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ENGROSSED HOUSE
BILL NO. 4227 By: Boatman of the House
and
Paxton of the Senate
An Act relating to mental health; amending 43A O.S.
2021, Section 1-103, which relates to definitions;
adding definition; amending 43A O.S. 2021, Section 5-
207, which relates to imme diate emergency action;
modifying requirement; amending 43A O.S. 2021,
Section 5-302, which relates to the status of
informal patient; including private centers; amending
43A O.S. 2021, Section 5-309, which relates to
detention of persons; including private centers;
amending 43A O.S. 2021, Section 5-415, which relates
to records; creating exemption; amending 43A O.S.
2021, Section 5-420, which relates to the review
status of persons involuntarily committed; modifying
requirement; repealing 43A O.S. 2021, Sections 8-101,
8-103, 8-104, 8-105, 8-106, 8-107, and 8-108, which
relate to mental health; and pr oviding an effective
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 43A O.S. 2021, Section 1-103, is
amended to read as follows :
Section 1-103. When used in this title, unless oth erwise
expressly stated, or unless the context or subj ect matter otherwise
requires:
1. "Department" means the Department of Mental Health and
Substance Abuse Services;
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2. "Chair" means the chair of the Board of Mental Health and
Substance Abuse Services ;
3. "Mental illness" means a substantial disorder of thought,
mood, perception, psychological orientation or memory that
significantly impairs judgm ent, behavior, capacity to recognize
reality or ability to meet the ordinary demands of life;
4. "Board" means the Board of Mental Health and Substance Abuse
Services as established by the Mental Health Law;
5. "Commissioner" means the individual selecte d and appointed
by the Board to serve as Com missioner of Mental Health and Substance
Abuse Services;
6. "Indigent person" means a person who has not sufficient
assets or resources to support the person and to support members of
the family of the person la wfully dependent on the person for
support;
7. "Facility" means any hospital, school, building, house or
retreat, authorized by law to have the care, treatment or custody of
an individual with mental illness, or drug or alcohol dependency,
gambling addiction, eating disorders, an opioid substitutio n
treatment program including, but not limited to, public or p rivate
hospitals, community mental health centers, cli nics, satellites or
facilities; provided, that facility shall not mean a child guidance
center operated by the State Department of Health;
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8. "Consumer" means a person under care or treatment in a
facility pursuant to the Mental Health Law, or in an outpa tient
status;
9. "Care and treatment" means medical care and behavioral
health services, as wel l as food, clothing and maintenance,
furnished to a person;
10. Whenever in this law or in any other law, or in any rule or
order made or promulgated pursuant to this law or to any other law,
or in the printed forms prepared for the admission of consumers or
for statistical reports, the words "insane", "insanity", "lunacy",
"mentally sick", "mental disease" or "mental disorder" are used,
such terms shall have eq ual significance to the words "mental
illness";
11. "Licensed mental health professional " means:
a. a psychiatrist who is a diplomate of th e American
Board of Psychiatry and Neurology,
b. a psychiatrist who is a diplomate of the American
Osteopathic Board of Neurology and Psychiatry,
c. a physician licensed pursuant to the Oklahoma
Allopathic Medical and Surgical Licensure and
Supervision Act or the Oklahoma Osteopathic Medicine
Act,
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d. a clinical psychologist who is duly licensed to
practice by the State Board of Examiners of
Psychologists,
e. a professional counselor licensed pursuant to the
Licensed Professional Counselors Act,
f. a person licensed as a clinical social worker pursuant
to the provisions of the Social Worker 's Licensing
Act,
g. a licensed marital and family therapist as defined in
the Marital and Family Therapist Licensure Act,
h. a licensed behavioral practitioner as defined in the
Licensed Behavioral Practitioner Act ,
i. an advanced practice nurse as defined in the Oklahoma
Nursing Practice Act,
j. a physician's assistant who is licensed in good
standing in this state, or
k. a licensed drug and alcohol counselor/mental health
(LADC/MH) as defined in the Licensed Alcohol and Drug
Counselors Act;
12. "Mentally incompetent person " means any person who has been
adjudicated mentally or legally incompetent by an appropriate
district court;
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13. a. "Person requiring treatment " means a person who
because of his or her mental illness or drug or
alcohol dependency:
(1) poses a substantial risk of imm ediate physical
harm to self as manifested by evidence or serious
threats of or attempts at suic ide or other
significant self-inflicted bodily harm,
(2) poses a substantial risk of immediate physical
harm to another person or persons as manifested
by evidence of violent behavior directed toward
another person or persons,
(3) has placed another person or persons in a
reasonable fear of violent behavior directed
towards such person or persons or serious
physical harm to them as manifested by serious
and immediate threats,
(4) is in a condition of severe deterioration such
that, without immediate interve ntion, there
exists a substantial risk that severe impairment
or injury will result to the person, or
(5) poses a substantial risk of immediate serious
physical injury to self or death as manifested by
evidence that the person is unable to provide for
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and is not providing for his or her basic
physical needs.
