HF 2216

as introduced - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to mental health; providing services to 
  1.3             individuals experiencing mental health crises; 
  1.4             permitting the establishment of mobile mental health 
  1.5             crisis teams; requiring triage protocols to be used by 
  1.6             mental health emergency service providers; requiring 
  1.7             development of mental health crisis plans; 
  1.8             establishing a statewide mental health crisis line; 
  1.9             appropriating money; amending Minnesota Statutes 2000, 
  1.10            sections 245.462, by adding a subdivision; 245.469, 
  1.11            subdivision 2, by adding subdivisions; 245.4871, 
  1.12            subdivision 3, by adding a subdivision; 245.4879, 
  1.13            subdivision 2, by adding subdivisions; 245.4881, 
  1.14            subdivision 3, by adding a subdivision; 245.4886, by 
  1.15            adding a subdivision; proposing coding for new law in 
  1.16            Minnesota Statutes, chapter 245. 
  1.17  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.18     Section 1.  Minnesota Statutes 2000, section 245.462, is 
  1.19  amended by adding a subdivision to read: 
  1.20     Subd. 15a.  [MENTAL HEALTH CRISIS.] "Mental health crisis" 
  1.21  means an urgent behavioral, emotional, or psychiatric condition 
  1.22  that is likely to cause significantly reduced levels of 
  1.23  functioning in primary aspects of daily living such as personal 
  1.24  relations, living arrangements, work, school, and recreation, if 
  1.25  mental health services are not provided as soon as possible. 
  1.26     Sec. 2.  Minnesota Statutes 2000, section 245.469, 
  1.27  subdivision 2, is amended to read: 
  1.28     Subd. 2.  [SPECIFIC REQUIREMENTS.] (a) The county board 
  1.29  shall require that all service providers of emergency services 
  1.30  to adults with mental illness provide immediate direct access to 
  1.31  a mental health professional during regular business hours.  For 
  2.1   evenings, weekends, and holidays, the service may be by direct 
  2.2   toll free telephone access to a mental health professional, a 
  2.3   mental health practitioner, or until January 1, 1991, a 
  2.4   designated person with training in human services who receives 
  2.5   clinical supervision from a mental health 
  2.6   professional.  Emergency service providers shall not use the 
  2.7   statewide mental health crisis line established under section 
  2.8   245.4889 to satisfy the requirement of providing direct, 
  2.9   toll-free telephone access during nonbusiness hours to a mental 
  2.10  health professional, mental health practitioner, or other 
  2.11  designated person. 
  2.12     (b) The commissioner may waive the requirement in paragraph 
  2.13  (a) that the evening, weekend, and holiday service be provided 
  2.14  by a mental health professional or mental health practitioner 
  2.15  after January 1, 1991, if the county documents that: 
  2.16     (1) mental health professionals or mental health 
  2.17  practitioners are unavailable to provide this service; 
  2.18     (2) services are provided by a designated person with 
  2.19  training in human services who receives clinical supervision 
  2.20  from a mental health professional; and 
  2.21     (3) the service provider is not also the provider of fire 
  2.22  and public safety emergency services. 
  2.23     (c) The commissioner may waive the requirement in paragraph 
  2.24  (b), clause (3), that the evening, weekend, and holiday service 
  2.25  not be provided by the provider of fire and public safety 
  2.26  emergency services if: 
  2.27     (1) every person who will be providing the first telephone 
  2.28  contact has received at least eight hours of training on 
  2.29  emergency mental health services reviewed by the state advisory 
  2.30  council on mental health and then approved by the commissioner; 
  2.31     (2) every person who will be providing the first telephone 
  2.32  contact will annually receive at least four hours of continued 
  2.33  training on emergency mental health services reviewed by the 
  2.34  state advisory council on mental health and then approved by the 
  2.35  commissioner; 
  2.36     (3) the local social service agency has provided public 
  3.1   education about available emergency mental health services and 
  3.2   can assure potential users of emergency services that their 
  3.3   calls will be handled appropriately; 
  3.4      (4) the local social service agency agrees to provide the 
  3.5   commissioner with accurate data on the number of emergency 
  3.6   mental health service calls received; 
  3.7      (5) the local social service agency agrees to monitor the 
  3.8   frequency and quality of emergency services; and 
  3.9      (6) the local social service agency describes how it will 
  3.10  comply with paragraph (d). 
