N.Y. MHY Law § 29.15 — New York Code / Act MHY / Title E / Article 29 / Section 29.15
Discharge and conditional release of patients to the community
Status: in_force

§ 29.15 Discharge and conditional release of patients to the community.\n  (a) A patient may be discharged or conditionally released to the\ncommunity by the director of a department facility, if, in the opinion\nof staff familiar with the patient's case history, such patient does not\nrequire active in-patient care and treatment.\n  (b) A patient may be conditionally released, rather than discharged,\nwhen in the opinion of staff familiar with the patient's case history,\nthe clinical needs of such patient warrant this more restrictive\nplacement, provided, however, that\n  1. an involuntary patient may be conditionally released only for the\nremainder of the authorized retention period; and\n  2. except as provided in subdivision (d) of this section, a voluntary\npatient may be conditionally released only for a twelve month period,\nprovided however that (i) a voluntary patient under sixteen years of age\nmay be conditionally released only after consultation with the parent,\nlegal guardian, or next-of-kin of such patient; (ii) a voluntary patient\nover sixteen and under eighteen years of age may be conditionally\nreleased only with his consent or with the consent of the parent, legal\nguardian, or next-of-kin of such patient; (iii) a voluntary patient\neighteen years of age or older may be conditionally released only with\nhis consent.\n  (c) The director of a department facility from which any patient is\nconditionally released shall cause all such patients to be informed once\nduring each one hundred twenty days of conditional release of their\nstatus and rights, including their right to avail themselves of the\nfacilities of the mental hygiene legal service. At the time of such\nperiodic notification, the written consent of a patient to his continued\nstay on conditional release status shall be obtained and a copy thereof\nshall be given to the mental hygiene legal service.\n  (d) 1. No voluntary patient who has been conditionally released shall\nbe continued on such status for a period beyond twelve months from the\ndate of commencement of such status or beyond twelve months from the\neffective date of this statute, whichever is later, unless the\nsuitability of such patient to remain on such status and his willingness\nto so remain have been reviewed. The director shall review the\nsuitability of such patient to remain in such status, and the mental\nhygiene legal service shall review the willingness of such patient to\nremain in such status. Notice of the determination of the patient's\nsuitability made by the director shall be given to the mental hygiene\nlegal service. If the mental hygiene legal service finds that there is\nany ground to doubt the director's determination of the suitability of\nsuch patient to remain on such status, or the willingness of the patient\nto so remain, it shall make an application, upon notice to the patient\nand the director of the facility for a court order determining those\nquestions. In any such proceeding, the patient or someone on his behalf\nor the mental hygiene legal service may request a hearing. If the mental\nhygiene legal service finds no grounds to doubt the determination of the\ndirector as to the suitability or the willingness of the patient to\ncontinue on conditional release status, it shall so certify and the\npatient may be continued on such status. A copy of such certification of\nreview shall be filed in the patient's record.\n  2. If an application for a court order has been made, the court, in\ndetermining the proceeding, may approve the continued conditional\nrelease of the patient or, if the court finds that the patient is not\nsuitable or willing to continue on conditional release status, it may\norder the discharge of such patient.\n  3. Prior to the termination of twelve months from the date of the\ncertification by the mental hygiene legal service of such first review\nor, if an application for a court order has been made, from the date of\nthe first order and, thereafter, prior to the termination of twelve\nmonths from any subsequent certification or subsequent order, as the\ncase may be, the director and the mental hygiene legal service shall\nconduct another review of the patient's suitability and willingness to\nremain on conditional release status, as set forth in the foregoing\nsubdivisions.\n  (e) * 1. In the case of an involuntary patient on conditional release,\nthe director may terminate the conditional release and order the patient\nto return to the facility at any time during the period for which\nretention was authorized, if, in the director's judgment, the patient\nneeds in-patient care and treatment and the conditional release is no\nlonger appropriate; provided, however, that in any such case, the\ndirector shall cause written notice of such patient's return to be given\nto the mental hygiene legal service. The director shall cause the\npatient to be retained for observation, care and treatment and further\nexamination in a hospital for up to seventy-two hours if a physician on\nthe staff of the hospital determines that such person may have a mental\nillness and may be in need of involuntary care and treatment in a\nhospital pursuant to the provisions of article nine of this chapter. Any\ncontinued retention in such hospital beyond the initial seventy-two hour\nperiod shall be in accordance with the provisions of this chapter\nrelating to the involuntary admission and retention of a person. If at\nany time during the seventy-two hour period the person is determined not\nto meet the involuntary admission and retention provisions of this\nchapter, and does not agree to stay in the hospital as a voluntary or\ninformal patient, he or she must be released, either conditionally or\nunconditionally.