homicidal or other violent behavior, or other overt act,
attempt or threat to do serious physical harm w hich puts others in reasonable fear for their
safety, that there is a substantial probability of physical harm to other persons.
c. The individual has show n by a recent act or omission show ing impaired judgment, that the
individual has a substantial probability of physically impairing or injuring him or herself.
(There is not a basis for emergency detention if there is reasonable provision in the
community for the protection of the individual, i.e., food, shelter, other care or services, it
is likely the individual w ill use these services and the individual is capable of obtaining
these services for him or herself).
d. The individual has show n by a recent act or omission due to mental illness or drug
dependency that there is a substantial probability that death or serious physical injury,
debilitation or disease w ill imminently ensue because the individual is unable to satisfy
his/her basic needs for nourishment, medical care, shelter or safety.
(There is not a basis for emergency detention if there is a reasonable provision in the
community for treatment and protection of the individual, it is likely the individual w ill use
these services or can receive protective placement under s. 55.06, Stat. and the individual
is capable of obtaining these services for him or herself.)
iii. A verbal threat may or may not constitute an overt act depending upon the circumstances
surrounding the threat.
iv. The County Department of Community Programs (51.42 Board) must approve the Emergency
Detention.
B. Minimal Legal Requirements for Treatment Director's Emergency Detention of a patient hospitalized on
Inpatient Psychiatry.
i. Statutory criteria: They are the same as for a law enforcement off icer as stated in II. A. (i) and (ii).
ii. Designees of the treatment director are any psychiatry faculty member w ith UWHC medical staff
privileges serving as Inpatient Psychiatry unit director in the Director's absence and psychiatry
faculty members w ith UWHC medical staff privileges on call nights or w eekends.
iii. Approval by the County 51.42 Board is not required.
C. Procedures for Alcohol Dependent Patients: Where alcohol dependence is the primary problem, see UWHC
policy #8.09, Protective Custody, Emergency and Involuntary Commitment for Persons Intoxicated and
Incapacitated by Alcohol.
III. POLICY ELEMENTS



UW HEALTH CLINICAL POLICY 5
Policy Title: Emergency Detention – State Mental Health Act
Policy Number: 1.2.1


A. A patient at UW Health w ho has a mental illness may be involuntarily detained under Wisconsin State
Mental Health Act (Chapter 51) only after the emergency detention procedure is initiated. Unless a hearing
is held under the involuntary commitment procedures (see UW Health clinical policy 1.2.2, Involuntary
Commitment – State Mental Health Act) or the protective placement procedures, UW Health may not detain
a patient/individual for more than a total of 72 hours, exclusive of Saturdays, Sundays, and holidays.
B. For patients voluntarily admitted to the Inpatient Psychiatry Unit, Emergency Detention is initiated w hen the
Treatment Director, or his/her designee, declares an intention to seek an Emergency Detention and
immediately thereafter begins preparation and f iling of the Statement of Emergency Detention by Treatment
Director (refer to section V. Forms).
C. For patients not on the Inpatient Psychiatry Unit, Emergency Detention is initiated w hen a law enforcement
off icer declares an intention to seek an Emergency Detention by Law Enforcement Officer (refer to section
V. Forms). The county Department of Community Programs (51.42 Board) must approve of the Emergency
Detention and the law enforcement off icer immediately thereafter beings preparation and f iling of the
Statement of Emergency Detention. For purposes of f iling this Statement, inpatients and outpatients,
including those seen in the Emergency Department, w ill be treated in the same manner.
D. Emergency Detention deprives an individual of his or her freedom; therefore, prior to initiation of the
procedure, the person initiating it should be aw are of:
i. The appropriate w itness w ho observed the “specif ic recent overt act or attempt or threat of act or
omission,” w hich indicates a substantial risk of physical harm to self or others and
ii. A licensed physician w ho has given an opinion as to mental illness or drug dependence.