  3.11     (d) Whenever emergency service during nonbusiness hours is 
  3.12  provided by anyone other than a mental health professional, a 
  3.13  mental health professional must be available on call for an 
  3.14  emergency assessment and crisis intervention services, and must 
  3.15  be available for at least telephone consultation within 30 20 
  3.16  minutes.  
  3.17     Sec. 3.  Minnesota Statutes 2000, section 245.469, is 
  3.18  amended by adding a subdivision to read: 
  3.19     Subd. 3.  [TRIAGE PROTOCOL.] (a) The county board shall 
  3.20  ensure that all providers of mental health emergency services 
  3.21  for adults under this section use a triage protocol for 
  3.22  emergency services provided during nonbusiness hours, to 
  3.23  determine the appropriate response to calls regarding adults 
  3.24  experiencing an emergency or a mental health crisis.  Persons 
  3.25  who provide triage services and who are not mental health 
  3.26  professionals or mental health practitioners must satisfy the 
  3.27  requirements for initial and continued training in emergency 
  3.28  mental health services in subdivision 2, paragraph (c), clauses 
  3.29  (1) and (2).  The triage protocol must meet the requirements of 
  3.30  this subdivision. 
  3.31     (b) The triage protocol must allow an assessment of the 
  3.32  following: 
  3.33     (1) the extent to which the adult is at risk for physical 
  3.34  harm to self or others; 
  3.35     (2) the need for an immediate response to the situation; 
  3.36     (3) the appropriate level of response; 
  4.1      (4) if there is a crisis plan in place for the adult, and 
  4.2   whether the crisis plan addresses the immediate situation; 
  4.3      (5) the capacity of the caller to manage the situation; 
  4.4      (6) whether there are medication issues; 
  4.5      (7) whether there are chemical dependency issues; 
  4.6      (8) financial contributors; and 
  4.7      (9) other systems and resources impacted by the adult's 
  4.8   emergency or mental health crisis. 
  4.9      (c) The triage protocol must include the following 
  4.10  responses to crisis situations: 
  4.11     (1) in emergency situations where there is an immediate 
  4.12  threat of physical harm to the adult or others, the caller must 
  4.13  be kept on the telephone line and appropriate emergency 
  4.14  services, such as an ambulance service or law enforcement, must 
  4.15  be contacted on the caller's behalf; 
  4.16     (2) in mental health crisis situations, a mobile mental 
  4.17  health crisis team must be dispatched, if available, and a 
  4.18  mental health professional or mental health practitioner must 
  4.19  contact the caller within 20 minutes; and 
  4.20     (3) for all callers, the provider of mental health 
  4.21  emergency services must: 
  4.22     (i) contact an appropriate individual to provide follow-up 
  4.23  services to the adult, such as a case manager or mental health 
  4.24  provider; 
  4.25     (ii) if no case manager or mental health provider is 
  4.26  currently serving the adult, refer the adult to the appropriate 
  4.27  county agency for the provision of follow-up services; and 
  4.28     (iii) contact the adult or another appropriate person by 
  4.29  phone to ensure that follow-up services are being provided. 
  4.30     Sec. 4.  Minnesota Statutes 2000, section 245.469, is 
  4.31  amended by adding a subdivision to read: 
  4.32     Subd. 4.  [MOBILE MENTAL HEALTH CRISIS TEAM.] County boards 
  4.33  may establish or contract with mobile mental health crisis teams 
  4.34  to immediately respond to calls regarding emergencies or mental 
  4.35  health crises experienced by adults with mental illness.  When 
  4.36  responding to a call, a team must have immediate access by 
  5.1   telephone to law enforcement personnel, an ambulance service, a 
  5.2   crisis shelter if available, and hospital emergency room staff.  
