D.C. Act 25-698. Enhancing Mental Health Crisis Support and Hospitalization Amendment Act of 2024.

AN ACT

To amend Chapter 5 of Title 21 of the District of Columbia Official Code to ensure that healthcare workers and residents possess the requisite information and resources to secure mental health support for individuals at risk of self-harm or harm to others, to authorize qualified nurse practitioners to initiate the process for emergency hospitalization, and to extend the time for the court to conduct certain hearings; to amend section 21-2047 of the District of Columbia Official Code to clarify the authority of a general guardian or limited guardian to consent to medical examination or care for their ward; to amend the Incompetent Defendants Criminal Commitment Act of 2004 to allow 48 hours for the court to hold a probable cause hearing on a defendant's continued detention; and to amend the Department of Behavioral Health Establishment Act of 2013 to develop online training materials covering the District's mental health laws.

BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the "Enhancing Mental Health Crisis Support and Hospitalization Amendment Act of 2024".

Sec. 2. Chapter 5 of Title 21 of the District of Columbia Official Code is amended as follows:

(a) Section 21-501 is amended as follows:

(1) Paragraph (4A) is amended by striking the phrase "Department of Mental Health" and inserting the phrase "Department of Behavioral Health" in its place.

(2) Designate the existing paragraph (9A) as paragraph (9B).

(3) A new paragraph (9A) is added to read as follows:

"(9A) "Qualified nurse practitioner" means a person who is licensed under the laws of the District of Columbia to practice as a certified nurse practitioner pursuant to § 3-1206.07a, has completed a master's or doctoral degree in psychiatric nursing, and is nationally board-certified as a psychiatric-mental health nurse practitioner.".

(4) Paragraph (9B) is amended by striking the word "section" and inserting the symbol "§" in its place.

(5) Paragraph (10) is amended by striking the phase "section 501 of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.01)," and inserting the phrase "§ 3-1205.01, or working as a psychologist and authorized to practice pursuant to § 3-1205.02(a)(2)," in its place.

(b) Section 21-501.01(a) is amended by striking the phrase "the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1201.01 et seq.)." and inserting the phrase "§ 3-1201.01 et seq." in its place.

(c) Section 21-511(b) is amended by striking the phrase "the Mental Health Service Delivery Reform Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code § 7-1131.01 et seq.)," and inserting the phrase "§ 7-1131.01 et seq.," in its place.

(d) Section 21-512 is amended by striking the phrase "section 21-511" wherever it appears and inserting the phrase "§ 21-511" in its place.

(e) Section 21-513 is amended by striking the phrase "section 21-514" and inserting the phrase "§ 21-514" in its place.

(f) Section 21-514 is amended by striking the phrase "section 21-513" and inserting the phrase "§ 21-513" in its place.

(g) Section 21-521 is amended to read as follows:

"Sec. 21-521. Detention of persons believed to be mentally ill; transportation and application to hospital.

"An accredited officer or agent of the Department of Behavioral Health, or an officer authorized to make arrests in the District of Columbia, or a physician, qualified psychologist, or qualified nurse practitioner of the person in question, who has reason to believe that a person is mentally ill and, because of the illness, is likely to injure themselves or others if they are not immediately detained may, without a warrant, take the person into custody, transport them to a public or private hospital, or to the Department, and make application for their admission thereto for purposes of emergency observation and diagnosis. The application shall reveal the circumstances under which the person was taken into custody and the reasons therefor.".

(h) Section 21-522 is amended as follows:

(1) Strike the word "section" wherever it appears and insert the symbol "§" in its place.

(2) Subsection (d) is amended by striking the phrase "the District of Columbia Mental Health Information Act of 1978, effective March 3, 1979 (D.C. Law 2-136; D.C. Official Code § 7-1201.01 et seq.)," and inserting the phrase "§ 7-1201.01 et seq.," in its place.

(i) Section 21-523 is amended as follows:

(1) Designate the existing text as subsection (a).

(2) Subsection (a) is amended by striking the phrase "section 21-522" and inserting the phrase "§ 21-522" in its place.