b. The mental health or substance abuse history of t he
person may be used as part of the evidence to
determine whether the person is a person requiring
treatment or an assisted outpatient. The mental
health or substance abuse history of the pers on shall
not be the sole basis for this determination.
c. Unless a person also meets the criteria established in
subparagraph a or b of this paragraph, "person
requiring treatment" or an "assisted outpatient" shall
not mean:
(1) a person whose mental proce sses have been
weakened or impaired by reason of advanced year s,
dementia, or Alzheimer 's disease,
(2) a person with intellectual or developmental
disability as defined in Title 10 of the Oklahoma
Statutes,
(3) a person with seizure disorder,
(4) a person with a traumatic brain injury, or
(5) a person who is homeless .
d. A person who meets the criteria established in th is
section but who is medically unstable, or the facility
holding the person is unable to treat the additional
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medical conditions of that pe rson, should be
discharged and transported in accordance with Section
1-110 of this title;
14. "Petitioner" means a person who files a petition alleging
that an individual is a person requiring treatment or an a ssisted
outpatient;
15. "Executive director" means the person in charge of a
facility as defined in this section;
16. "Private hospital or facility " means any general hospital
maintaining a neuro-psychiatric unit or ward, or any private
hospital or facility for care and treatment of a person havin g a
mental illness, which is not supported by the state or fed eral
government. The term "private hospital" or "facility" shall not
include nursing homes or other facilities maintained primarily for
the care of elderly and disabled persons;
17. "Individualized treatment plan " means a proposal developed
during the stay of an individual in a facility, under the provision s
of this title, which is specifically tailored to the treatment needs
of the individual. Each plan shall clearly include the following:
a. a statement of treatment goals or objectives, based
upon and related to a clinical evaluation, which can
be reasonably achieved within a designated time
interval,
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b. treatment methods and procedures to be used t o obtain
these goals, which methods and proc edures are related
to each of these goals and which include sp ecific
prognosis for achieving each of these goals,
c. identification of the types of professional personnel
who will carry out the treatment procedur es including
appropriate medical or other pr ofessional involvement
by a physician or other health professi onal properly
qualified to fulfill legal requirements mandated under
state and federal law,
d. documentation of involvement by the individual
receiving treatment and, if applicable, the accordan ce
of the individual with the treatment plan, and
e. a statement attesting that the executive director of
the facility or clinical director has made a
reasonable effort to meet the plan 's individualized
treatment goals in the least restrictive environment
possible closest to the home community of the
individual;
18. "Telemedicine" means technology-enabled health and ca re
management and delivery systems that extend capacity and access,
which includes:
a. synchronous mechanisms, which may include live
audiovisual interaction between a patient and a health
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care professional or real-time provider to provider
consultation through live interactive audiovisual
means,
b. asynchronous mechanisms, which include store and
forward transfers, online exchange of health
information between a patient and a health care
professional and online exchange of health information
between health care professionals, but shall not
include the use of automated text messages or
automated mobile applications that serve as the sole
interaction between a patient and a health care
professional,
c. remote patient monitoring, and
d. other electronic means that support clinical health
care, professional consultation, patient and
professional health-related education, public health
and health administration;
19. "Recovery and recovery support " means nonclinical services
that assist individuals and families t o recover from alcohol or drug
problems. They include social support, linkage to and coordinati on
among allied service providers including but not limited to
transportation to and from treatment or emp loyment, employment
services and job training, case ma nagement and individual services
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coordination, life skills education, relapse prevention, housin g
assistance, child care, and substance abus e education;
20. "Assisted outpatient" means a person who:
a. is either currently under the care of a facility
certified by the Department of Mental Health and
Substance Abuse Services as a Community Mental Heal th
Center, or is being discharged from the c ustody of the
Oklahoma Department of Corrections, or is being
discharged from a residential placement by the Office
of Juvenile Affairs,
b. is suffering from a mental illness,
c. is unlikely to survive safely in the community without
supervision, based on a clinical determination,
d. has a history of lack of complian ce with treatment for
mental illness that has:
(1) prior to the filing of a petition, at least twice
within the last thirty -six (36) months been a
significant factor in necessitating
hospitalization or treatment in a hospital or
residential facility includ ing admission to a
community-based structured crisis c enter as
certified by the Oklahoma Department of Mental
Health and Substance Abuse Services, or receipt
of services in a forensic or other m ental health
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unit of a correctional facility, or a specialized
treatment plan for treatment of mental illness in