IV. PROCEDURE

A. Initial Steps and Decision to File a Statement of Emergency Detention
i. Determine if Minimal Legal Requirements for a Law Enforcement of Treatment Director’s
Emergency Detention are met. See III - above. A verbal threat may or may not constitute an overt
act depending on the circumstances surrounding the threat.
ii. A patient/individual may be involuntarily detained only after a law enforcement off icer or the
Treatment Director for In-Patient Psychiatry determines the Minimal Legal Requirements for
Emergency Detention are met and declares his/her intention to f ile a Statement of Emergency
Detention and immediately thereafter initiates the Statement.
iii. In cases w here staff, police or family have observed behavior that may be evidence for initiating an
Emergency Detention but it is determined by law enforcement off icer or the Treatment Director that
the minimal requirements for emergency detention are not satisf ied at that time, the observed
behavior and the w itness(es) name(s) should be noted in the medical record to assure the
availability of w itnesses if needed later. This is particularly important in cases w here the police
bring the patient to the Emergency Department and then decide not to f ile the Statement.
iv. If a patient is brought by the police and a Statement has already been filed, the patient's medical
needs should be cared for in the Emergency Department. The patient may be admitted to UWHC
inpatient psychiatry (if accepted for admission by an attending Psychiatrist), or then transported to
another accepting psychiatric facility (e.g. – state (Winnebago Mental Health Institute) or private
facility).
B. Who May Initiate the Statement of Emergency Detention
i. For patients in the Emergency Department at the University Hospital (600 Highland Avenue), the
Resident on the psychiatry consult service, or the Psychiatry Resident on call in consultation w ith
the attending psychiatrist, the Law Enforcement Officer and a representative of the County 51.42
Board determine w hether an Emergency Detention should be initiated for the benefit of the patient.
ii. For patients in the Emergency Department at The American Center (TAC), the Emergency
Medicine team (attending and social w ork) assess the patient and then contact the Psychiatry
faculty covering TAC to determine support for an Emergency Detention. The Emergency Medicine
team w ith the Law Enforcement Officer and a representative of the County 51.42 Board determine
w hether an Emergency Detention should be initiated for the benefit of the patient.
iii. For patients on the Inpatient Psychiatry Unit, the resident on Inpatient Psychiatry or the Psychiatry
resident on call in consultation w ith the attending psychiatrist determine w hether an Emergency
Detention should be initiated for the benefit of the patient.
iv. For patients in other areas of the hospital, the attending physician may make this determination
only after consultation w ith a medical staff member from the Department of Psychiatry.



UW HEALTH CLINICAL POLICY 5
Policy Title: Emergency Detention – State Mental Health Act
Policy Number: 1.2.1

