Factors to Deciding whether to Hospitalize or refer to ...



PURPOSE: To establish policies and procedures to assist staff in decision-making when the severity of an individual’s mental illness requires 24-hour supervision and medically supervised care.

II. APPLICATION: All programs operated directly by Community Mental Health for Central Michigan (CMHCM).

III. REFERENCE:

1. Michigan Mental Health Code.

2. Suicide Prevention Protocol is available for staff reference within the Paperwork Resource Manual.

IV. DEFINITIONS:

| | |

|CLINICIAN |A mental health professional – physician, psychologist, licensed master’s social worker |

| |(LMSW), licensed professional counselor (LPC), licensed marriage and family therapist, |

| |registered professional nurse, nurse practitioner, qualified mental health professional |

| |(QMHP), qualified mental retardation professional (QMRP), and certified mental health |

| |professional (CMHP). |

| | |

|CO-OCCURRING DISORDER |A serious emotional disturbance or serious mental illness in conjunction with a substance |

| |use disorder. |

| | |

|EMERGENCY SITUATION |A situation in which an individual is experiencing a serious mental illness, co-occurring |

| |disorder, or a developmental disability, or a child is experiencing a serious emotional |

| |disturbance, and one of the following applies: (a) The individual can reasonably be |

| |expected within the near future to physically injure himself/herself or another individual,|

| |either intentionally or unintentionally; (b) the individual is unable to provide |

| |himself/herself food, clothing, or shelter or to attend to basic physical activities such |

| |as eating, toileting, bathing, grooming, dressing, or ambulating, and this inability may |

| |lead in the near future to harm to the individual or to another individual, or (c) the |

| |individual’s judgment is so impaired that he or she is unable to understand the need for |

| |treatment and, in the opinion of the mental health professional, his/her continued behavior|

| |as a result of the mental illness, developmental disability, or emotional disturbance can |

| |reasonably be expected in the near future to result in physical harm to the individual or |

| |to another individual. |

| | |

|HOSPITALIZATION OR HOSPITALIZE |Provide treatment for an individual as an inpatient in a hospital. |

| | |

|PERSON REQUIRING TREATMENT |An individual who meets the criteria described in section 401 of the Michigan Mental Health|

| |Code. |

| | |

|PSYCHIATRIC HOSPITAL |An inpatient program operated by the Michigan Department of Community Health for the |

| |treatment of individuals with serious mental illness and/or a co-occurring disorder, |

| |serious emotional disturbance, or a psychiatric hospital or a psychiatric unit licensed |

| |under section 137 of the Michigan Mental Health Code. |

| | |

|STATE FACILITY |A hospital operated by the Michigan Department of Community Health. |

| | |

|SUBSTANCE ABUSE |Taking alcohol or other drugs at dosages that place an individual's social, economic, |

| |psychological, or physical welfare in potential hazard or to the extent that an individual |

| |loses the power of self-control as a result of the use of alcohol or drugs, or while |

| |habitually under the influence of alcohol or drugs, endangers public health, morals, |

| |safety, or welfare, or a combination thereof. |

| | |

|URGENT SITUATION |A situation in which an individual is determined to be at risk of experiencing an emergency|

| |situation in the near future if he or she does not receive care, treatment, or support |

| |services. |

V. POLICY:

It is the policy of CMHCM to provide services for persons with serious mental illness, serious emotional disturbances, developmental disabilities, and co-occurring disorders that embody the principles of recovery. To that end, individuals receiving services who may be in need of intensive, 24-hour medically supervised care should be assessed and several factors considered when deciding whether the individual would be best treated in the consumer’s own home with support staff, referred to a crisis bed, or hospitalized. The goal is to restore maximum independent living as rapidly as possible, using the appropriate level of care for the appropriate illness and using the least restrictive setting.

VI. PROCEDURE:

The following factors should be considered in deciding whether to use support staff in the consumer’s own home, refer to a crisis bed, or hospitalize.

A. Consumer’s Own Home

This selection will most often correspond with the following responses on the prescreen form:

◆ Severity of Illness: mild to moderate for psychiatric symptoms (a LOCUS Level III and a score of 22-23 allows for Crisis Residential or supervised community setting), mild to moderate disruption of self-care abilities, mild to moderate for self-harm or harm to others; and mild drug or medical complications.

