GLOSSARY of MENTAL TERMS

Collaborative Assessment and Management of Suicide (CAMS): An approach to treating suicidality that emphasizes problem-focused intensive outpatient treatment.

Columbia Suicide Severity Ratings Scale (C-SSRS): A tool to assess suicidal ideation, commonly used in emergency departments. Free on-line training and forms available at http://www.cssrs.columbia.edu/

Corporation Counsel: In Wisconsin, civil commitment cases are prosecuted by a county’s Corporation Counsel. A person who is involuntarily hospitalized or committed to treatment will be appointed counsel through the Wisconsin Public Defender’s Office. See Wisconsin statutes § 51.20(3) and § 51.60.

Council on § 51.02: Created in 1983, among other duties, the council on mental health is to serve as an advocate for persons with mental illness and advise DHS on the expenditure of federal funds received under the community mental health block grant plan.

Counseling on Access for Lethal Means (CALM): Free on-line training to promote the recognition among healthcare providers of the danger of ready access to lethal weapons with the goal of educating patients and families, decreasing access to lethal means, and saving lives.

Crisis Assessment Response Team (CART): a partnership between the Behavioral Health Division of Milwaukee County’s Department of Health & Human Services and the Milwaukee Police Department, the team is comprised of crisis team clinicians and police officers who can respond to situations when police intervention may be needed.

Crisis Mobile Team: A service of the Milwaukee County Behavioral Health Division, the crisis mobile team is a telephone and mobile crisis service for adults and is available to provide assessments in the community if it is impractical for the individual to come to the Behavioral Health Division’s assessment center.

Emergency Detention (commonly “ED,” “Chapter 51 Hold,” “Chapter,” “Hold,” “24 hour hold”) – Milwaukee County § 51.15 (4): A police hold (in the case of an adult, or a hold by a person authorized under Ch. 48 “Children’s Code”) which allows an individual to be involuntarily detained up to 24 hours* (does not include time directly attributable to evaluation or stabilizing treatment of non—psychiatric medical conditions) because a police officer has filed a statement in support of commitment that the individual evidences a substantial probability that they are dangerous to themselves or others. The officer or authorized person under Ch. 48 must also believe that the dangerousness is related to mental illness or drug use or a . The Behavioral Health Division treatment provider must make a determination within 24 hours whether or not to continue to detain the person, and the Probable Cause Hearing must take place within 72 hours. *See also, Treatment Director’s Supplement.

Emergency Detention – other than Milwaukee County § 51.15(5): Same as above except the detaining officer’s statement in support of commitment allows the individual to be held up to 72 hours before a probable cause hearing is held. Emergency Detention (Detention Program; Milwaukee County only) § 51.15(4m): 2013 Wisconsin Act 235 established a pilot program effective April 10, 2014, that authorized certain mental health professionals in Milwaukee County to carry out emergency detentions and requires the Legislative Audit Bureau (LAB) to conduct a performance evaluation audit of the pilot program to include the effectiveness of the emergency detention procedure under the pilot program. The Pilot Program was established in response to criticism of Wisconsin’s usual practice of utilizing law enforcement rather than mental health professionals to make emergency detention decisions. The law remained in effect until July 1, 2017. The LAB’s audit report was published December 2017 and concluded that too few individuals were assessed and too few emergency detentions were conducted under the pilot program to allow for meaningful comparison with those assessed before the pilot program.

Emergency Mental Health Services Program (“Crisis Intervention”) DHS 34, Subchapter II: Most counties have what’s commonly called “crisis intervention” programs, which are the agencies charged with approving hospitalizations for individuals under an emergency detention by authority of Wisconsin Chapter 51.15. 2015 Wisconsin Act 55, §1881 amended Wisconsin Chapter §51.15(2) in relation to emergency detentions to require a “ who has completed a residency in , a , or a mental health professional to perform a crisis assessment on the individual and agrees with the need for detention and the individual will not voluntarily consent to treatment necessary to stabilize the individual and remove the substantial probability of harm to himself, herself, or others.” The crisis assessment may be conducted in person, by telephone or by telemedicine or videoconferencing technology. The amendment took effect July 1, 2016, and is likely to have substantial effect on some (smaller) counties, and little or no effect on other (larger) counties.