a. At the CSC, the Psychiatry Consult service can be contacted to assess in person.
b. At TAC, social w ork w ill assist w ith the assessment, and the Psychiatry Faculty covering
TAC w ill be contacted for phone or video consultation.
C. Procedure for Preparing the Statement of Emergency Detention by Law Enforcement Officer
i. Copies of the Statement w ith instructions are available from the police, on inpatient psychiatry, and
at Probate Court. The form may be prepared by the Law Enforcement off icer, or the examining
physician or nurse. The statement is not complete until signed by the Law Enforcement off icer.
ii. If the Law Enforcement off icer is not already present, contact the University of Wisconsin Police
Department (University Hospital) or the Madison Police Department (TAC). They w ill come to
UWHC to evaluate the patient for appropriateness of Emergency Detention and to sign the form.
iii. Contact the County 51.42 Board for approval. (In Dane County this is Emergency Services Unit
(crisis) of Journey Mental Health Center.)
iv. The patient may be detained at UWHC or be transferred to another accepting psychiatric facility
(e.g. – state (Winnebago Mental Health Institute) or private facility. If transferred, Law Enforcement
w ill take custody of the patient and arrange for transport. UWHC staff w ill give the police off icer the
original Statement and one copy.
v. The off icer w ill read the part of the Statement entitled "Subject's Rights" to the patient and w ill
provide the patient w ith a copy of the rights. If rights have not been read by the off icer, the rights
w ill be read by inpatient psychiatry clinical staff. The police off icer w ill immediately f ile the original
Statement w ith the appropriate county Court. A copy of the Statement, the name of the off icer, and
the date and time of detention must be placed in the UWHC paper medical record.
D. Procedure for Preparing the Statement of Emergency Detention by the Treatment Director
i. Copies of the Statement w ith instructions are available on Inpatient Psychiatry.
ii. The Treatment Director or designee completes the Statement and f iles it w ith the court. It is not
necessary to contact a Law Enforcement off icer or the County 51.42 Board.
iii. The patient may be detained at UWHC Inpatient Psychiatry unit.
iv. Inpatient Psychiatry clinical staff w ill read the “Subjects Rights at Initial Detention” to the patient and
w ill provide a copy to the patient.
E. Court Proceedings and 72-Hour Limit on Emergency Detention
i. Upon receipt of the Statement of Emergency Detention by a law enforcement off icer or treatment
director, the court shall order a probable cause hearing to be scheduled or order a dismissal of the
Statement and immediate discharge of the patient. If the individual is released, the treatment
director or his designee w ill contact the responsible county to arrange transportation back to their
residence.
ii. Unless a hearing is held under the involuntary commitment procedures or the protective placement
procedures, the off icer and UWHC may not detain a patient/individual for more than a total of 72
hours, exclusive of Saturdays, Sundays and holidays.
iii. When the probable cause hearing is scheduled, the court w ill appoint counsel for the patient in the
event the patient does not have his/her ow n counsel. Counsel for the patient may have full access
to the patient's medical record, w ith access arranged by Health Information Management.
Reasonable questions relating to observed behavior and professional assessment may be
answ ered as time and conditions permit. If the medical record is needed at the hearing, the record
can be provided either w ith the patient's w ritten consent or pursuant to a court subpoena or other
court order.
iv. During the 72-hour period, no involuntary psychiatric treatment may be rendered. The patient may
be offered and can consent to treatment and medication. Restraints intervention can be
administered, limited to unit seclusion, room seclusion, and restraints or medications w ith sedative
effects, in emergency situations, w here the patient is actively dangerous to self or others in
accordance w ith UW Health clinical policy 1.2.2. Necessary and appropriate medical treatment to
preserve life and health must be provided.
v. If probable cause is found at the time of the probable cause hearing, the patient may continue to be
detained at UWHC pursuant to a court order.
vi. For the next steps in the involuntary commitment procedure, see UW Health clinical policy 1.2.2,
Involuntary Commitment – State Mental Health Act.

V. FORMS




UW HEALTH CLINICAL POLICY 5
Policy Title: Emergency Detention – State Mental Health Act
Policy Number: 1.2.1

Statement of Emergency Detention by Law Enforcement Officer (“Statement”).
Statement of Detention by Treatment Director (“Statement”).

VI. COORDINATION

Author: Nurse Manager, Inpatient Psychiatry
Senior Management Sponsor: SVP, Patient Care Services and Chief Nursing Officer
Review ers: Director, Hospital Psychiatry Services; Medical Directors, Inpatient Psychiatry; Legal Services
Department
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: August 17, 2015

UW Health is a cohesive, united and integrated academic medical enterprise compr ised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VII. APPROVAL

Jeff Grossman MD
UW Health CEO

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VIII. REFERENCES

Section 51.15 of the Wisconsin Statutes - Emergency Detention
UWHC policy #8.09 Protective Custody, Emergency and Involuntary Commitment for Persons Intoxicated
and Incapacitated by Alcohol
UW Health Clinical Policy 1.2.2, Involuntary Commitment – State Mental Health Act

IX. REVIEW DETAILS
Version: Revision
Next Revision Due: September 7, 2017
Formerly Know n as: Hospital Administrative policy #10.14