2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART VIII - Mental Health (§§ 4001-6151 — 6184) › Chapter 201A - Mental Health Code of 2000 (§§ 6152 — 6166g) › Subchapter VIII - Mental Health Care System for Minors (§§ 6159 — 6159y) › § 6159 - Levels of care

Mental healthcare services for minors shall be rendered in a therapeutically adequate setting according the greatest autonomy, pursuant to the mental healthcare system concept and befitting the diagnosis and severity of symptoms and signs at the time the person is evaluated. The levels of mental healthcare shall be organized by different levels of intensity, and integrated and articulated in order to ensure ongoing treatment. Levels of ongoing mental healthcare include services that range from the most intensive, such psychiatric hospitalization, to those which accord the greatest autonomy, such as outpatient services. At any level of treatment, the use of medications may be required, as per the diagnosis and the severity of symptoms and signs at the time the minor is evaluated.
Levels of care in order of greatest intensity and lesser autonomy are:
(1) Psychiatric hospitalization for children and adolescents.
(2) Psychiatric quarters or wards at general hospitals for children and/or adolescents and psychiatric addiction or addictive medicine quarters or wards at general hospitals for children and/or adolescents.
(3) Emergency rooms for minors.
(4) Live-in treatments for children or adolescents.
(5) Partial or day hospitalizations for children or adolescents.
(6) Intensive outpatient services for minors.
(7) Outpatient services for minors.
(8) Maintenance for minors with or without medications.
All institutional providers shall establish the mechanisms, norms and procedures to give access to comprehensive services through collaborative partnerships between the various mental healthcare agencies and providers, in order to facilitate the minor’s progression through the mental healthcare system as his/her changing needs dictate and until it is clinically indicated to transfer him/her to alternatives that accord greater autonomy, or in default thereof, to alternatives which, albeit more intensive, are clinically necessary. [In the case of minors receiving special education services for mental disorders and mental health services, the coordination of those should be evident in the individualized education plan.]
Those circumstances which require the minor to be transferred to another level which requires greater intensity, the review of the inter- or multidisciplinary individualized treatment, recovery and rehabilitation plan shall be mandatory in order to determine the modifications, if any, that should be made, to maintain the progress of the recovery. The determination of placing the minor in a greater-autonomy level of care shall be based on the recommendation made by a child and adolescent psychiatrist, in consultation with the inter- or multidisciplinary team.
This provision shall apply to cases in which the parent with legal or physical custody, the legal guardian or the surrogate parent consent to the treatment, and to cases in which the court has ordered the minor to be institutionalized in an institutional provider.
The lack of interest or the inability of the parent with legal or physical custody, the legal guardian, or the person with physical custody or the duty to provide care or shelter, shall not constitute grounds for having a minor institutionalized in a mental healthcare institution serving minors, unless the services thereof are designed to fulfill such a purpose. If this should be the case, the director of the institution shall file a petition with the court to secure care and shelter for such minor. The court may order the Department of the Family to give the minor proper placement.
History —Oct. 2, 2000, No. 408, § 8.01; Aug. 6, 2008, No. 183, § 38.