Current through Register 1531, September 27, 2024
(1) For the
purpose of involuntary commitment, mental illness is defined as a substantial
disorder of thought, mood, perception, orientation, or memory which grossly
impairs judgment, behavior, capacity to recognize reality or ability to meet
the ordinary demands of life, but shall not include intellectual or
developmental disabilities, autism spectrum disorder, traumatic brain injury or
psychiatric or behavioral disorders or symptoms due to another medical
condition as provided in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), 5th edition
published by the American Psychiatric Association, or except as provided in
104 CMR
27.18, alcohol and substance use disorders;
provided however, that the presence of such conditions co-occurring with a
mental illness shall not disqualify a person who otherwise meets the criteria
for admission to a mental health facility.
(2) For the purposes of voluntary or
conditional voluntary admission to mental health facilities in the
Commonwealth, any degree of severity of a mental disorder, including
co-occurring substance use disorders, may qualify a person for admission to a
mental health facility at the discretion of the facility director or designee
when it is determined that the person is in need of care and treatment, and
that the admitting facility is suitable for such care and treatment.
(3) No facility licensed as Class III through
VII shall have exclusion criteria for admission that would result in the
rejection of any patient who has been determined by a designated physician or
designated Psychiatric APRN of the facility to meet the clinical criteria for
involuntary commitment pursuant to M.G.L. c. 123, § 12(b), or who has been
committed pursuant to M.G.L. c. 123, § 12(e); provided however, that a
facility that has been certified to treat specialty populations, such as for
treating geriatric patients or patients with co-occurring intellectual or
developmental disabilities, may preferentially admit such patients. Facilities
may not deny admission to a patient for whom it has the clinical competency and
staffing to appropriately treat, except as provided in 104 CMR 27.05(3) (b)
through (d).
(a) A facility licensed as Class
III through VII shall have the capacity to care for patients otherwise meeting
admission criteria who have co-occurring medical needs in accordance with
clinical competencies and operational standards determined by the
Department.
(b) A facility may deny
admission to a patient if such admission would result in a census exceeding the
facility's operational capacity; provided however, that the facility is able to
demonstrate that, despite its best efforts, it is unable to accommodate the
additional capacity.
(c) A
facility may deny admission to a patient if such admission would result in a
census exceeding the facility's licensed capacity.
(d) A facility may deny admission to a
patient whose needs have been determined by the facility medical director to
exceed the facility's capability at the time admission is sought. The
determination shall include the factors justifying denial of admission and why
mitigating efforts, such as utilization of additional staff, would have been
inadequate. This determination must be recorded in writing and shall be subject
to review by the Department; provided however, that such written determination
need not contain patient-identifiable information.
(e) Facilities shall keep data on patients
referred for admission in a form and format and containing data elements as
determined by the Department; provided however, that facilities shall not be
required to maintain patient-identifiable data on individuals not accepted for
admission. Such data shall be available for inspection by the Department upon
request.
(4)
Admission Examination. Upon admission, each patient
shall receive a mental status examination and, within 24 hours of admission, a
complete psychiatric and physical examination. In the case of admissions to an
IRTP, such physical examination shall occur within seven calendar days of
admission. As part of the admission examination, staff shall seek to determine
from the patient, the patient's record, the patient's legally authorized
representative or, if appropriate, from other sources, whether the patient has
a history of trauma including, but not limited to, physical or sexual abuse or
witnessing violence. At the completion of each admission examination, the
admitting clinician shall make an admission diagnosis, and shall enter the
findings of such admission examination in the patient's medical
record.
(5)
Admission
Examination for Patients Younger than 22 Years Old.
(a) In addition to the requirements of 104
CMR 27.05(4), the admission examination for patients younger than 22 years old
shall include a determination as to whether the patient has special educational
needs.
(b) If the patient has
special educational needs, the facility director shall seek written
authorization to provide necessary clinical information to the patient's Local
Education Authority (LEA) in order that an educational program can be jointly
developed for such patient by the LEA and the facility.
(6)
Notice to Family or
Others.
(a)
Admission
of Patients 16 Years of Age or Older. In accordance with M.G.L. c.
123, § 4, the facility director or designee shall, within 48 hours after
admission of any patient, including a patient 16 or 17 years of age who has
applied for admission himself or herself, notify the patient's legally
authorized representative or, if there is no such legally authorized
representative and the patient does not knowingly object, his or her nearest
relative. Notice may be given by telephone, letter or other appropriate
means.
(b)
Emergency or
Court Ordered Admissions of Minors. Except in the case of a mature
or emancipated minor as defined in
104 CMR
25.03: Emancipated and Mature
Minors, the legally authorized representative of a minor shall be
notified immediately upon receipt of the minor who is admitted pursuant to
court order or an application for admission pursuant to M.G.L. c. 123, §
12.
(7)
Denial of Admission. Applicants for voluntary or
conditional voluntary admission to mental health facilities shall not be denied
admission without an explanation of the basis for such refusal, and
alternatives shall be offered or recommended by the admitting clinician where
feasible.
(8)
Prohibition of Admission of Individuals Younger than 19 Years Old
to Adult Inpatient Units; Exceptions. Except as provided in 104
CMR 27.05(8), no individual younger than 19 years old shall be admitted to an
adult unit of a Department operated facility.
(a) The Department may place an individual 17
or 18 years of age on such an adult inpatient unit where a judge of a court of
competent jurisdiction has issued an order for the commitment of the individual
to a mental health facility pursuant to the provisions of M.G.L. c. 123,
§§ 15, 16, 17 or 18, or where the individual has been committed to
the Department of Youth Services, and the Commissioner or designee has
determined that one or both of the following factors exist:
1. placement of the individual on an
adolescent inpatient unit would create a likelihood of serious harm to the
individual or others; or
2. the
individual is in need of stricter security than is available on an adolescent
inpatient unit.
(b) The
factors to be considered in the above determinations include, but are not
limited to, the following:
1. the nature,
circumstances and seriousness of the offense with which the individual has been
charged;
2. the individual's court
and delinquency record;
3. the
individual's maturity;
4. the
individual's history of mental illness;
5. the individual's social history;
6. the risk of harm presented by the
individual's placement on an adolescent inpatient unit;
7. the individual's history of victimizing
others; and
8. the mental health
treatment most suitable for the individual.
(c) Specialty services or units designated by
the Department may admit individuals younger than 19 years old, provided that
they ensure appropriate separate physical space and programmatic services, as
approved by the Commissioner.
(9) Unless otherwise specified, computation
of time for any action required to be taken under
104 CMR 27.00 shall be in
accordance with
104 CMR
25.04: Computation of
Time.