(3) A new subsection (b) is added to read as follows:

"(b) A person brought in for emergency diagnosis and observation may be provided treatment if the person gives their informed consent or has been deemed incapacitated and substituted consent has been given, pursuant to § 21-2210, prior to commitment.".

(j) Section 21-524 is amended as follows:

(1) Subsection (a) is amended by striking the phrase "section 21-523" and inserting the phrase "§ 21-523" in its place.

(2) Subsection (b) is amended by striking the phrase "section 21-522" and inserting the phrase "§ 21-522" in its place.

(k) Section 21-525 is amended to read as follows:

"Sec. 21-525. Hearing by court.

"The court shall grant a hearing to a person whose continued hospitalization is ordered under § 21-524, if they request the hearing. The hearing shall be held within 48 hours after receipt of the request.".

(l) Section 21-526 is amended as follows:

(1) Subsection (a) is amended to read as follows:

"(a) If the maximum period of time prescribed by §§ 21-512, 21-523, 21-524, 21-525, or 21-548, during which an action or determination may or shall be taken, expires on a Saturday, Sunday, legal holiday, or day on which the Court is closed, the period may be extended to not later than noon of the next succeeding day which is not a Saturday, Sunday, legal holiday, or day on which the Court is closed.".

(2) Subsection (c) is amended as follows:

(A) Strike the phrase "section 21-524" and insert the phrase "§ 21-524" in its place.

(B) Strike the phrase "section 21-543(b)" and insert the phrase "§ 21-543(b)" in its place.

(3) Subsection (d) is amended by striking the phrase "section 21-542" and inserting the phrase "§ 21-542" in its place.

(4) Subsection (e) is amended by striking the phrase "chapter." and inserting the phrase "chapter; except, that the person may agree to remain in an inpatient status on a voluntary basis until an appropriate discharge plan is implemented if the Department agrees that this is an appropriate accommodation." in its place.

(5) A new subsection (f) is added to read as follows:

"(f)(1) If it is determined by the Court that transporting the person who is the subject of detention for emergency observation and diagnosis to the courthouse for a hearing under § 21-525 poses a significant risk to the safety and wellbeing of the person, court personnel, or the public, the Court may, upon written request from the chief of service of a hospital, the chief clinical officer of the Department of Behavioral Health or their designee, or the person's attorney, grant a continuance of the hearing. The Court shall consider reasonable alternatives to in-person attendance, such as virtual attendance, in lieu of granting a continuance under this subsection. The continuance shall last no longer than 48 hours and shall take into consideration the nature of the case and the specific circumstances that would warrant a continuance, which may include:

"(A) severe weather conditions that pose a safety risk;

"(B) threats to the security of the individuals transporting the person who is the subject of detention for emergency observation and diagnosis;

"(C) medical conditions of the person that would make transportation unsafe; and

"(D) A declaration of a public health emergency that would make an in-person hearing unsafe.

"(2) If the Court grants a continuance under paragraph (1) of this subsection, the 48-hour time period for holding a hearing under § 21-525 shall be tolled for the duration of the continuance.".

(m) Section 21-527 is amended as follows:

(1) Strike the phrase "section 21-524" both times it appears and insert the phrase "§ 21-524" in its place.

(2) Subsection (a)(3)(D) is amended by striking the phrase "the District of Columbia Mental Health Information Act of 1978, effective March 3, 1979 (D.C. Law 2-136; D.C. Official Code § 7-1201.01 et seq.)." and inserting the phrase "§ 7-1201.01 et seq." in its place.

(3) Subsection (b) is amended as follows:

(A) Paragraph (1) is amended by striking the phrase "section 21-526(c)" and inserting the phrase "§ 21-526(c)" in its place.

(B) Paragraph (2)(D) is amended by striking the phrase "the District of Columbia Mental Health Information Act of 1978, effective March 3, 1979 (D.C. Law 2-136; D.C. Official Code § 7-1201.01 et seq.)." and inserting the phrase "§ 7-1201.01 et seq." in its place.

(n) Section 21-541 is amended as follows:

(1) A new subsection (a-1) is added to read as follows:

"(a-1) Except for those petitions filed by the Department, all petitions seeking commitment of a person to the Department shall be served upon the Director of the Department or their designee.".