Involuntary commitment for treatment § 51.20 (see “Three Party Petition”).

Lessard, Alberta – The Wisconsin woman whose landmark lawsuit changed the mental health commitment landscape nationally. The schoolteacher’s case was heard by a federal district court in Milwaukee, with the court finding Wisconsin’s commitment laws unconstitutional, rejecting the traditional parens patriae grounds for commitment, and replacing it with a dangerousness standard. Additionally, the court for the first time required that commitment proceedings provide the mentally ill with all the protections afforded the criminal suspect such as right to counsel. The case was appealed to the U.S. Supreme Court. See Schmidt v. Lessard, 414 U.S. 473 (1974).

Mental Health America of Wisconsin (MHA of WI): An affiliate of the nation’s leading community-based non-profit dedicated to helping all Americans achieve wellness by living mentally healthier lives, MHA of WI’s website provides information on MH services in all Wisconsin counties: http://www.mhawisconsin.org/search-stateresources.aspx

Milwaukee County Mental Health Board (MHB): established in 2014 through Wisconsin Act 203, the board is made up of 13 volunteer members and includes mental health professionals, consumers and advocates. The MHB is responsible for setting policy for the Behavioral Health Division of the Milwaukee County Department of Health & Human Services.

Mobile Urgent Treatment Team (MUTT): A service of the Milwaukee County Behavioral Health Division, MUTT is a telephone and mobile crisis service for children and adolescents (under age 18) and is available to provide assessments in the community if it is impractical for the child to come to the Behavioral Health Division’s psych assessment center. National Instant Criminal Background Check System (NICS): The federal background check system intended to prevent the dangerously mentally ill from purchasing firearms. A person subject to a federal “mental health prohibitor” may not legally possess or receive firearms. To date, the NICS is generally regarded as ineffective in fulfilling its intended purpose.

Office of Children’s Mental Health § 51.025: Created by legislation in 2013, this office is to study and recommend ways to improve mental health services to children. Each January 1st it must submit a report summarizing how the state’s delivery of mental health services for children could be improved.

Probable Cause Hearing § 51.20(7): A preliminary hearing at which typically a court commissioner decides if there is probable cause for commitment. Probable cause is found if there is evidence of mental illness (and/or drug use or developmental disability) and dangerousness, and that the person is an appropriate subject for treatment. Note: most cases do not go through the full commitment process. Usually, the individual improves sufficiently before the trial and is released OR the individual agrees to treatment and signs a settlement agreement.

Psychiatric Crisis Service (PCS) Admission Center/Observation Unit: A program of the Milwaukee County Behavioral Health Division, the Psychiatric Crisis Service - Admission Center (PCS) is located at 9499 Watertown Plank Road. PCS provides 24-hour, 7-day psychiatric emergency service. As part of the crisis service, PCS provides assessment and evaluation, crisis intervention, medications, and the capacity for observation for up to 48 hours as needed. In addition to referral and coordination with other mental health providers, persons are evaluated for possible admission into the Behavioral Health Division inpatient units or for admission to a community .

Request for Discharge (“R.F.D.”) § 51.10(5)(b): A document that a patient who voluntarily agreed to inpatient psychiatric treatment can request to sign which puts in writing their wish to be discharged. From the time this request is made known to the treating staff, the treating physician has up to 24 hours to address by either releasing the patient OR filing a “Treatment Director’s Affidavit.” 51.10(5)(c). The probable cause hearing must then be held within 72 hours.

Settlement Agreement § 51.20(8)(bg) – At any time after the commencement of the commitment proceedings, the subject of the commitment can agree to waive the time period for the probable cause or final commitment hearing and to receive treatment for up to 90 days. The settlement agreement must include an inpatient or outpatient treatment plan, and be agreed to by the individual and the corporation counsel and approved by the court. The court will designate the county department to monitor the individual’s treatment.

Standard of Commitment § 51.15 (1) and § 51.20 (2)a. The “substantial probability of harm to self or others” language in 51.15 (emergency detention) and 51.20 (Involuntary commitment for treatment) is parallel.

