An Act To Allow Law Enforcement and Family Members To Petition the District Court To Initiate Assisted Outpatient Treatment 2,2009
Maine Legislature, Session 124, LD 1360
Committee: Health and Human Services
Sponsors: NUTTING, MILLS, LEWIN, PIEH
Amends: 34-B MRSA §3601, 34-B MRSA §3602, 34-B MRSA §3604, 34-B MRSA §3610, 34-B MRSA §3612

FlKSl' REGULAR SESSION-2009 
Legislative Document 
No. 1360 
S.P.495 
In Senate, 
An Act To Allow Law Enforcement and Family Members To 
Petition the District Court To Initiate Assisted Outpatient 
'Treatment 
2,2009 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator NUTTING of Androscoggin. 
9t8{J~ 
JOY J. O'BRIEN 
Secretary of the Senate 
Cosponsored by Senators:MARRACHE of Kennebec, MILLS of Somerset, RA YE of' 
Washington, Representatives: LEWIN of Eliot, ,PIEH of Bremen. 
Printed on rccyd~cJ p<lpcr 
Be it enacted by the People 'ofthe State of Maine as follows: 
Sec. 1. 34-B MRSA §3601, as amended by PL 1987, c.246, §3, is further 
amended to read: 
' 
§3601. Definitions 
As used in this subchapter, unless the context otherwise indicates, the following 
terms have the following meanings. 
1. Agency. "Agency" means a person, firm, association or corporation, but does not 
include the individual or corporate professional practice of one or more psychologists or 
psychiatrists. 
' 
I-A. 
Case management services. 
"Case management services" means those 
services which assist an individual in gaining access to and making effective use of the 
range of medical, psychological and other related services available to them'. 
, 31 
"-
I-B. Long-term mentally ill. "Long-term mentally ill" means persons ,who suffer 
certain mental, or emotional disorders, such as organic brain syndrome, schizophrenia, 
recurrent depressive and manic-depressive disorders, paranoid and other psychoses, plus 
other disorders which may become chronic, that erode or prevent the capacities in relation 
to 3 or more of the primary aspects of daily life, such as personal hygiene and self-care, 
self-direction, interpersonal relationships, social transactions, learning, recreation and 
economic self-sufficiency. While these persons may be at risk of institutionalization, 
there is no requirement that these persons are or have been, residents of institutions 
providing rriental health services. 
2. Mental health services. "Mental health services" means out-patient counseling; 
other psychological, psychiatric, diagnostic or therapeutic services and other allied 
servIces. 
3. Assertive community treatment. "Assertive community treatment" has the same 
meaning as in section 3801, subsection 11. 
4. Assisted outpatient treatment. "Assisted outpatient treatment" means cOUli-
ordered commitment to community mental health treatment, provided by the department 
directly or indirectly through contracted services, including assertive community 
treatment if appropriate to the person ordered to participate in assisted outpatient 
treatment. 
5. Chronically disabled. "Chronically disabled" means that a person is incapable of 
making an informed medical decision and, based on the person's severe and persistent 
mental illness and psychiatric history, that the person is unlikely to comply with treatment 
and, as a consequence, the person's current condition is likely to deteriorate until the 
mental illness significantly impairs the person's judgment, reason, behavior or capacity to 
recognize reality and has a substantial probability of causing the person to suffer or 
continue to suffer severe psychiatric, emotional or physical harm. 
) 
) 
) 
() 
II 
' 
\~) 
6. Community mental health treatment. "Community mental health treatment" 
'means a comprehensive system of deli'vering mental health treatment services to a person 
who suffers from a severe and persistent mental illness through outpatient mental health 
services, including but not limited to assertive community,treatment. 
7. Family member. "Family m'ember" means a grandparent, parent, sibling or child 
of the person who is the subject of an application filed under section 3612, whether 
related by blood, adoption or marriage. 
' 
8. Gravely disabled. "Gravely disabled" means that a person is unable to make an 
informed medical decision about mental health treatment and has behaved in such a 
manner as to indicate the likelihood of being unlikely, without supervision and the 
assistance of others, to satisfy the need for nourishment, personal or medical care, shelter, 
self-protection and safety', with the result that it is probable that bodily harm, significant 
psychiatric deterioration or debilitation or serious illness is likely to result unless 
adeguate treatment is provided. ' 
,9. 
In need of assisted outpatient treatment. 
"In need of assisted outpatient 
treatment" means that a person is suffering from a severe and persistent mental illness 
based on a clinical determination and as a result of the mental illness: 
A. 
Is unlikely to survive safely in the community without superVISIOn and the 
support of family, friends and licensed mental health professionals a'ndis unlikely to 
voluntarily comply with recommended treatment; and 
B. Poses a likelihood of serious harm, as defined in section 380 I, subsection 4, or is 
gravely or chronically disabled and is likely to benefit from assisted outpatient 
treatment. 
10. Severe and pe'rsistent mental illness. "Severe and persistent mental illness" has 
the same meaning as in section 3801, subsection'8-A. 