(2) Subsection (b) is amended to read as follows:

"(b) Within 3 days after the Department receives a petition filed under subsection (a) of this section, the Department shall serve a copy of the petition on the person with respect to whom it was filed by:

"(1) personally serving the person with a copy of the petition;

"(2) mailing a copy of the petition to the person's last known home address; or

"(3) delivering a copy of the petition to the person's last known home or business address and leaving it with someone of suitable age and discretion who resides or is employed there and who attests that the person with respect to whom the petition was filed also resides there."

(3) A new subsection (c) is added to read as follows:

"(c) If the petition is served via a method authorized under subsection (b)(2) or (b)(3) of this section, the petition shall be sealed in an envelope and conspicuously marked with the following statement:

"IMPORTANT LEGAL DOCUMENTS - TO BE OPENED ONLY BY THE INDIVIDUAL NAMED ON THIS ENVELOPE".".

(o) Section 21-542 is amended as follows:

(1) Subsection (a) is amended by striking the phrase "section 21-541" and inserting the phrase "§ 21-541" in its place.

(2) Subsection (b) is amended by striking the phrase "section 21-586" and inserting the phrase "§ 21-586" in its place.

(3) A new subsection (c) is added to read as follows:

"(c) If it is determined by the Commission that transporting a person who is the subject of a petition filed under § 21-541 for a hearing under this section poses a significant risk to the safety and wellbeing to the person, court personnel, or the public, the Commission may, upon written request from the chief of service of a hospital, the chief clinical officer of the Department of Behavioral Health or their designee, or the person's attorney, grant a continuance of the hearing. The Commission shall consider reasonable alternatives to in-person attendance, such as virtual attendance, in lieu of granting a continuance under this subsection. The continuance shall last for no longer than 48 hours and shall take into consideration the nature of the case and the specific circumstances that would warrant a continuance, which may include:

"(1) severe weather conditions that pose a safety risk;

"(2) threats to the security of the individuals transporting the person subject to the petition;

"(3) medical conditions of the person that would make transportation unsafe; or

"(4) a declaration of a public health emergency that would make an in-person hearing unsafe.".

(p) Section 21-544 is amended by striking the phrase "section 21-542" and inserting the phrase "§ 21-542" in its place.

(q) Section 21-545 is amended as follows:

(1) Subsection (a) is amended as follows:

(A) Strike the phrase "section 21-544" and insert the phrase "§ 21-544" in its place.

(B) Strike the phrase "served personally" and insert the word "served" in its place.

(r) Section 21-545.01 is amended as follows:

(1) Strike the phrase "registered mail" both times it appears and insert the word "mail" in its place.

(2) Strike the phrase "section 21-545" wherever it appears and insert the phrase "§ 21-545" in its place.

(3) Subsection (a) is amended as follows:

(A) Designate the existing text as paragraph (1).

(B) Paragraph (1) is amended by striking the phrase "a petition of commitment" and insert the phrase "a petition for renewal of commitment" in its place.

(C) A new paragraph (2) is added to read as follows:

"(2) In lieu of a certificate from a psychiatrist or qualified psychologist, the petition for renewal of commitment may be supported by a sworn written statement from the petitioner that:

"(A) the petitioner has good reason to believe that the person is mentally ill, and, because of the illness, is likely to injure themselves or others if not recommitted; and

"(B) the person has refused to submit to examination by a psychiatrist or qualified psychologist.".

(4) Subsection (c) is amended by striking the phrase "sections 21-542 and 21-543" and insert the phrase "§§ 21-542 and 21-543" in its place.

(s) Section 21-546 is amended as follows:

(1) Strike the phrase "section 21-545" wherever it appears and insert the phrase "§ 21-545" in its place.

(2) Strike the phrase "section 21-545.01" wherever it appears and insert the phrase "§ 21-545.01" in its place.

(t) Section 21-547(a) is amended by striking the phrase "section 21-546" and inserting the phrase "§ 21-546" in its place.

(u) Section 21-548 is amended as follows:

(1) Strike the phrase "section 21-545 or section 21-545.01" both times it appears and insert the phrase "§ 21-545 or § 21-545.01" in its place.

