Highlight on Delaware: Modernizing Mental Health Law

On October 14th 2014, Delaware Governor, Jack Markell, signed legislation intended to update Delaware’s mental health law. Specifically, the legislation, House Bill 346, is designed to help individuals get the most appropriate mental health treatment at the most appropriate time, while implementing stronger procedural and civil rights protections for patients.

House Joint Resolution 17 Mental Health Law Study Group

The law is the product of what the Delaware press release refers to as “hundreds of hours of work” from the members of the House Joint Resolution 17 Mental Health Law Study Group. The group was established  in 2012 for the purpose of revisiting the state’s health care laws, most of which had not been updated since the 1950’s. The goals of the study group were to ensure that Delawareans with mental health needs: (1) have the “most appropriate mental health treatment, in the most appropriate but least restrictive setting, at the most appropriate time;” (2) receive excellent care while their civil rights are respected; and (3) have improved access to care, treatment, and housing.

Mental Health Screeners

A significant provision of the law is premised on the use of individuals designated as “credentialed mental health screeners.” Under the legislation, mental health screeners are mental health professionals who will be called upon during a mental health crisis to evaluate individuals, where they are, and determine if an emergency detention process is warranted. Significantly, through the 350 mental health screeners in the state, the legislation will take the responsibility of evaluating mental health crises away from law enforcement, and put it in the hands of mental health professionals. The goal of the change is to reduce the number of involuntary admissions and commitments for mental health treatment by resolving mental health crises through voluntary treatment.

Due Process

The law also increases protections for juveniles by requiring that emergency detention decisions can only be made by psychiatrists and mental health screeners. Additionally, once admitted, minors or their parents can make a written request to a psychiatrist to be discharged at any time. However, discharge can be conditioned on parent, legal custodian, or legal guardian consent. In emergency situations, when minors are detained, under the new law, generally, evaluation and treatment is to occur within 24 hours of the detention.

Critique

Although the passage of the law is being celebrated by the Governor’s office as a success, not everyone is applauding the new provisions. For example, according to a Newsworks report on the legislation, Brian Stettin, a policy director at the watchdog organization, Treatment Advocacy Center, said that the inclusion of some provisions, like one that requires a patient to be an imminent danger to themselves before treatment can begin, are too restrictive. As a result, he said treatment may not begin until an injury is about to happen, which, in some cases, may be a lot later than it should be.

Old Law

The new law, however, improves upon the  law prior to 2012, when the House Joint Resolution 17 Mental Health Law Study Group was formed and reforms began. Under the earlier law, any individual had the authority to file a complaint to start the involuntary mental health detainment process. Critics of the earlier process pointed to the fact that thousands of residents each year were arrested by police officers and taken before a licensed physician.  Under the pre-2012 system, about eight Delaware residents were involuntarily detained each day. Although the new program has not avoided all criticism, it does present a significant step towards protecting the rights of individuals while balancing the need to provide them optimal mental health care.