a secure juvenile facility or placement in a
specialized residential program for juveniles, or
(2) prior to the filing of the petition, resulte d in
one or more acts of serious violent behavior
toward self or others or threats of, or attempts
at, serious physical harm to self or others
within the last twenty-four (24) months,
e. is, as a result of his or her mental illness, unlikely
to voluntarily participate in outpatient treatment
that would enable him or her to live safely in the
community,
f. in view of his or her treatment history and current
behavior, is in need of assisted outpatient treatment
in order to prevent a relapse or deterioration w hich
would be likely to result in serious harm to the
person or persons as defined in this section, and
g. is likely to benefit from assisted outpatient
treatment; and
21. "Assisted outpatient treatment " means outpatient services
which have been ordered b y the court pursuant to a treatment plan
approved by the court to treat an assisted outpatient 's mental
illness and to assist the person in living and functioning in the
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community, or to attempt to prevent a rela pse or deterioration that
may reasonably be predicted to result in suicide or the need for
hospitalization; and
22. "Urgent recovery clinics " means clinics that offer
voluntary services aimed at the assessment and immediate
stabilization of acute symptoms of mental illness, alcohol and other
drug abuse, and emotional distress. Unless the person receiving
treatment consents to a longer duration, or if the person is placed
into emergency detention status, no more than twenty-three (23)
hours and fifty-nine (59) minutes of services may be provided to a
consumer during one episode of care at an urgent recovery clin ic.
SECTION 2. AMENDATORY 43A O.S. 2021, Section 5-207, is
amended to read as follows:
Section 5-207. A. Any person who ap pears to be or states that
such person is mentally ill, alcohol -dependent, or drug-dependent to
a degree that immediate emergency action is necessary may be tak en
into protective custody and detained as provided pursuant to the
provisions of this section. Nothing in this section shall be
construed as being in lieu of prosecution under state or local
statutes or ordinances relating to public intoxication offenses .
B. 1. Any peace officer who reasonably believes that a person
is a person requiring treatmen t as defined in Section 1 -103 of this
title shall take the person into protective custody. The officer
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shall make every reasonable effort to take the person in to custody
in the least conspicuous manner.
2. Upon taking the person into protective custody, the officer
may relinquish custody of the person believed to require treatment
to a duly qualified reserve officer or deputy employed by the same
agency to fulfill the officer's duties as required by this title.
C. The officer shall prepare a written stat ement indicating the
basis for the officer's belief that the person is a person requiring
treatment and the circumstances under which the officer took the
person into protective custody. The officer shall give a copy of
the statement to the person or the person's attorney upon the
request of either. If the officer does not make the determination
to take an individual into protective custody on the basis of the
officer's personal observation, the officer shall not be required to
prepare a written statement . However, the person stating to be
mentally ill, alcohol -dependent or drug-dependent or the person upon
whose statement the officer relies shall sign a writte n statement
indicating the basis for such person's belief that the person is a
person requiring treatment. Any false statement given to the
officer by the person upon whose statement the officer relies shall
be a misdemeanor and subject to the sanctions o f Title 21 of the
Oklahoma Statutes.
D. If the person is medically stable, the officer shall
immediately transport the person to an urgent recovery clinic or to
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the nearest facility, as defined in Section 1 -103 of this title, for
an initial assessment wit hin a thirty (30) mile radius of the peace
officer's operational headquarters, or may use teleme dicine with a
licensed mental health professional employed or under contract with
a facility operated by, certified by or contracted with the
Department of Mental Health and Substance Abuse Services to perform
an initial assessment. If, subsequent to an i nitial assessment, it
is determined that emergency detention is warranted, the officer
shall immediately transport the person to the nearest facility that
has bed space available if the facility is within thirty (30) miles
of the peace officer 's operational headquarters and the individu al
was determined to be a person requiring treatment. The Department
of Mental Health and Substance Abuse Services may contract for the
use of alternative transportation providers to transport individuals
to facilities designated for emergency detention w hen the nearest
facility with available bed space is more than thirty (30) miles
from the peace officer 's operational headquarter s and the individual
was determined to be a person requiring treatment. For the purposes
of this section, "urgent recovery clinics" means clinics that offer
services aimed at the assessment and immediate stabilization of
acute symptoms of mental illness, alcohol and other drug abuse and
emotional distress,; provided that, unless the person consents to a
longer duration, no more than twenty-three (23) hours and fifty -nine
(59) minutes of services are provided to a consumer during one
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episode of care. If it is determined by the facility director or
designee that the person is not medically stable, the officer shall
immediately transport the person to the nearest hospital or other
appropriate treatment facility.