◆ Intensity of Service: generally does not apply to this population as the categories on the pre-admission screening (LOCUS score) indicate that to treat the consumer safely and effectively a restrictive, 24-hour medical hospital or similar facility is required.

Support staff in the consumer’s own home shall be considered if:

1. There are no significant medical issues and the consumer has access to psychiatric services for medication consideration.

2. There are no significant safety concerns for either consumer or staff.

3. Staff is of the same gender unless otherwise indicated in the Crisis Plan, Psychiatric Advance Directive, etc.

4. Staff coverage (hours, duties, etc.) is specified in the Crisis Plan.

5. The consumer is someone known to CMHCM and CMHCM is in a position to provide needed services (e.g. medication consultation, individual therapy, etc.).

B. Emergency/Crisis Bed – A short-term alternative to inpatient care in a licensed, residential facility. Placement is often made with short notice. (For additional information, please refer to the Licensed Residential Placement Protocol Administrative Guideline – 2.300.023.)

This selection will most often correspond with the following responses on the prescreen form:

◆ Severity of Illness: psychiatric symptoms rate mild, moderate, or severe (a LOCUS Level IV and a score of 24-27 allows for Crisis Residential/Medically Managed Residential) and, while disturbing for the individual, are manageable for the caregiver. Disruption of self-care is severe or serious and a caregiver is needed to help the individual meet his/her needs. The potential risk to self or others is viewed as manageable in less than a hospital setting. The drug or medical complications are assessed as no higher than moderate. Substance abuse concerns might need Detox before transferring to an emergency bed.

◆ Intensity of Service: although the individual may meet the criteria for inpatient hospitalization, the individual can safely and effectively be treated in a less restrictive environment.

A crisis bed should be considered if:

1. The individual has a doctor and/or has current prescriptions that seem to meet his/her needs. Also, check with the emergency room doctor who may be willing to prescribe medication for a limited time period until a follow-up review is scheduled with a CMHCM psychiatrist.

2. The individual needs to have people around to give support, assure medications are taken, etc. However, services do not need to be provided by medical personnel nor would the individual require 24-hour support.

3. The individual’s current difficulties stem from stressors of everyday life such as homelessness, relationship difficulties, unemployment, etc.

4. If an individual is resistant to the idea of a crisis bed, ask him/her how the inpatient unit will help him/her resolve the stressors contributing to his/her distress. Explore this in depth as many issues can only be effectively addressed outside of the hospital. If issues are just “put on hold” until after discharge, then the hospitalization has been a temporary solution.

5. The individual exhibits mild to very moderate psychiatric symptoms of depression which may include: some appetite disturbance, insomnia or hypersomnia, vague suicidal threats, etc. Other DSM IV diagnostic categories and symptoms include questionable reports of psychosis (an individual reporting that the TV is talking just to them), symptoms of mania, such as driving at very high speeds or spending money recklessly, co-occurring disorders, and severe anxiety (pacing constantly and unable to sleep). The reported symptoms are not severe enough to cause any significant impairment in functioning and the person may reasonably expect to do well with on-going contact with others by having access to caring staff, still wish to participate in some aspects of community life (e.g., attend AA meetings), and only need some assurances of safety.

6. The individual is willing and motivated to participate in treatment that will keep him/her in the community.

7. The individual is having difficulties but his/her need is for attention and having someone close by, rather than medical treatment. Perhaps the individual is saying the “right things” for hospitalization but his/her motive may be more to avoid unpleasant realities such as an alcoholic spouse, bills, legal trouble, etc.

8. The individual has a Psychiatric Advance Directive and/or crisis plan that requests a crisis bed as an option.

C. Hospitalization

State Facility (Caro, Hawthorne, Kalamazoo, Ypsilanti-Forensics)

Placement consideration requires Deputy Director of Services or designee approval and a LOCUS Level V score of 28.

Community Inpatient Mental Health Unit

If a person is determined to have a mental illness and is potentially dangerous to self or others, action must be taken to assure the safety of the person and of any others who might be harmed by the person. The following procedures are intended to aid clinicians in arranging for hospitalization in an inpatient mental health unit or state hospital. While the procedures are quite clear, the decisions as to whether to hospitalize and which avenues to follow in accomplishing the hospitalization require use of judgment. Since these decisions are most often made under stressful conditions and in response to crises, clinicians should, to the extent possible, seek out consultation from supervision, CMIT, or from professional colleagues before implementing a plan of action. A Suicide Prevention Protocol is available for reference within the Paperwork Resource Manual. Also, detailed information can be found in the Mental Health Code to further assist decision-making. The agency will make a commitment to provide suicide risk training to staff on an annual basis.