Sec. 2. 34-B MRSA §3602, as enacted by PL 1983, c. 459, §7, is amended to 
read: 
§3602. Purpose 
The purpose of this subchapter is to expand comrnunity mental health services, 
encourage paIticipa,tion in a program of community mental health services by persons in 
local communities, obtain better understanding of the need for those servicesfHffi, secure 
aid for programs of community mental health services by state aid and local financial 
SUppOIt and provide for assisted outpatient treatment and for mental health services ,to 
persons with severe and persistent mental illness who are the subject ora COllIt order of 
ass isted outpatient treatment. 
' 
Sec. 3. 34-B MRSA §3604, sub-§l, as enacted by PL 1983, c, 459, §7, IS 
amended to read: 
' 
1. Provision of services. The commissioner may provide mental health services 
throughout the State and for that purpose may cooperate with other state agencies, 
municipalities, persons, unincorporated associations and nonstock corporations. 
The 
commissioner shall provide community mental health treatment for persons with severe 
and persistent mental illness who are ordered by a court to participate in assisted 
outpatient' treatment under section 3612 beginning no later than 3 working days after 
~entry of the order by the court. 
Sec. 4. 34-B MRS A §3604" sub-§.5, as, amemded by Pi, 2007, c. 286,;, §5, IS, 
further amended to read: 
5. Exclusion. Beginning October 1, 1996, an An entity that applies for the award or 
renewal of a grant or contract for the provision of mental health services must be a 
participating member of the institute council or the community service network, as 
established in section 3608, for the region of the State subject to that grant or contract and 
must provide community mental health' treatment to persons ordered by a court to 
participate in assisted outpatient treatment under section 3612. 
Sec. 5. 34-B MRSA §3610, first elJ, as amended by PL 2007, c. 286, § 1 O,is 
further amended to read: 
' 
The department is responsible for providing a safety net of adult mental health 
services for peeple persons with major mental illness who the depaltment or its designee 
determines can not otherwise be served by the community service networks and for 
persons ordered by a court to participate in assisted outpatient treatment under section 
3612. 
The department may develop contracts to deliver safety net services if the 
department determines contracts to be appropriate and cost-effective. The state-operated 
safety net must include, but is not limited to: 
Sec. 6. 34-B MRS A §3610, sub-§2-A is enacted to read: 
,2-A. Community mental health treatment. Community mental health treatment 
for persons ordered by a court to participate in assisted outpatient treatment pursuant to 
section 3612; 
Sec. 7. 34-B MRSA §3612 is enacted to read: 
§3612. Court-ordered assisted outpatient treatment 
A person who is 19 years of age or older who is suffering froni a severe and 
persistent mental illness and is in need of assisted outpatient treatment may be ordered by 
a court to participate in assisted outpatient ti'eatment in accordance with the following 
procedures. 
1. 'Application; certifying examination. 
A law enforcement officer or family 
member may make a written application for a court order that a person who meets the 
,criteria of paragraphs A and B participate in assisted outpatient treatment including: 
A. A statement of the applicant's good faith belief that the person suffers 'from a 
severe and persistent mental illness and, because of the person's illness, is in need of 
assisted outpatient treatment and the grounds for this belief; and 
) 
) 
) 
n 
I 
r 
g 
II· 
IS 
\,J 
.8. A certificate from a licensed' physician or clinical psychologist stating that the 
physician or psychologist has examined the person and that the physician or 
psychologist is of the opinion that the person meets the criteria for assisted outpatient 
treatment. If the person with regard to whom the application is made refuses to 
undergo an examination, the applicant may apply to the court for an examination in 
accordance with the procedures of section 3863. 
2. Judicial review .. The application and certificate of mental health examination 
under subsection I must be reviewed by a Judge of the District Court, after notice to the 
person with regard to whom the application is made, and a hearing held on the application 
within 14 days of the date of filing of the application. Upon motion of any party and 
upon finding good cause, the hearing may be continued for up to 10 days. 
A. Upon receipt of the application and accompanying documents, the District COlllt 
shall give written notice of the application and provide the date of the hearing by 
mailing notice through the United States Postal Service within 2 days of the filing of 
the application to the person with regard to whom the application was filed or to the 
legal guardian of the person. A docket entry is sufficient evidence that notice under 
this paragraph has been given. 
8. TIie hearing must be held in as informal Ii manner as is consistent with orderly 
procedure and in a physical setting not likely to have a harmful effect on the mental 
health of the person with regard to whom the application was filed. 
e. If the person with regard to whom the application was filed requires transportation 
to and fi'om the hearing, the depaltment shall bear the responsibility and expense of 
transportation. The court shall pay any costs for witness fees and expenses and other 
costs under this subsection. 
. 
D. At the hearing the person who is the subject of the application has the right of 
representation by an attorney of the person's choice or if no attorney is chosen by the 
person at the choice of the depaltment and at the department's expense. 
. E. 