  5.3   A team is not required to have a mental health professional or 
  5.4   mental health practitioner as part of the team.  If a team does 
  5.5   not include a mental health professional or mental health 
  5.6   practitioner and is responding to a call, the team must be in 
  5.7   telephone contact at all times with a mental health professional 
  5.8   or mental health practitioner. 
  5.9      Sec. 5.  Minnesota Statutes 2000, section 245.4871, 
  5.10  subdivision 3, is amended to read: 
  5.11     Subd. 3.  [CASE MANAGEMENT SERVICES.] "Case management 
  5.12  services" means activities that are coordinated with the family 
  5.13  community support services and are designed to help the child 
  5.14  with severe emotional disturbance and the child's family obtain 
  5.15  needed mental health services, social services, educational 
  5.16  services, health services, vocational services, recreational 
  5.17  services, and related services in the areas of volunteer 
  5.18  services, advocacy, transportation, and legal services.  Case 
  5.19  management services include assisting in obtaining a 
  5.20  comprehensive diagnostic assessment, if needed, developing a 
  5.21  functional assessment, developing an individual family community 
  5.22  support plan, developing a mental health crisis plan and 
  5.23  monitoring its use, and assisting the child and the child's 
  5.24  family in obtaining needed services by coordination with other 
  5.25  agencies and assuring continuity of care.  Case managers must 
  5.26  assess and reassess the delivery, appropriateness, and 
  5.27  effectiveness of services over time.  
  5.28     Sec. 6.  Minnesota Statutes 2000, section 245.4871, is 
  5.29  amended by adding a subdivision to read: 
  5.30     Subd. 24a.  [MENTAL HEALTH CRISIS.] "Mental health crisis" 
  5.31  means an urgent behavioral, emotional, or psychiatric condition 
  5.32  that is likely to cause significantly reduced levels of 
  5.33  functioning in primary aspects of daily living such as personal 
  5.34  relations, living arrangements, work, school, and recreation, if 
  5.35  mental health services are not provided as soon as possible. 
  5.36     Sec. 7.  Minnesota Statutes 2000, section 245.4879, 
  6.1   subdivision 2, is amended to read: 
  6.2      Subd. 2.  [SPECIFIC REQUIREMENTS.] (a) The county board 
  6.3   shall require that all service providers of emergency services 
  6.4   to the child with an emotional disturbance provide immediate 
  6.5   direct access to a mental health professional during regular 
  6.6   business hours.  For evenings, weekends, and holidays, the 
  6.7   service may be by direct toll-free telephone access to a mental 
  6.8   health professional, a mental health practitioner, or until 
  6.9   January 1, 1991, a designated person with training in human 
  6.10  services who receives clinical supervision from a mental health 
  6.11  professional.  Emergency service providers shall not use the 
  6.12  statewide mental health crisis line established under section 
  6.13  245.4889 to satisfy the requirement of providing direct, 
  6.14  toll-free telephone access during nonbusiness hours to a mental 
  6.15  health professional, mental health practitioner, or other 
  6.16  designated person. 
  6.17     (b) The commissioner may waive the requirement in paragraph 
  6.18  (a) that the evening, weekend, and holiday service be provided 
  6.19  by a mental health professional or mental health practitioner 
  6.20  after January 1, 1991, if the county documents that:  
  6.21     (1) mental health professionals or mental health 
  6.22  practitioners are unavailable to provide this service; 
  6.23     (2) services are provided by a designated person with 
  6.24  training in human services who receives clinical supervision 
  6.25  from a mental health professional; and 
  6.26     (3) the service provider is not also the provider of fire 
  6.27  and public safety emergency services. 