E. If the person is medically unstable, the per son may be
transported to an appropriate medical facility for medical
treatment. A treating ph ysician may authorize that the p erson be
detained until the person becomes medically stable. When the person
becomes medically stable, if in the opinion of the treating or
discharging physician, the patient is still a person requiring
treatment as defined in Section 1-103 of this title, the physician
shall authorize detention of the patient for transportation as
provided in subsection D of this section.
F. The parent, brother or sister who is eighteen (18) years of
age or older, child who is eighteen (18) years of age or older, or
guardian of the person, or a person who appears to be or states that
such person is mentally ill, alcohol -dependent or drug-dependent to
a degree that emergency action is necessary may request the
administrator of a facility desi gnated by the Commissioner as an
appropriate facility for an initial assessment to conduct an initial
assessment to determine whether the condition of the person is such
that emergency detention is warranted and, if emergency detention is
warranted, to detain the person as provided in Se ction 5-206 of this
title.
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SECTION 3. AMENDATORY 43A O.S. 2021, Section 5-302, is
amended to read as foll ows:
Section 5-302. A. Any person may be admitted to a state mental
hospital or state-operated community mental health center or a
private mental health hospital or pr ivate community mental health
center on a voluntary basis as an informal consumer when there are
available accommodations and in the judgment of the person in charge
of the facility or a designee such person may require treatment
therein. Such person may be admitted as an informal consumer
without making formal or written application theref or and any such
informal consumer shall be free to leave such facility on any day
between the hours of 9:00 a.m. and 5:00 p.m. and at such other times
as the person in charge of the facility may determine.
B. No person shall be admitted as an informal consumer pursuant
to the provisions of this section to any state mental hospital or
state-operated community mental health center unless the person in
charge of the facility or a designee has informed such consumer in
writing of the following:
1. The rules and procedures of the facility relating to the
discharge of informal consumers;
2. The legal rights of an informal consumer receiving treatment
from the facility; and
3. The types of treatment which are available to the informal
consumer at the facility.
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SECTION 4. AMENDATORY 43A O.S. 2021, Section 5-309, is
amended to read as follows:
Section 5-309. No consumer admitted to a state or private
mental hospital under the provisions of the Mental Hospital
Voluntary Admission Procedur es Act shall be detained in a mental
hospital against the will of the person more than one hundred twenty
(120) hours or five (5) days, excluding weekends and holidays, after
the consumer gives notice in writing to the executive director of
the facility of the desire of the consumer to be discharged from the
facility. The executive director of the fa cility may designate one
or more employees of the facility to receive a notification provided
by this section with the same effect as if delivered to the
executive director personally.
SECTION 5. AMENDATORY 43A O.S. 2021, Section 5-415, is
amended to read as follows :
Section 5-415. A. Upon receiving a petition alleging a person
to be a person requiring treatment, the court shall set a day and
time for the hearing.
1. If the person alleged to be a person requiring treatment
does not have an attorney, the court shall immediately appoint an
attorney for the person.
2. If a copy of a mental health ev aluation is not attached to
the petition at the time it is filed, the court shall immediately
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order a mental health evaluation of the per son as provided by
Section 5-414 of this title.
B. If the court deems it necessary, or if the person alleged to
be a person requiring treatment demands, the cou rt shall schedule
the hearing on the petition as a jury trial to be held within one
hundred twenty (120) hours or five (5) days of the demand, excluding
weekends and holidays, or within as much additional time as i s
requested by the attorney of such person upon good cause shown.
C. The court, at the hearing on the petition, shall determine
by clear and convincing evidence whether the person is a person
requiring treatment.
1. The court shall take evidence and make findings of fact
concerning the person 's competency to consent to or refuse the
treatment that may be ordered, including, but not limite d to, the
consumer's right to refuse medication.
2. If a jury trial is not demanded, the court may receive as
evidence and act upon the affidavits of the licens ed mental health
professionals who evaluated the person and the mental health
evaluation.
3. When the hearing is conducted as a jury trial, the
petitioner and any witness in behalf of the petitioner shall be
subject to cross-examination by the attorney fo r the person alleged
to be a person requiring treatment. The person alleged to be a
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person requiring treatment may also be called as a witness and
cross-examined.