\n  * NB Effective until June 30, 2027\n  * 1. In the case of an involuntary patient on conditional release, the\ndirector may terminate the conditional release and order the patient to\nreturn to the facility at any time during the period for which retention\nwas authorized, if, in the director's judgment, the patient needs\nin-patient care and treatment and the conditional release is no longer\nappropriate provided, however, that in any such case, the director shall\ncause written notice of such patient's return to be given to the mental\nhygiene legal service. If, at any time prior to the expiration of thirty\ndays from the date of return to the facility, he or any relative or\nfriend or the mental hygiene legal service gives notice in writing to\nthe director of request for hearing on the question of the suitability\nof such patient's return to the facility, a hearing shall be held\npursuant to the provisions of this chapter relating to the involuntary\nadmission of a person.\n  * NB Effective June 30, 2027\n  2. In the case of a voluntary patient on conditional release, the\ndirector may terminate the conditional release and order the patient to\nreturn to the facility at any time, if, in the judgment of the director,\nthe patient needs in-patient care and treatment and the conditional\nrelease is no longer appropriate, provided, however, that if such\npatient does not consent to return to the facility, he shall not be\nreturned to the facility, except in accordance with the provisions of\nthis chapter and the regulations of the commissioner for the involuntary\nadmission of a person.\n  (f) The discharge or conditional release of all clients at\ndevelopmental centers, patients at psychiatric centers or patients at\npsychiatric inpatient services subject to licensure by the office of\nmental health shall be in accordance with a written service plan\nprepared by staff familiar with the case history of the client or\npatient to be discharged or conditionally released and in cooperation\nwith appropriate social services officials and directors of local\ngovernmental units. In causing such plan to be prepared, the director of\nthe facility shall take steps to assure that the following persons are\ninterviewed, provided an opportunity to actively participate in the\ndevelopment of such plan and advised of whatever services might be\navailable to the patient through the mental hygiene legal service: the\npatient to be discharged or conditionally released; with the consent of\nthe patient, a representative of a community provider of mental health\nservices, including a provider of case management services, that\nmaintains the patient on its caseload, if applicable, and local programs\nthat provide peer supports and services, if available; an authorized\nrepresentative of the patient, to include the parent or parents if the\npatient is a minor, unless such minor sixteen years of age or older\nobjects to the participation of the parent or parents and there has been\na clinical determination by a physician that the involvement of the\nparent or parents is not clinically appropriate and such determination\nis documented in the clinical record and there is no plan to discharge\nor release the minor to the home of such parent or parents; and upon the\nrequest of the patient sixteen years of age or older, an individual\nsignificant to the patient including any relative, close friend or\nindividual otherwise concerned with the welfare of the patient, other\nthan an employee of the facility. With the consent of the patient and\nconsistent with section 33.13 of this chapter, such service plan may be\nprovided to a parent or parents, any relative, close friend, or\nindividual otherwise concerned with the welfare of the patient.\n  (g) A written service plan prepared pursuant to this section shall\ninclude, but shall not be limited to, the following:\n  1. a statement of the patient's need, if any, for supervision,\nmedication, aftercare services, and assistance in finding employment\nfollowing discharge or conditional release, and\n  2. a specific recommendation of the type of residence in which the\npatient is to live and a listing of the services available to the\npatient in such residence.\n  3. A listing of organizations, facilities, including those of the\ndepartment, and individuals who are available to provide services in\naccordance with the identified needs of the patient.\n  4. The notification of the appropriate school district and the\ncommittee on special education regarding the proposed discharge or\nrelease of a patient under twenty-one years of age, consistent with all\napplicable federal and state laws relating to confidentiality of such\ninformation.\n  5. An evaluation of the patient's need and potential eligibility for\npublic benefits following discharge or conditional release, including\npublic assistance, medicaid, and supplemental security income.\n  6. Material providing information related to extreme risk protection\norders, pursuant to article sixty-three-A of the civil practice law and\nrules. Such information may be provided to the patient or, upon consent\nof the patient, to an authorized representative who has actively\nparticipated in the patient's treatment plan. Such information may only\nbe provided if the director of the facility and such facility's clinical\nstaff who worked directly with the patient determine through an\nevaluation and assessment, that there is the presence of a mental health\ndiagnosis or symptoms of a mental illness exhibited by the patient,\nwhich indicates the patient may be at substantial risk of physical harm\nto himself or herself, or has made threats of or attempts at suicide.