  6.28     (c) The commissioner may waive the requirement in paragraph 
  6.29  (b), clause (3), that the evening, weekend, and holiday service 
  6.30  not be provided by the provider of fire and public safety 
  6.31  emergency services if: 
  6.32     (1) every person who will be providing the first telephone 
  6.33  contact has received at least eight hours of training on 
  6.34  emergency mental health services reviewed by the state advisory 
  6.35  council on mental health and then approved by the commissioner; 
  6.36     (2) every person who will be providing the first telephone 
  7.1   contact will annually receive at least four hours of continued 
  7.2   training on emergency mental health services reviewed by the 
  7.3   state advisory council on mental health and then approved by the 
  7.4   commissioner; 
  7.5      (3) the local social service agency has provided public 
  7.6   education about available emergency mental health services and 
  7.7   can assure potential users of emergency services that their 
  7.8   calls will be handled appropriately; 
  7.9      (4) the local social service agency agrees to provide the 
  7.10  commissioner with accurate data on the number of emergency 
  7.11  mental health service calls received; 
  7.12     (5) the local social service agency agrees to monitor the 
  7.13  frequency and quality of emergency services; and 
  7.14     (6) the local social service agency describes how it will 
  7.15  comply with paragraph (d). 
  7.16     (d) When emergency service during nonbusiness hours is 
  7.17  provided by anyone other than a mental health professional, a 
  7.18  mental health professional must be available on call for an 
  7.19  emergency assessment and crisis intervention services, and must 
  7.20  be available for at least telephone consultation within 30 20 
  7.21  minutes. 
  7.22     Sec. 8.  Minnesota Statutes 2000, section 245.4879, is 
  7.23  amended by adding a subdivision to read: 
  7.24     Subd. 3.  [TRIAGE PROTOCOL.] (a) The county board shall 
  7.25  ensure that all providers of mental health emergency services 
  7.26  for children under this section use a triage protocol for 
  7.27  emergency services provided during nonbusiness hours, to 
  7.28  determine the appropriate response to calls regarding children 
  7.29  experiencing an emergency or a mental health crisis.  Persons 
  7.30  who provide triage services and who are not mental health 
  7.31  professionals or mental health practitioners must satisfy the 
  7.32  requirements for initial and continued training in emergency 
  7.33  mental health services in subdivision 2, paragraph (c), clauses 
  7.34  (1) and (2).  The triage protocol must meet the requirements of 
  7.35  this subdivision. 
  7.36     (b) The triage protocol must include an assessment of the 
  8.1   following: 
  8.2      (1) the extent to which the child is at risk for physical 
  8.3   harm to self or others; 
  8.4      (2) the need for an immediate response to the situation; 
  8.5      (3) the appropriate level of response; 
  8.6      (4) if there is a crisis plan in place for the child, and 
  8.7   whether the crisis plan addresses the immediate situation; 
  8.8      (5) the capacity of the child's caregiver to manage the 
  8.9   situation; 
  8.10     (6) whether there are medication issues; 
  8.11     (7) whether there are chemical dependency issues; 
  8.12     (8) risk to current placement; 
  8.13     (9) financial contributors; and 
  8.14     (10) other systems and resources impacted by the child's 
  8.15  emergency or mental health crisis. 
  8.16     (c) The triage protocol must include the following 
  8.17  responses to crisis situations: 
  8.18     (1) in emergency situations where there is an immediate 
  8.19  threat of physical harm to the child or others, the caller must 
  8.20  be kept on the telephone line and appropriate emergency 
  8.21  services, such as an ambulance service or law enforcement, must 
  8.22  be contacted on the caller's behalf; 
  8.23     (2) in mental health crisis situations, a mobile mental 
  8.24  health crisis team must be dispatched if available, and a mental 
  8.25  health professional or mental health practitioner must contact 
  8.26  the caller within 20 minutes; and 
  8.27     (3) for all callers, the provider of mental health 
  8.28  emergency services must: 
  8.29     (i) contact an appropriate individual to provide follow-up 
  8.30  services to the child, such as a case manager or mental health 
  8.31  provider; 
  8.32     (ii) if no case manager or mental health provider is 
  8.33  currently serving the child, refer the child to the appropriate 
  8.34  county agency or local children's mental health collaborative 
  8.35  for the provision of follow-up services; and 
  8.36     (iii) contact the child's parent or guardian by phone to 
  9.1   ensure that follow-up services are being provided. 