(2) Subsection (b) is amended as follows:

(A) Paragraph (2) is amended by striking the number "24" and inserting the number "48" in its place.

(B) Paragraph (3) is amended as follows:

(i) Strike the number "24" and insert the number "48" in its place.

(ii) Strike the word "affidavit" both times it appears and insert the word "statement" in its place.

(C) Paragraph (4) is amended by striking the phrase "notice and affidavit" and inserting the phrase "notice and statement" in its place.

(D) Paragraph (6) is amended by striking the phrase "section 21-526" and inserting the phrase "§ 21-526" in its place.

(v) Section 21-551(a) is amended by striking the phrase "section 21-545" and inserting the phrase "§ 21-545" in its place.

(w) Section 21-561(a) is amended to read as follows:

"(a) A person hospitalized in a public or private hospital pursuant to this chapter, or committed under §§ 21-545, 21-545.01, or 21-548, may exercise the right to communicate with others as set forth in § 7-1231.01 et seq.".

(x) Section 21-562 is amended by striking the phrase "the District of Columbia Mental Health Information Act of 1978, effective March 3, 1979 (D.C. Law 2-136; D.C. Official Code § 7-1201.01 et seq.)," and inserting the phrase "§ 7-1201.01 et seq." in its place.

(y) Section 21-563 is amended by striking the phrase "the Mental Health Consumers' Rights Protection Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code § 7-1231.01 et seq.)." and inserting the phrase "§ 7-1231.01 et seq." in its place.

(z) Section 21-582 is amended to read as follows:

"Sec. 21-582. Petitions, applications, or certificates of physicians, qualified psychologists, and qualified nurse practitioners.

"(a)(1) A petition, application, or certificate authorized under §§ 21-521, 21-541(a), 21-545.01, or 21-548 may not be considered if made by a psychiatrist, physician, qualified psychologist, or qualified nurse practitioner who is related by blood, marriage, or domestic partnership to the person about whom the petition, application, or certificate is made.

"(2) A petition, application, or certificate authorized under §§ 21-521, 21-523, 21-541(a), 21-545.01, or 21-548 may be considered if made by a psychiatrist, physician, qualified psychologist, or qualified nurse practitioner employed or contracted by the hospital in which the person is to be detained and the psychiatrist, physician, qualified psychologist, or qualified nurse practitioner may admit the person to the hospital if they certify in writing that their financial arrangement with the hospital is not based on the volume of inpatient referrals or admissions.

"(b) A petition, application, or certificate of a physician, qualified psychologist, or qualified nurse practitioner may not be considered unless it is based on the personal observation and examination of the person made by the physician, qualified psychologist, or qualified nurse practitioner not more than 72 hours prior to the making of the petition, application, or certificate. The certificate shall set forth in detail the facts and reasons on which the physician, qualified psychologist, or qualified nurse practitioner based their opinions and conclusions.".

(aa) Section 21-583 is amended to read as follows:

"Sec. 21-583. Physicians, psychiatrists, qualified psychologists, and qualified nurse practitioners as witnesses.

"A physician, psychiatrist, qualified psychologist, or qualified nurse practitioner making application or conducting an examination under this chapter is a competent and compellable witness at any trial, hearing or other proceeding conducted pursuant to this chapter and the physician- or psychologist-patient privilege is not applicable.".

(bb) Section 21-589 is amended as follows:

(1) Subsection (a) is amended by striking the word "sections" both times it appears and inserting the symbol "§§" in its place.

(2) Subsection (b) is amended by striking the phrase "section 21-546" and inserting the phrase "§ 21-546" in its place.

(cc) Section 21-589.01 is amended as follows:

(1) Subsection (a) is amended by striking the phrase "section 21-545" and inserting the phrase "§ 21-545" in its place.

(2) Subsection (b) is amended by striking the phrase "section 21-545.01" and inserting the phrase "§ 21-545.01" in its place.

(dd) Section 21-591(3) is amended by striking the phrase "or qualified psychologist" and inserting the phrase ", qualified psychologist, or qualified nurse practitioner" in its place.