\nSuch determination and the basis for it shall be included in the written\nclinical record.\n  7. For patients at psychiatric centers or psychiatric inpatient\nservices subject to licensure by the office of mental health, a\nscreening to determine the patient's suicide, violence, and substance\nuse risk to be incorporated into safety planning for the patient's\ndischarge plan. Individuals with an elevated risk of self-harm or\nsuicide shall have an individualized community suicide safety plan\ncompleted before discharge and such plan shall be provided to the\npatient's aftercare providers.\n  An inpatient facility operated or licensed by the office of mental\nhealth shall provide reasonable and appropriate assistance to the\npatient, in cooperation with local social services districts, in\napplying for benefits identified in the written service plan pursuant to\nparagraph five of this subdivision, prior to discharge or conditional\nrelease.\n  (g-1) For patients at psychiatric centers or psychiatric inpatient\nservices subject to licensure by the office, it shall also be the\nresponsibility of the director of any department facility from which a\nclient or patient has been discharged or conditionally released, in\ncollaboration, when appropriate, with appropriate social services\nofficials and directors of local governmental units, and consistent with\nsection 33.13 of this chapter:\n  1. to provide a discharge summary to the service provider or providers\nresponsible for the patient's care after discharge under the service\nplan as described in subdivisions (f) and (g) of this section. Such\ndischarge summary shall include relevant clinical information and\npost-discharge treatment recommendations in accordance with regulations\npromulgated by the commissioner;\n  2. to obtain contact information of the patient, if possible, and\nconfirm a follow-up appointment has been scheduled for the patient with\nthe appropriate service provider or providers to occur within seven days\nof discharge. If, after making diligent efforts, the facility cannot\nidentify an aftercare provider with an available appointment within\nseven days, the facility shall document its efforts and schedule the\nappointment for as soon as possible thereafter. Individuals who are\nleaving the facility against medical advice or who decline aftercare\nservices shall be provided with information about available treatment\noptions, and have an appointment scheduled whenever possible; and\n  3. for a patient with an elevated risk of violence, to work\ncollaboratively with the director of community service of the county\nwhere the patient resides, if available, such patient's outpatient\ntreatment providers, residential providers, if applicable, and school,\nif applicable, to incorporate strategies to address violence risk\nfactors and access to weapons into their overall discharge plan.\n  (h) It shall also be the responsibility of the director of any\ndepartment facility from which a client or patient has been discharged\nor conditionally released, in collaboration, when appropriate, with\nappropriate social services officials and directors of local\ngovernmental units, to prepare, to cause to be implemented, and to\nmonitor a comprehensive program designed:\n  1. to determine whether the residence in which such client or patient\nis living, is adequate and appropriate for the needs of such patient or\nclient;\n  2. to verify that such patient or client is receiving the services\nspecified in such patient's or client's written service plan; and\n  3. to recommend, and to take steps to assure the provision of, any\nadditional services.\n  (i) 1. No patient about to be discharged or conditionally released\nfrom a department facility or an inpatient facility operated or licensed\nby the office of mental health shall be directly referred to any\nfacility subject to licensure, certification or approval by any state\nagency or department, unless it has been determined that such facility\nhas a current and valid license, certificate or approval. In addition,\nno patient about to be discharged or conditionally released from a\ndepartment facility shall be directly referred to any residential\naccommodation not subject to licensure, certification or approval by any\nstate agency or department unless it has been determined, after\nconsultation with appropriate local agencies, that such residential\naccommodation complies with all appropriate local zoning, building, fire\nand safety codes, ordinances and regulations.\n  2. (I) A patient about to be discharged or conditionally released from\na department facility licensed or operated by the office for people with\ndevelopmental disabilities or from an inpatient facility operated or\nlicensed by the office of alcoholism and substance abuse services or the\noffice of mental health to an adult home or residence for adults, as\ndefined in section two of the social services law, shall be referred\nonly to such home or residence that is consistent with that patient's\nneeds and that operates pursuant to section four hundred sixty of the\nsocial services law, provided further that: (A) for a department\nfacility licensed or operated by the office for people with\ndevelopmental disabilities or for an inpatient facility operated by the\noffice of alcoholism and substance abuse services or the office of\nmental health, the facility director retains authority to determine\nwhether the home, program or residence is consistent with that patient's\nneeds and (B) such referral shall be made to the patient's home county\nwhenever possible or appropriate.