Hospitalization will most often correspond with the following responses on the prescreen form:

◆ Severity of Illness: the individual’s psychiatric symptoms, self-care abilities, and risk potential to self or others all rate a one (1) and therefore, he/she would require 24-hour medical monitoring (a LOCUS Level V score of 28). (Should the individual have serious drug or alcohol complications a medical setting would be most appropriate. Once stable, he/she should be evaluated for the appropriateness of a psychiatric hospital setting.)

◆ Intensity of Service: indicates that only the most restrictive, inpatient psychiatric setting could safely and effectively treat the individual.

1. Crisis Mobilization and Intervention Team (CMIT) assistance: With the CMIT in all six counties, many of the after-hour pre-screen activities will happen between a Crisis Stabilization Specialist (CSS) and the consumer. This means that for the rest of the CMHCM clinicians making hospitalization decisions will occur during the day or less often after hours. If you find yourself in a situation with a consumer known to you that requires hospitalization, often it is best handled by you. A CMIT person is available to consult, especially if you are considering an involuntary admission.

2. Hospitalization should be considered if:

a. The individual has no doctor and/or no prescriptions and is unlikely to be immediately linked to these services and the emergency room doctor is unwilling to prescribe medication even for a few days.

b. The individual needs a 24-hour controlled environment with medical personnel when safety cannot be assured in a less restrictive modality.

c. The individual’s difficulties are so severe that any type of community involvement, even with trained staff, is contraindicated.

d. The individual’s suicidal ideation/psychotic symptoms/mania are so pronounced that any inclusion in the community is unreasonable.

e. The individual has a long history of noncompliance and must be hospitalized on petition in order to come under a Mental Health Court Order.

f. The individual, due to their mental illness or emotional state, verbalizes the intent, and has the means, to impose serious bodily harm toward another identified person. The following applies:

1) Hospitalize the person or initiate proceedings to hospitalize the person.

2) The clinician or CMIT staff will immediately determine whether or not a duty-to-warn situation exists and will be responsible for making all reasonable attempts to notify the endangered individual(s). Depending on immediacy of the need, a supervisor may be consulted/notified. In determining whether a duty-to-warn situation exists, assess the following:

• The specificity of the plan – clarity, severity, imminence;

• Capability of the person making the threat;

• Opportunity and availability of the means;

• The person’s history of known violent behavior (if history is available).

3) If a determination is made to communicate with the third person, only that information which is necessary for the individual(s) to take protective action is to be released. Specific details about the threat and the appraisal of the degree of dangerousness may be released but not the mental status of the person, or therapeutic content of the case.

4) If a decision is made to contact the police, the local police, county sheriff, or state police responsible for law enforcement in the person’s or identifiable third person’s area of residence should be contacted.

5) Document events including entry on the Record of Disclosure form (CMHCM 104) in the case record, names of everyone contacted, and outcome.

3. Hospital Screening/Consultation:

a. Clinicians may go to a local hospital (emergency room) or other approved screening site:

1) If the individual to be screened is indigent or has Medicaid only, or

2) If the individual is an existing CMHCM consumer (in some cases phone consultations would be permissible), or

3) If there is a need for a petition, refer to #4 – Types of Hospitalization.

4) When a person is court-ordered to comply with CMHCM treatment even when not on Medicaid or BC/BS, the agency has an obligation to monitor their discharge and connection with an appropriate treating professional.

b. CMHCM needs to be viewed as welcoming and accessible to consumers with a co-occurring disorder (i.e., mental illness and substance abuse) presenting in the emergency room. Pre-screens should be individualized decisions and may be based on information from family and friends and/or prior history with the agency. Clinicians do not need to wait for a Blood Alcohol Level (BAL) of below .08 to perform a pre-screen. However, the hospital may be asked for a BAL to aid in the screen.

c. When to use each of the three CMHCM hospitalization forms:

1) Complete the Preadmission Screening (CMHCM-728) for an individual who has Medicaid only, or is indigent. Pre-screens are also needed if the individual could go to the state hospital, regardless of insurance type.

Timeframes on the Preadmission Screening form are defined as follows: (note: 12 p.m. is noon and 12 a.m. is midnight).

• Time referral received: Enter the time that the first communication regarding the emergency was received (e.g., call from Listening Ear).