Sec. 3. Section 21-2047(b)(4) of the District of Columbia Official Code is amended to read as follows:

"(4)(A) Consent to medical and psychiatric examinations and treatment, including medical treatment, psychiatric treatment, the administration of medications, including psychotropic medications, or other professional care, treatment, or advice for the ward.

"(B) A general guardian or limited guardian consenting to treatment outlined in subparagraph (A) of this paragraph shall not be liable for civil damages for any act or omission, unless the act or omission constitutes gross negligence;".

Sec. 4. Section 107(c)(2) of the Incompetent Defendants Criminal Commitment Act of 2004, effective May 24, 2005 (D.C. Law 15-358; D.C. Official Code § 24-531.07(c)(2)), is amended by striking the phrase "within 24 hours" and inserting the phrase "within 48 hours" in its place."

Sec. 5. The Department of Behavioral Health Establishment Act of 2013, effective December 24, 2013 (D.C. Law 20-61; D.C. Official Code § 7-1141.01 et seq.), is amended by adding a new section 5117c to read as follows:

"Sec. 5117c. Development of online training materials.

"(a)(1) The Department shall, in collaboration with relevant stakeholders, including healthcare professionals, legal experts, and community-based organizations, develop a detailed online training module for healthcare professionals of varying disciplines and levels of expertise on the District's voluntary treatment, involuntary hospitalization, and civil commitment laws and procedures, which shall include information on:

"(A) Distinctions between voluntary treatment, involuntary hospitalization, and civil commitment;

"(B) Legal rights of individuals receiving mental health services;

"(C) Step-by-step procedures for initiating an involuntary hospitalization or civil commitment;

"(D) Criteria for determining when involuntary hospitalization or civil commitment is warranted;

"(E) Protocols for involving law enforcement in a mental health crisis; and

"(F) Cultural competency and sensitivity training in mental health interactions, including topics related to religion, race or ethnicity, language access, and understanding and respecting diverse cultural backgrounds during mental health assessments.

"(2) The Department shall coordinate with healthcare institutions to integrate the training module into continuing education or other training programs for relevant healthcare workers.

"(b)(1) The Department shall develop a publicly available online resource to provide information for members of the public on voluntary and involuntary mental health treatment, which shall include information on:

"(A) Distinctions between voluntary treatment, involuntary hospitalization, and civil commitment;

"(B) Alternatives to involuntary hospitalization or civil commitment, including resources for voluntary treatment;

"(C) Legal rights of individuals receiving mental health services;

"(D) Step-by-step procedures for initiating an involuntary hospitalization or civil commitment;

"(E) Criteria for determining when involuntary hospitalization or civil commitment is warranted;

"(F) Protocols for involving law enforcement in a mental health crisis;

"(G) Information on crisis helplines and mental health resources that families can access in case of emergencies; and

"(H) Information on how family and friends can contribute to the ongoing care and recovery of an individual receiving mental health services.

"(2) The Department shall collaborate with mental health professionals, legal experts, community-based organizations, and individuals with lived experience in the development of the online resource.

"(3) The Department shall engage in semiannual public awareness campaigns to promote the availability of the online resource, including by engaging media outlets and online platforms, utilizing social media, partnering with educational institutions and healthcare organizations, educating emergency services personnel, collaborating with government agencies, and actively involving community groups, such as religious organizations, cultural associations, and neighborhood associations.".

Sec. 6. Applicability.

(a) Section 5 shall apply upon the date of inclusion of its fiscal effect in an approved budget and financial plan.

(b) The Chief Financial Officer shall certify the date of the inclusion of the fiscal effect in an approved budget and financial plan and provide notice to the Budget Director of the Council of the certification.

(c)(1) The Budget Director shall cause the notice of the certification to be published in the District of Columbia Register.

(2) The date of publication of the notice of the certification shall not affect the applicability of the provision identified in subsection (a) of this section.

Sec. 7. Fiscal impact statement.

The Council adopts the fiscal impact statement in the committee report as the fiscal impact statement required by section 4a of the General Legislative Procedures Act of 1975, approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a).

Sec. 8. Effective date.

This act shall take effect after approval by the Mayor (or in the event of veto by the Mayor, action by the Council to override the veto) and a 30-day period of congressional review as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)).