  9.2      Sec. 9.  Minnesota Statutes 2000, section 245.4879, is 
  9.3   amended by adding a subdivision to read: 
  9.4      Subd. 4.  [MOBILE MENTAL HEALTH CRISIS TEAM.] County boards 
  9.5   may establish or contract with mobile mental health crisis teams 
  9.6   to immediately respond to calls regarding emergencies or mental 
  9.7   health crises experienced by children with emotional 
  9.8   disturbance.  When responding to a call, a team must have 
  9.9   immediate access by telephone to law enforcement personnel, an 
  9.10  ambulance service, a crisis shelter if available, and hospital 
  9.11  emergency room staff.  A team is not required to have a mental 
  9.12  health professional or mental health practitioner as part of the 
  9.13  team.  If a team does not include a mental health professional 
  9.14  or mental health practitioner and is responding to a call, the 
  9.15  team must be in telephone contact at all times with a mental 
  9.16  health professional or mental health practitioner. 
  9.17     Sec. 10.  Minnesota Statutes 2000, section 245.4881, 
  9.18  subdivision 3, is amended to read: 
  9.19     Subd. 3.  [DUTIES OF CASE MANAGER.] (a) Upon a 
  9.20  determination of eligibility for case management services, the 
  9.21  case manager shall complete a written functional assessment 
  9.22  according to section 245.4871, subdivision 18.  The case manager 
  9.23  shall develop an individual family community support plan for a 
  9.24  child as specified in subdivision 4, develop a mental health 
  9.25  crisis plan for a child as specified in subdivision 6a, review 
  9.26  the child's progress, and monitor the provision of services and 
  9.27  use of the mental health crisis plan.  If services are to be 
  9.28  provided in a host county that is not the county of financial 
  9.29  responsibility, the case manager shall consult with the host 
  9.30  county and obtain a letter demonstrating the concurrence of the 
  9.31  host county regarding the provision of services.  
  9.32     (b) The case manager shall note in the child's record the 
  9.33  services needed by the child and the child's family, the 
  9.34  services requested by the family, services that are not 
  9.35  available, and the unmet needs of the child and child's family.  
  9.36  The information required under section 245.4886 shall be 
 10.1   provided in writing to the child and the child's family.  The 
 10.2   case manager shall note this provision in the child's record.  
 10.3      Sec. 11.  Minnesota Statutes 2000, section 245.4881, is 
 10.4   amended by adding a subdivision to read: 
 10.5      Subd. 6a.  [MENTAL HEALTH CRISIS PLAN.] For each child, the 
 10.6   case manager must develop a mental health crisis plan.  A mental 
 10.7   health crisis plan must establish a behavioral intervention plan 
 10.8   as the initial approach to a mental health crisis, and must 
 10.9   include positive instructions with a crisis control focus, 
 10.10  specific information on factors that may cause the crisis to 
 10.11  escalate, and specific control measures.  The mental health 
 10.12  crisis plan must be developed within 30 days of intake by the 
 10.13  case manager, and must be reviewed after each use and no less 
 10.14  frequently than every 180 days.  To the extent appropriate, the 
 10.15  child, the child's family, advocates, service providers, and 
 10.16  significant others must be involved in all phases of the mental 
 10.17  health crisis plan's development.  With the consent of a child 
 10.18  who meets the requirements of section 144.341 or 144.342 or the 
 10.19  parent or legal guardian of a child, a case manager may make the 
 10.20  child's mental health crisis plan available to a mobile mental 
 10.21  health crisis team, a provider of mental health emergency 
 10.22  services under section 245.4879, and other appropriate health 
 10.23  care providers. 