\n  (II) No patient about to be discharged or conditionally released from\na department facility licensed or operated by the office for people with\ndevelopmental disabilities or from an inpatient facility operated or\nlicensed by the office of alcoholism and substance abuse services or the\noffice of mental health shall be referred to any adult home or residence\nfor adults, as defined in section two of the social services law, which\nhas received an official written notice from the department of health\nof: (A) the proposed revocation, suspension or denial of its operating\ncertificate; (B) the limitation of its operating certificate with\nrespect to new admissions; (C) the issuance of a department of health\norder or commissioner of health's order or the seeking of equitable\nrelief pursuant to section four hundred sixty-d of the social services\nlaw; (D) the proposed assessment of civil penalties for violations of\nthe provisions of subparagraph two of paragraph (b) of subdivision seven\nof section four hundred sixty-d of the social services law; or placement\non the "do not refer list" pursuant to subdivision fifteen of section\nfour hundred sixty-d of the social services law. Referrals may resume\nwhen such enforcement actions are resolved.\n  (III) A community provider of mental hygiene services, including a\nprovider of case management services, which serves residents of any home\nor residence in which the department of social services has acted\npursuant to subdivision nine of section four hundred sixty-one-c of the\nsocial services law, shall assist the operator of such home or residence\nor the department of social services in efforts to secure an appropriate\nalternate placement of a resident.\n  (IV) The commissioner shall promptly refer to the department of social\nservices any serious complaint received about the care provided or\nhealth and safety conditions in an adult home or residence for adults.\nThe commissioner may as appropriate assist the department of social\nservices in the investigation and resolution of such complaints as well\nas in the investigation and resolution of any such complaint which is\ninitially received by the department of social services.\n  (j) The department shall submit to the legislature and the governor by\nthe first day of January, nineteen hundred seventy-eight, a\ncomprehensive plan describing those reasonable steps taken or to be\ntaken by the department to locate former patients who had been in a\ndepartment facility for a continuous period for two or more years prior\nto their discharge or conditional release and who had been discharged or\nconditionally released on or after the thirty-first day of December,\nnineteen hundred seventy without the benefit of a written service plan.\nIn each case in which the person has been located, the department, in\ncooperation with appropriate social services officials and directors of\ncommunity services, shall make every effort to develop a written service\nplan for such person and shall assume the same responsibilities with\nrespect to such person as the department is required to assume with\nrespect to a person who was discharged or conditionally released from a\ndepartment facility pursuant to a written service plan.\n  (k) No patient shall be required, as a condition precedent to his\ndischarge, to agree to the terms of a written service plan. If after the\nadvisability of following the program proposed in the written service\nplan has been explained to the patient who has been discharged or who is\nto be discharged, such patient expresses his objection to such program\nor any part thereof, a notation of such objection shall be made in the\npatient's records.\n  (l) Nothing in this section shall be construed to prohibit, limit, or\nrestrict the obligation of the director of a department facility to make\nnecessary expenditures for the board and family care of patients subject\nto the approval of the commissioner, provided that no such expenditure\nshall be made with respect to any patient who is receiving public\nassistance and care under the social services law.\n  (m) It shall be the responsibility of the chief administrator of any\nfacility providing inpatient services subject to licensure by the office\nof mental health to notify, when appropriate, the local social services\ncommissioner and appropriate state and local mental health\nrepresentatives when an inpatient is about to be discharged or\nconditionally released and to provide to such officials the written\nservice plan developed for such inpatient as required under subdivision\n(f) of this section.\n  (n) It shall be the duty of directors of local social services\ndistricts and local governmental units to cooperate with facilities\nlicensed or operated by an office of the department in the preparation\nand implementation of comprehensive written services plans as required\nby this section.\n  (o) Service plans and discharge summaries for individuals with complex\nneeds at psychiatric centers or psychiatric inpatient services subject\nto licensure by the office. For purposes of this subdivision, an\n"individual or patient with complex needs" shall be defined by\nregulations of the commissioner. The facility shall comply with all\nother provisions of this section, in addition to the following:\n  1. service plans and discharge summaries shall be provided in writing\nto the patient;\n  2. referrals to services described in service plans shall be\nfacilitated at the time of discharge;\n  3. a verbal clinical sign-out shall be provided on or before the day\nof discharge to the receiving outpatient treatment program and if\napplicable, the licensed residential program;\n  4. the patient's discharge plan shall be communicated to the\ndesignated post-discharge care manager, if applicable, to facilitate\ncontinuity of care and service coordination; and\n  5. referrals for care management services or community-based services\nand peer based programs shall be facilitated, as clinically appropriate\nand in accordance with regulations promulgated by the commissioner.\n