• Special Considerations:

o In cases where the consumer is not appropriate to be screened (e.g., unconscious), the time of referral will be adjusted to reflect the time when the consumer is medically cleared and able to be screened.

o In cases where a decision to not hospitalize is made and new information changes that decision (e.g., information from a relative, a petition, etc.) complete another prescreening document as this warrants a new episode.

• Time screening started: Enter the time that the face-to-face contact was initiated.

• Time of decision: Enter the time that the determination of disposition took place. The time from time referral received to time of decision must not be in excess of 3.0 hours per DCH standards. If time exceeds 3.0 hours, notify assigned supervisor of details by next working day.

• Total Time: Enter the total number of hours and minutes starting with the time screening started and including all time for collateral activity necessary to complete the episode. This time will be consistent with the time entered on the clinicians Staff Activity Log.

2) Complete the Continuing Stay (CMHCM-713) for the individual who has Medicaid only and needs additional days, or is indigent and needs additional days, or when the hospital identifies after admission that CMHCM funding is needed, and a supervisor approves. Examples include:

• The individual has Blue Cross/Blue Shield (BC/BS) and Medicaid, and BC/BS pays only 50%.

• A Medicare recipient has used his/her 60 days per episode.

• It became evident after admission that the individual is eligible for CMHCM payment.

3) Complete the Retrospective Review (CMHCM-734) when it is discovered after discharge that the individual is eligible for CMHCM payment.

4) On or before discharge from an inpatient psychiatric hospital, individuals will be provided with a follow-up appointment within seven days. CMIT members or an Access Manager will be responsible to assure that an appointment is provided. If the appointment is cancelled or not kept by the consumer, the CMIT staff member or an Access Manager will follow-up in the same day to determine the reason and reschedule if appropriate.

4. Types of Hospitalization: Procedures for hospitalization are dictated first by a determination as to whether the person can be hospitalized on a voluntary basis, or whether the person must be hospitalized against his/her will. Generally, a person can only be hospitalized on an involuntary basis if he/she refuses to accept voluntary hospitalization. Therefore, in every case, an effort must be made to accomplish the hospitalization on a voluntary basis. Although a voluntary admission allows a person to leave the hospital voluntarily, hospital staff can and will retain a person if he/she continues to represent a danger to self or others. A voluntary admission can generally be accomplished with less stress to the individual and his/her family and with less expenditure of agency and community resources. At the same time, clinicians should not hesitate to proceed with involuntary hospitalization when it is judged that the person will not cooperate.

2 Voluntary Hospitalization:

• Managed Care Prescreening, Financial Arrangements: While making hospitalization arrangements, it is necessary to determine how the hospitalization will be paid. If the person has the financial or insurance resources to pay for the hospitalization, this information will be required by the hospital, but no prescreening will be required. If the person lacks the financial resources or has a primary insurance coverage of Medicaid, clinicians will need to complete the managed care prescreening process and provide the hospital with a Medicaid Managed Care Mental Health Certification. This is CMH’s guarantee that it will be financially responsible for the cost of hospitalization. Clinicians should refer to prescreening guidelines and procedures for details.

• Admission Arrangements:

o Determine, with the consumer, whether they feel they may be in immediate danger of harming themselves or others. If they feel they are unsafe, then determine whether they need supervision and of what nature (e.g. law enforcement, family member, staff, etc.).

o Call the Mental Health Unit directly and advise that you are calling from CMH to arrange an admission.

o Provide complete information on the person and the reasons for seeking admission. An Information Release should be obtained prior to referral, if possible.

o The Mental Health Unit staff will need to confer with the on-call psychiatrist to obtain authorization for the admission. You may have to wait for a call back confirming the admission.

o Obtain directions as to where the person should go for admission, e.g., to Admitting, directly to the unit, etc.

o Make transportation arrangements (see item C.4.c) on page 10).

a) Involuntary Hospitalization:

• Alternative Treatment Orders and Combined Hospitalization and Alternative Treatment: Remember, the documents required for an involuntary admission become a part of a legal process.* The need for hospitalization is based upon the belief that the person has a mental illness and is a danger to self or others and that no good options exist outside of a hospital setting to ensure safety. If this is the case, the clinician or CMIT member must receive approval from a supervisor prior to facilitating the hospitalization.