D. After the hearing, when the court determines t hat the person
is not a person requiring t reatment, the court shall dismiss the
petition and, if the person is being detained, order the person to
be discharged from detention.
E. After the hearing, when the court determines the person to
be a person requiring treatment, the court shall order the person to
receive the least restrictive treatment consistent with the
treatment needs of the p erson and the safety of the person and
others.
1. The court shall not order hospitalization without a thorough
consideration of available treatment alternatives to hospitalization
and may direct the submission of evidence as to the least
restrictive treatment alternative or may order a mental health
examination.
2. If the court finds that a program other than hospitaliza tion
is appropriate to meet the treatment needs of the individual and is
sufficient to prevent injury to the individual or to others, the
court may order the individual to receive whatever treatment other
than hospitalization that is appropriate for a peri od set by the
court, during which time the court shall continue its jurisdiction
over the individual as a person requiring treatment.
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3. If the court orders the person to be committed for
involuntary inpatient treatment, the court shall commit the person
to the custody of the Department of Mental Health and Substance
Abuse Services for a placement that is suitable to the person 's
needs or to a private facility willing to accept the person for
treatment.
4. The person shall be delivered to the custody of t he
Department of Mental Health and Substan ce Abuse Services for a
placement that is suitable to the person's needs or to a private
facility willing to accept the person for treatment.
5. If the person is placed in the custody of the Department,
the Department may designate two or more facilities to provide
treatment and if the person to be treated or a parent, spouse,
guardian, brother, si ster or child, who is at least eighteen (18)
years of age, of the person, expresses a preference for one such
facility, the Department shall attempt, if administ ratively
possible, to comply with the preference.
6. The person shall be discharged from inpat ient treatment at
such time as the person no longer requires treatment as determined
by the executive director of the f acility or the designee of the
executive director, or as otherwise required by law.
F. The court shall make and keep records of all case s brought
before it.
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1. Except as provided in Section 3 1290.27 of this act Title 21
of the Oklahoma Statutes , no records of proceedings pursuant to this
section shall be open to public inspection excep t by order of the
court or to employees of the Department of Mental Health and
Substance Abuse Services if the person is placed at a state facility
or the employees of the pr ivate facility where admitted if accepted
into a private facility , the person's attorney of record, the
person's treatment advocate as defined pursuant to Section 1 -109.1
of this title, if any, a person having a valid power of attorney
with health care decision -making authority, a person having valid
guardianship with heal th care decision-making authority, a person
having an advance health care directive, a person having an
attorney-in-fact as designated in a valid mental health advance
directive or persons having a legitimate treatment interest, unless
specifically indicat ed otherwise by the instrument or court order.
The documents shall not identify the alleged person requiring
treatment directly or indirectly as a person with a substance abuse
disorder.
2. Bonded abstractors may be deemed to be persons having a
legitimate interest for the purpose of having access to records
regarding determinations of persons requiring treatmen t under this
section.
SECTION 6. AMENDATORY 43A O.S. 2021, Section 5-420, is
amended to read as follows:
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Section 5-420. A. The Board of Mental Health and Substance
Abuse Services shall adopt rules and procedures to ensure that
persons involuntarily committed to the facilities of the Department
of Mental Health and Substance Abuse Services for treatment by a
court receive review of their involuntary status at least once every
three (3) months, and the Department of Mental Health and Substance
Abuse Services shall take appropriate a ction based upon this review.
B. Any person receiving involuntary inpatient treatment, or
such person's attorney, may at any time file a written request that
the treatment order be reviewed by the committing court, o r a court
in the county where the perso n is located. If a review is
requested, the court shall hear the matter within thirty (30) days
after the request, and t he court shall give notice to the person and
such person's attorney and the person in charge of the facility of
the time and place of t he hearing. The hearing shall be to
determine if the person can be treated on a less restrictiv e basis.
At the conclusion of the hearing, the court may confirm the order of
treatment, modify the order of treatment, discharge the respondent,
or enter any appropriate order.
SECTION 7. REPEALER 43A O.S. 2021, Sections 8-101, 8-
103, 8-104, 8-105, 8-106, 8-107 and 8-108, are hereby repealed.
SECTION 8. This act shall become effectiv e November 1, 2022.
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Passed the House of Representatives the 15th day of March, 2022.
Presiding Officer of the House
of Representatives
Passed the Senate the ___ day of __________, 2022.
Presiding Officer of the Senate