Three Party Petition (“Petition for Examination” or “P.E.”) § 51.20 – Another of 3 methods (the others are law enforcement or treatment director emergency detention) of initiating an involuntary civil commitment proceeding. Requires the written testimony and signatures of 3 separate parties that the individual in question meets the standard for commitment. Normally filed by Corporation Counsel (but can be filed by others if Corporation Counsel declines, see 51.20 (4)(b)). Filed with the probate branch of the circuit court for the county where the subject of the commitment actually is located OR for the individual’s county of residence. The court then can either order detention for up to 72 hours OR set the matter for a probable cause hearing. If the probate court approves the petition, an order will be sent to the Sheriff’s office to pick up the individual and bring them to the county behavioral health for examination.

Treatment Director § 51.01(18): The person who has primary responsibility for the treatment provided by a treatment facility. Includes the medical director of a treatment facility.

Treatment Director’s Affidavit § 51.10 (5)(c): May be filed by the treatment director of a voluntarily- admitted patient requesting discharge if the treatment director believes that the patient is dangerous under the “substantial probability of harm” to self or others standard of 51.20 (Involuntary commitment for treatment). The filing of the affidavit results in a “treatment director’s hold” wherein the patient can be detained.

Treatment Director’s Hold § 51.10 (5)(c): One of three ways (the others are Petition for Examination or law enforcement emergency detention) to start a civil commitment proceeding. See Treatment Director’s Affidavit.

Treatment Director’s Supplement (“T.D.S.”) § 51.15(4)(b): In the implementation of an emergency detention in Milwaukee county, the treatment director may supplement the law enforcement officer’s (or other authorized person under Chapter 48) statement supporting the commitment, which extends the hold to 72 hours in Milwaukee county.

Treatment Facility § 51.01(19): A public or private facility (or unit thereof) that provides inpatient or outpatient treatment of alcoholic, drug dependent, mentally ill or developmentally disabled persons.

Treatment Prior to Commitment § 51.20(8)(c), § 51.61(1)(g): Prior to the probable cause hearing, treatment can only be provided if the individual agrees to accept it or if it is necessary to prevent harm to the individual or others. Patients rights section § 51.61(h) addresses emergency administration of medication:

Except when medication . . . is necessary to prevent physical harm to others as evidenced by a recent overt act, attempt or threat to do such harm, a patient may refuse medications and medical treatment . . . . and 51.61(i) addresses physical restraints:

Each patient shall . . . have a right to be free from physical restraint and isolation except for emergency situations or when isolation or restraint is a part of a treatment program. Isolation or restraint may be used only when less restrictive measures are ineffective or not feasible and shall be used for the shortest time possible. When a patient is placed in isolation or restraint, his or her status shall be reviewed once every 30 minutes. . . .

Voluntary admission of adults § 51.10: Adults who voluntarily consent to be admitted to a private psychiatric hospital or unit when there is no funding from the county DHS is simply a hospital admission (the patient does not have to meet the dangerousness standard).

It is also possible to voluntarily admit an adult and involve county DHS funding; in this situation, the director of the treatment facility and the director of the county department must approve the admission. Approval is based on whether or not the patient is mentally ill and will benefit from inpatient treatment. The patient does not have to meet the dangerousness standard.

If the adult does not protest the admission but neither do they consent (e.g., a confused elder or a catatonic or paranoid adult) and county funding is involved, the procedure to follow is found in § 51.10(4m).

Voluntary admission of children § 51.13: As with adults, if county DHS funds are involved, the director of the county department and also the treatment director of the facility must approve the admission, and if no county funds are involved, court review of the admission is not required (unless the child over 14 does not consent to the admission). Minors have the same right to request discharge as do adults.

Wraparound Milwaukee: A program of the Milwaukee County Behavioral Health Division, this program is designed to provide comprehensive individualized care to children with complex mental health and emotional needs and serves families living in Milwaukee County who have a child who has serious emotional or mental health needs, is referred through the child welfare or juvenile justice system, and is at immediate risk of placement in a residential treatment center, juvenile correctional facility or psychiatric hospital.

By: Sheridan Ryan, MCW Risk Management, and edited by Colleen Foley, Deputy Corporation Counsel, Milwaukee County www.mcw.edu/MCW-Risk-Management.htm