*CMHCM staff may be one of many participants in the legal process related to an involuntary hospitalization of someone but the agency is not a defendant and do not need to have legal representation. What the agency does need to have is petitions filed that present clear and factual information regarding the basis of our decision. Further, the Michigan Mental Health Code, page 71, 330.1439, states that … if an individual, who in good faith files a petition alleging that an individual is a person requiring treatment, unless filed as the result of an act or omission amounting to gross negligence or willful and wanton misconduct, is not to be held cognizable in a court in Michigan.

• Court Proceedings/Orders: Depending on the circumstances under which an individual or an individual that the agency will be assigned responsibility for on an Alternative Treatment Order, enters the hospital the court-ordered follow-up may differ. Specifics regarding the various admission avenues (i.e. formal voluntary, informal voluntary, and involuntary) are located in the Michigan Mental Health Code (page 58). For the majority of CMHCM staff that weren’t involved in the actual hospitalization, the case manager’s work will begin the day of notification by the hospital or CMIT staff member that the consumer was hospitalized. The individual will face one of the following scenarios and that will determine the case manager’s role in their return to the community.

• Demand for Hearing: As soon as the court receives notice of an application for hospitalization or a petition for determination that an individual continues to be a person requiring treatment (already hospitalized), the following occurs. The hospital is responsible for informing the individual of their legal rights.

o Hearing to be convened promptly but not more than seven days, excluding holidays and Sunday.

o The individual must be represented by an attorney (guardian ad litem may be appointment).

o Options exist regarding individual’s attendance at the hearing.

o May demand a jury trial.

o Testimony of at least one physician or psychologist who has personally examined the individual will be taken.

o The individual has the right to demand an independent medical examination.

o Legal standard of proof is clear and convincing evidence.

For the purposes of these procedures, situations will be addressed where the admission was a result of a petition/involuntary process. The individual may have opted to be hospitalized on an informal voluntary basis, but the hospitals don’t often like to accept individuals under that option. Their reasoning is that the individual has the right to terminate their stay and leave the hospital, at any time during the normal work day, and if not mentally stable presents a conundrum for the hospital staff. A formal voluntary hospitalization gives the hospital up to three days to act in the event that the individual provides written notice of intent to terminate their stay. If the hospital believes the person remains in need of hospitalization, they will need to complete the clinical certifications.

• Possible Dispositions:

o Dismissal and release.

o Hospitalization (or continued if already inpatient).

o Combination hospitalization and alternative treatment.

o Alternative treatment.

• Deferred Hearing - Formal Voluntary Admission: Individuals that prefer to participate in treatment may select a deferred hearing. CMHCM staff participation is important during this process.

o Individuals have a right to terminate involuntary commitment proceedings by signing formal voluntary admission. The hospital is required to offer formal voluntary admission.

o The court must then dismiss any pending proceeding unless it finds that dismissal would not be in the best interest of the individual or the public.

Now that the individual is on a formal voluntary having deferred the hearing here are the steps to assist in bringing them back into the community.

• Alternative Treatment Order: Before proceeding with this option it is the court’s duty to do the following:

o Inquire as to the desires of the individual.

o Review a written alternative report prepared not more than 15 days before the hearing. (This should be prepared within a collaborative effort between the hospital and the CMHCM clinician that know the person best).

o Receive a written report or oral testimony from supervising agency that they are capable of such supervision.

o Execute the order.

At this point, CMHCM follow-up requires close linkage with the hospital. CMIT has one of their clinicians make daily contact on the psychiatric units of the major hospitals CMHCM works with; this is to ensure coordination of care, but the case manager is responsible for preparing the individual to re-enter the community. CMIT communicates regularly with the case manager.

1 Law enforcement involuntary hospitalization procedures:

o Staff transport is contraindicated.

o Supervised transportation is required.

o Legal processes involved.

Before a person can be hospitalized involuntarily, he/she must be determined to meet the Mental Health Code definition of a “Person requiring treatment”, and he/she must have refused voluntary hospitalization. Procedures for involuntary hospitalization will vary depending on such things as the urgency of the situation, the degree of non-cooperation on the part of the person, involvement of others (family, friends, etc.) in the process, and whether the situation occurs during normal Probate Court business hours (8 a.m. – 5 p.m., Monday thru Friday). All such hospitalizations will require a Petition (Petition/Application for Hospitalization) and most will also require a pick-up order (Supplemental Petition for Examination/Hospitalization and Order).

Who Petitions?