The court shall receive all material and relevant evidence regarding the 
application. The applicant, the person with regard to whom the application was made 
and all other persons allowed by the court may attend the hearing for fhe purpose of 
presenting evidence, including psychiatric and psychological evidence and a 
proposed individual treatment plan, and examining witnesses. 
F. The COlllt shall maintain a record of the hearing and all proceedings with regard to 
the application. 
G. The hearing is confidential and may not be open to the public except by request of 
the person with regard to whom the application was made or counsel for the person. 
The record of the hearing and proceedings is confidential and may not bedisclosed to 
the pliblic except with the permission of the person with regard to whom the 
application was made or that person's counsel. 
I 
3. Order of participation in assisted outpatient treatment. The judge shall enter a 
judgment on the application under subsection I within 24 hours of completion of the 
hearing under subsection 2. 
. 
A. If the judge finds by clear and convinci~g evidence that the person with regard to 
whom the application was made is in need of assisted outpatient treatment, the judge 
shall enter an' order that the per'son participate in assisted outpatient treatment for a 
period no longer than 6 months. 
' 
' 
B. An order that a person participate in assisted outpatient treatment must include an 
individualized treatment plan for assisted outpatient treatment. ' The plan may 
include, as appropriate to the person, medication and medication' management; 
' community mental health treatment; periodic blood tests or urinalysis; individual or 
group therapy;' day or paIiial day programming; educational and vocational activities; 
alcohol 'and substance abuse treatment, including testing; supervision of living 
II 
arrangements; and any other services to treat the underlying mental illness, assist the 
person with living and functioning in the community and prevent relapse or 
deterioration of mental health . 
. 14 
C. 
After entry of the initial order that a person paliicipate in assisted outpatient 
treatment, any material modifications to the individualized treatment plan under 
paragraph B that are, not agreed to by the person ordered to participate must be 
7 
approved by the court. 
4. 
Appeals. 
A person ordered by the District COlui to paIiicipatein' assisted' 
outpatient treatment may appeal from that order to the Superior Court. 
A. The appeal is on questions of law only. 
B. Any findings of fact of the District Court may not be set aside unless clearly' 
erroneous. 
C. The order of the District COllli remains in effect pending the appeal. 
D. The District Court Civil Rules and the Maine Rules of Civil Procedure apply to 
the conduct of the appeals, except as otherwise specified in this subsection. 
5. Review. A court that has ordered that a person paliicipate in assisted outpatient 
treatment may review the order and the progress of the person in assisted outpatient 
treatment at any time. The procedures of subsection 2 apply to the review proceeding, 
except that notice of the review proceeding must be given to any person recognized as an 
'interested party in the initial proceeding or any subsequent review proceeding. If, upon 
reviewing an order of participation in assisted outpatient treatment, a couli determines 
that the person who was ordered to paliicipate will benefit from continued paIiicipation, 
the court may order a continuation of participation for up to 12 months. 
6. 
Nonparticipation. 
If a person ordered to, paliicipate in assisted outpatient 
treatment does not comply with the individi.lalized treatment plaIT under subsection 3, 
paragraph B and the person's mental health deteriorates to the extent that the person poses 
a likelihood of serious hanTI as defined by section 380 I, subsection 4, any health officer, 
law enforcement officer or other person may make a written application to admit the 
person to a psychiatric hospital, under the procedures for involuntalY emergency 
hospitalization under section 3863. 
' 
7. Educational and training materials. The department shall develop and publish 
educational and training materials describing assisted outpatient treatment and the judicial 
) 
) 
) 
I 
I 
process for distribution to providers and consumers of mental· health services, law 
enforcement, the coul1s and the general public. . 
Sec. 8. Report. The Department of Health and Human Services shall submit a 
rep0l1 describing implementation of assisted outpatient treatment under the Maine 
Revised Statutes, Title 34-8, chapter 3, subchapter 3, article I to the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
on or before January 1,2015. 
Sec. 9. Effective date. This Act takes effect January 1, 2010. 
SUMMARY 
This bill enables law enforcement or a family member of a person with a severe and 
persistent mental illness who is in need of assisted outpatient treatment to petition the 
District Court for an order that the person must partic i pate- in assisted outpatient 
treatment. The assisted outpatient treatment order lasts for 6 months and ·is renewable for 
an additional 12 months. The application, hearing, review and appeal process includes 
notice, a mental health examination, court-appointed. or retained counsel, the right to 
present evidence and cross-examine witnesses and a record of the proceedings. The order 
to paI1icipate· in assisted outpatient treatment includes within it an individualized 
treatment plan. 
The bill requires the Department of Health and Human Services to provide 
community mental health services, including assignment of an assertive community 
treatment team, for a person who is ordered to participate in assisted outpatient treatment. 
The bill requires providers of mental health services who apply for grants and· 
contracts with the Department of Health and Human Services to provide community 
mental health treatment to persons ordered bya court to participate in assisted outpatient 
treatment. 
. 
The bill includes as a duty of the Department of Health and Human Services, under 
the category of safety net services, providing services for persons ordered to participate in 
assisted outpatient treatment.