California Code of Regulations › Title 15 - Crime Prevention and Corrections › Division 3 - Adult Institutions, Programs and Parole › Chapter 2 - Rules and Regulations of Health Care Services › Subchapter 3 - Health Care Operations › Article 5 - Mental Health Care › Section 3999.345 - Involuntary Medication Definitions and Criteria

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Definitions:
(1) Serious Mental Disorder means an illness or
					 disease or condition that substantially impairs the person's thought, perception of
					 reality, emotional process, or judgment; or grossly impairs behavior; or
					 demonstrates evidence of an acute brain syndrome for which prompt remission, in the
					 absence of treatment, is unlikely.
(2)
					 Danger to Others means the patient has inflicted, attempted to inflict, or made a
					 credible threat of inflicting physical harm upon the person of another and, as a
					 result of a serious mental disorder, the patient presents a demonstrated danger of
					 inflicting physical harm upon others. Demonstrated danger may be based on an
					 assessment of the patient's present mental condition, including consideration of the
					 patient's historical course of a serious mental disorder, to determine if the
					 patient currently presents an elevated chronic risk or an imminent risk of harming
					 another person.
(3) Danger to Self means
					 the patient has made a credible threat or has attempted to engage in an act of
					 self-harm and the threat is ongoing; or has threatened, attempted, or inflicted
					 serious physical injury to self, and, as a result of a serious mental disorder, the
					 patient presents as a demonstrated danger to self. Demonstrated danger to self may
					 be based on an assessment of the patient's present mental condition, including
					 consideration of the patient's historical course of a serious mental disorder, to
					 determine if the patient currently presents an elevated chronic risk or an imminent
					 risk to his or her own safety.
(4)
					 Gravely Disabled means that there is a substantial probability, due to a serious
					 mental disorder and incapacity to accept or refuse psychiatric medication, that
					 serious harm to the physical or mental health of the patient will result. Serious
					 harm means significant psychiatric deterioration, debilitation or serious illness as
					 a consequence of his or her inability to function in a correctional setting without
					 the supervision or assistance of others, inability to satisfy his or her need for
					 nourishment, and/or inability to attend to needed personal or medical care, seek
					 shelter, and/or attend to self-protection or personal safety. The probability of
					 harm to the physical or mental health of the patient requires evidence that the
					 patient is presently suffering adverse effects to his or her physical or mental
					 health, or evidence that the patient has previously suffered these effects in the
					 historical course of his or her mental disorder and that his or her psychiatric
					 condition is again deteriorating. The fact that a patient has a diagnosis of a
					 mental disorder does not alone establish probability of serious harm to the physical
					 or mental health of the patient.
(5)
					 Informed Consent means that the patient, without duress or coercion, is able to
					 clearly give consent for the proposed psychiatric medication to the treating
					 Psychiatrist. In order to demonstrate that a patient has given informed consent, the
					 following criteria shall apply:
A. The patient has
					 been advised by the Psychiatrist or a Psychologist regarding the nature and
					 seriousness of his or her mental illness or disorder, and has communicated a
					 willingness to pursue a recommended course of treatment.
B. A Psychiatrist has explained the nature of the
					 medication to be used in the proposed treatment, including its probable frequency
					 and duration, and the patient, using a rational thought process, has communicated
					 his or her understanding of the fundamental meaning of the information
					 provided.
C. The Psychiatrist has stated
					 the probable degree and duration (temporary or permanent) of improvement or
					 remission of the patient's condition to be expected, with or without medication, and
					 the patient has communicated a choice.
D. The patient has been advised by a Psychiatrist
					 of how the medication is thought to work and the nature, degree, duration, and
					 probability of risk and/or side effects commonly associated with the medication. In
					 addition, this would include advising the patient of how the medication acts to
					 prevent, reduce, or address a particular mental health condition. The patient has
					 communicated a basic understanding of the information provided.
E. The patient has been advised by a Psychiatrist
					 if there is a difference of opinion within community standards as to the
					 effectiveness of the proposed medication and the patient has communicated a basic
					 understanding of the information.
F. The
					 patient has been advised of reasonable alternative treatments, if any, and why the
					 Psychiatrist is recommending a particular medication, and the patient has
					 communicated a basic understanding of the information.
G. The patient has been advised by a Psychiatrist
					 of his or her right to accept or refuse the proposed medication, and of their right
					 to revoke consent for any reason, at any time, prior to or between medications, and
					 is able to articulate by means of a rational thought process the basis for accepting
					 or rejecting the recommended course of treatment.
H. The patient exhibits a reasonable understanding
					 of his or her current condition and symptoms.
I. The patient demonstrates capacity to consent to
					 treatment, as defined in section
					 3999.98.
(6) Involuntary Medication means the
					 administration of any psychiatric medication or drug to a patient by the use of
					 force, discipline, or restraint, including administration upon a patient who lacks
					 capacity to accept or refuse medication. Involuntary psychiatric medications may be
					 utilized after less restrictive non-pharmaceutical alternatives have been deemed
					 unavailable or clinically inappropriate, or in a medical emergency. If psychiatric
					 medication is administered during an emergency, the medication shall only be that
					 which is required to treat the emergency condition and shall be administered for
					 only so long as the emergency exists.
(7) Psychiatric Medication means drugs or
					 medications used in the treatment of a serious mental disorder, mental disease, or
					 mental defect, or utilized to treat side effects caused by these medications or any
					 medications used to augment or temper the effects of psychiatric medications. The
					 drugs include, but are not limited to, antipsychotics, antidepressants, sedatives,
					 or mood stabilizers, in both their short-acting and long-acting
					 formulations.
(8) Elevated Chronic Risk
					 means the serious and persistent presentation of clinical factors that suggests an
					 inability to adequately navigate within society or inability to effectively navigate
					 within a structured environment such that, based on historical course of mental
					 disorder, there is a reasonably foreseeable elevated risk of self-harm, violence, or
					 grave disability.
(9) Imminent Risk
					 means the presence of clinical and situational factors that suggest a significant
					 risk of violence toward others, self, or grave disability and requires immediate
					 intervention.