 10.24     Sec. 12.  Minnesota Statutes 2000, section 245.4886, is 
 10.25  amended by adding a subdivision to read: 
 10.26     Subd. 4.  [GRANTS FOR SHELTER SERVICES.] (a) For purposes 
 10.27  of this subdivision, "shelter services" has the meaning given in 
 10.28  Minnesota Rules, part 9545.0945, subpart 37. 
 10.29     (b) The commissioner may make grants for shelter services 
 10.30  for children who are experiencing a mental health crisis.  
 10.31  Counties shall use the grant funds to establish, operate, or 
 10.32  contract with private residential treatment programs licensed 
 10.33  under Minnesota Rules, parts 9545.0905 to 9545.1125, or group 
 10.34  homes licensed under Minnesota Rules, parts 9545.1400 to 
 10.35  9545.1470, for shelter services.  Priority for grants must be 
 10.36  given to programs or homes that satisfy one or more of the 
 11.1   following requirements: 
 11.2      (1) have available on-site a temporary safe and secure 
 11.3   option for children acting out physically; 
 11.4      (2) demonstrate working relationships with and coordinate 
 11.5   their activities with mobile mental health crisis teams, if 
 11.6   available, and county social services agencies; 
 11.7      (3) have staff able to initiate processing requests for 
 11.8   mental health services for children receiving shelter services; 
 11.9   and 
 11.10     (4) have access to a mental health professional for 
 11.11  psychiatric consultations, as needed. 
 11.12     (c) When a child is discharged into the community from a 
 11.13  program providing shelter services under this subdivision, the 
 11.14  program must complete a discharge plan for the child which must 
 11.15  include referrals to appropriate community-based mental health 
 11.16  services for the child. 
 11.17     Sec. 13.  [245.4889] [STATEWIDE MENTAL HEALTH CRISIS LINE.] 
 11.18     Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
 11.19  provide or contract for the provision of at least one statewide 
 11.20  mental health crisis telephone line to provide immediate, direct 
 11.21  access to mental health professionals and mental health 
 11.22  practitioners for individuals experiencing a mental health 
 11.23  crisis.  The mental health crisis line must be answered 24 hours 
 11.24  a day, seven days a week; must be staffed by a mental health 
 11.25  professional or mental health practitioner; and must be 
 11.26  available to the general public, emergency service providers for 
 11.27  children with emotional disturbances and their families, and 
 11.28  adults with mental illness and their families; mental health 
 11.29  providers serving children with emotional disturbance or adults 
 11.30  with mental illness; and other health care providers, at no 
 11.31  direct cost to users.  Services provided to individuals 
 11.32  contacting the mental health crisis line may include information 
 11.33  on how to assess the level of a mental health crisis, 
 11.34  appropriate responses, and mental health crisis resources 
 11.35  available in various areas of the state. 
 11.36     Subd. 2.  [PUBLIC EDUCATION.] The commissioner shall 
 12.1   conduct ongoing activities to educate the general public and 
 12.2   health care providers about the mental health crisis line and 
 12.3   the services available from it. 
 12.4      Sec. 14.  [APPROPRIATIONS.] 
 12.5      Subdivision 1.  [CRISIS RESPITE CARE.] $....... is 
 12.6   appropriated for the 2002-2003 biennium from the general fund to 
 12.7   the commissioner of human services to increase funding for 
 12.8   children's mental health grants.  The commissioner shall use 
 12.9   this appropriation to provide funding to counties to recruit, 
 12.10  train, and pay providers of crisis respite care for children who 
 12.11  are experiencing a mental health crisis. 
 12.12     Subd. 2.  [SHELTER SERVICES.] $....... is appropriated for 
 12.13  the 2002-2003 biennium from the general fund to the commissioner 
 12.14  of human services for grants under Minnesota Statutes, section 
 12.15  245.4886, subdivision 3, for shelter services for children who 
 12.16  are experiencing a mental health crisis.