“That’s us cleaning our house internally but also telling the world that, ‘Hey, this is how documents should be filed and how the process works,’” Brannon said.
A recent Dayton Daily News investigation looked at approaches local agencies are using to reduce the number of inmates at the Montgomery County jail because of mental health or addiction problems. This story examines how civil commitments can divert people to treatment instead of putting them behind bars.
Civil commitment is the legal process for a probate court to mandate that a person gets treatment for a mental illness. It generally happens if a person represents a substantial risk of physical harm to self or others.
There are a number of ways a person can be committed, such as being “pink-slipped” by a health care professional or member of law enforcement and taken to a hospital for 24-hour observation. Family members can initiate the process, or people can be transferred from a criminal court over to probate court.
Probate courts enact local rules that supplement the law to iron out the procedures of what happens after someone has been involuntarily committed and what that case management looks like. Brannon and Doggett created draft rules for the civil commitment process in Montgomery County involving mental health because none existed.
“I’ve never seen a set of local rules for mental health, or at least the longest I’ve seen is a page and a half and not very substantive,” Brannon said.
Brannon was first elected Montgomery County Probate Court Judge in November of 2020, with his term beginning Feb. 9, 2021.
The new draft rules expanded to 36 pages outlining procedures, providing forms to be used and showing flow charts. They bring attention to the process.
“Mental health always kind of gets shoved into the dark corner,” Doggett said.
Stakeholders like the prosecutor’s office will give input, and the forms will also go before the Probate Law and Procedures Committee under the Ohio Association of Probate Judges. In the meantime, they can still begin using these rules to track where individuals are in their commitment process.
“You always want to do the shining the light and the transparency on this process, because that both protects individuals rights, and also kind of shows that if there’s flaws in the system, we can find them and we can change them,” Doggett said. “So a lot of those documents that we prepped are basically trying to figure out ways how to fill in the holes.”
After a person undergoes a 24-observation period, the hospital has three days to file an affidavit with the probate court, and an initial hearing must be set 10 days from date of when the individual first went under observation.
After going through the initial intake process of being committed, individuals with a mental illness who are now subject to court orders can be ordered to undergo treatment, such as through an inpatient or outpatient facility.
When individuals are committed, they are typically committed to the Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS) board, unless the individual is a veteran, than they are committed to the VA.
“When a person is discharged from the hospital and placed on outpatient commitment, they are linked with a mental health provider,” said Jennifer Hochdoerfer, ADAMHS’ forensic and civil commitment monitor. “The mental health provider is the person or agency that’s responsible for providing the mental health case management, psychiatric services.”
The civil commitment starts as a 90-day commitment, Hochdoerfer said, after which the provider agency must apply to continue their commitment. Then a commitment can be continued for up to two years, which is a change that Montgomery County made within the past year. Historically, Montgomery County had committed people for 365 days.
“Now people can be on a civil commitment up to 730 days. That doesn’t mean that they remain on that commitment that entire time,” Hochdoerfer said.
A provider agency can ask the court for an individual’s commitment to be discontinued if the person is voluntarily taking their medication and following appointments.
Montgomery County Probate Court is also working on establishing assisted outpatient treatment procedures, which is court-supervised treatment within the community. This is to help the court figure out which individuals are actually going to outpatient treatment, Doggett said.
ADAMHS also created a position within its organization at the end of 2022 called a justice liaison, which is dedicated to working with probate court and to oversee the probate court commitments and working with the provider agencies regarding the person who is receiving their services under that commitment, Hochdoerfer said.
The court is working with ADAMHS to increase the coordination between the two groups, as well as with the provider agencies, to find out who’s been put on outpatient, when they are supposed to go to their appointments, and if they are taking their required medications. Provider agencies can also notify the justice liaison the patient under civil commitment misses appointments.
“We didn’t really get that information before, and so the court didn’t really know what was going on with an individual after they were committed to ADAMHS,” Doggett said. “If they don’t go to their appointment, we can pull them in for a status hearing and just see why.”
The hearing can help the court figure out if it was a transportation issue preventing the individual from seeking treatment, or if they would prefer a different provider.
After going through the civil commitment process, an individual will eventually have their commitment dismissed, either due to ADAMHS withdrawing the case, the individual no longer meeting the criteria to be subject to a court order, or changes in the case, such as the individual being incarcerated or a lack of jurisdiction. If a patient needs to be committed longer than two years, the civil commitment needs to be refiled.
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