The petition must be completed by an adult (18 years of age or older) who has first- hand knowledge of the behaviors that warrant the petition. The petition can be completed by a family member, friend, or other concerned person. In such situations, clinicians can and should assist the petitioner in obtaining and completing necessary forms. When family, friends, or others are unavailable or unwilling to petition, and when the clinician has sufficient first-hand knowledge to petition, the clinician should complete the petition. In instances where the person has not been directly observed or evaluated by the clinician, the petition may need to be completed by law enforcement officers who are called on to intervene.

Petitioning:

During court business hours, the petition must normally be physically taken to the court. In very urgent situations, where taking the time to carry the petition to the court might place the person or others in danger, the clinician may advise the court by phone of the need for an order and complete the petition as soon as possible afterwards. Most often, when clinicians are petitioning or assisting with a petition, the court will issue the order for hospitalization based on CMHCM’s assessment and judgment. (It is important that the clinician make sure that the person meets the Mental Health Code requirements for involuntary hospitalization.) Outside court business hours, it is still necessary to complete a petition, but the petition will most often be taken to or completed at the Emergency Room (ER).

Pick-up Orders:

A pick-up order authorizes the police to take a person into protective custody and transport the person to the Emergency Room for examination. Like the petition for hospitalization, the petition for a pick-up order would normally be directly taken to the court. In urgent situations and outside court business hours, a pick-up order may be able to be obtained by a phone call to the Probate Judge, with the order being issued verbally. Outside court business hours, CMIT staff can assist in contacting the judge by phone. In urgent situations, it is sometimes appropriate to seek law enforcement intervention immediately, without first obtaining a pick-up order from the court. A law enforcement officer can, if he/she judges a person to be have a mental illness and are a danger to self or others, take a person into protective custody without a court order and transport the person to the ER for examination. However, whenever it is possible to first obtain a pick-up order, this should be done, since the order gives the officer the authority to take the person into custody regardless of how the person presents to the officer.

Obtaining Police Assistance to Hospitalize:

In some cases, a person who is being hospitalized involuntarily is already at the ER or is being transported to the ER by family or friends. In such cases, police assistance may not be required. However, in situations where there is no other way to assure that the person gets to the ER and remains there to be examined, police assistance should be sought. This is done by calling Central Dispatch (911). It is important, in such situations, to be prepared to provide Central Dispatch with as much information as possible about the person to be assessed or picked up. Clinicians should not hesitate to provide any information requested by Central Dispatch and should be prepared to assist the law enforcement officers in any way possible.

Hospitalization:

Depending on the circumstances, the clinician may need to go to the ER to complete or assist with the petition. If the clinician has already directly assessed the person and determined the need for hospitalization, the clinician may also need to complete the hospital prescreening as discussed above. The clinician should also consider providing consultation directly to the Mental Health Unit staff to assure that they have complete information about the person being admitted and about any treatment or aftercare concerns.

c) Transporting an Individual to the Mental Health Unit (refer to Administrative Manual 2-300-020 – Transporting Consumers)

The most appropriate means of transportation should be decided based on one of the following:

• No CMHCM staff supervision is required where all of the following apply:

o The person has voluntarily indicated their desire for treatment of an existing psychological condition.

o No medical supervision is or is likely to be required.

o No supervision is required to assure the continued safety of the individual or the safety of others.

o Dependable transportation is available and verification made, that individuals who have the best interest of the person in mind would provide it.

• CMHCM supervised transportation is required when:

o The person is resistant to prescribed treatments of an existing psychological condition, but cooperative and does not present a danger.

o The person requires medical observation due to the use of medications used for behavior control or the potential need for their usage, but does not require immediate medical care.

o Dependable medical transportation is required to address the medical condition and protect the safety of the individual or others.

o Serious medical issues or behavior concerns necessitate ambulance transport or a pick-up order/deputy transport.

Whenever a person who is considered a danger to self or others is being transported by staff, at least two staff should be involved in the transport and one staff person should remain with the person until the admission is completed.

d) Hospital Discharge Process: On or before discharge from an inpatient psychiatric hospital, individuals will be provided with a follow-up appointment within seven days. CMIT members or an Access Manager will be responsible to assure that an appointment is provided. If the appointment is cancelled or not kept by the consumer, the CMIT staff member or an Access Manager will follow-up in the same day to determine the reason and reschedule if appropriate.

Approved: 9/28/10

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