SOP 508.26-att-5: Mental Health Due Process Committee Involuntary Medication Review

Division:
Mental Health Administration
Effective Date:
August 8, 2023
Reference Code:
VG66-0001
Topic Area:
508 Policy - Mental Health Administration/Staff/Certification
PowerDMS:
View on PowerDMS
Length:
432 words

Summary

This form documents the Mental Health Due Process Committee's review and decision regarding involuntary medication for inmates with mental illness. The committee evaluates whether an inmate meets one of three criteria justifying involuntary medication: imminent risk of harm to self or others, inability to care for physical health creating life-endangering crisis, or history of decompensation without medication. The form requires participation of a hearing officer, mental health committee member, medical committee member, and includes offender and state advocates.

Key Topics

  • involuntary medication
  • mental health due process
  • medication review committee
  • mental illness
  • imminent harm
  • inmate mental health
  • medication criteria
  • hearing officer
  • mental health services
  • psychotropic medication
  • forced medication
  • mental health committee

Full Text

SOP 508.26
Attachment 5

8/8/23

Mental Health Due Process Committee Involuntary Medication Review

Offender Information:

Offender Name: ________________________________ ID#: ___________________________

Referring Facility: ______________________________________________________________

Offender Advocate (Name/Title): _________________________________________________

Offender Attorney
(Name – if present): ____________________________________________________________

State's Advocate (Name/Title): ___________________________________________________

Witnesses (presenter(s) questioned):

(Name/Title): ______________________________________________________________ ___

(Name/Title): _________________________________________________________________

Committee Members:

1) Hearing Officer:

_____________________________________________________  ________________________
Signature/Title Date/Time

2) Mental Health Committee Member:

_____________________________________________________  ________________________
Signature/Title Date/Time

3) Medical Committee Member:

_____________________________________________________  ________________________
Signature/Title Date/Time

Form No. M66-01-05 Page 1 of 2

Retention Schedule: Completed forms shall be given to the medical file (original), a copy shall be given to the offender and placed in the
offender’s mental health file (section 5). At the end of the offender’s need for mental health services and/or sentence, the mental health file shall
be placed within the offender’s health record and retained for 10 years.

SOP 508.26
Attachment 5

8/8/23

|Criteria|Yes|No|
|---|---|---|
|
1. The offender has a mental illness, that is, has a disorder of thought or
mood which significantly impairs judgment, behavior, capacity to
recognize reality, or ability to cope with the ordinary demands of life
AND the offender presents a substantial risk of imminent harm to
themselves or others as manifested by recent overt acts or recent
expressed threats which present a probability of injury to themselves
or to others and requires medication.

|||
|
2. The offender has a mental illness, that is, has a disorder of thought or
mood which significantly impairs judgment, behavior, capacity to
recognize reality, or ability to cope with the ordinary demands of life
AND the offender is unable to care for their own physical health and
safety as to create an imminently life endangering crisis and requires
medication.
|||
|
3. The offender has a mental illness, that is, has a disorder of thought or
mood which significantly impairs judgment, behavior, capacity to
recognize reality, or ability to cope with the ordinary demands of life
AND by history will decompensate to present a substantial risk of
imminent harm to themselves or others or will decompensate, by
history, without medication to a point where they would be incapable
of participating in any treatment plan which would give them a
realistic opportunity to improve their condition and requires
medication.
|||

Document Committee Reasons for the above decisions:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Note: _If any one of the criteria above is marked yes, then involuntary medication is justified._

_____________________________________________________  ________________________
Hearing Officer Signature Date

Form No. M66-01-05 Page 2 of 2

Retention Schedule: Completed forms shall be given to the medical file (original), a copy shall be given to the offender and placed in the
offender’s mental health file (section 5). At the end of the offender’s need for mental health services and/or sentence, the mental health file shall
be placed within the offender’s health record and retained for 10 years.

Attachments (7)

  1. Involuntary Medication Order Check Sheet (415 words)
  2. Physician Opinion for Involuntary Medication (70 words)
  3. Notification of Involuntary Medication Due Process Committee Hearing (291 words)
  4. Involuntary Medication Rights of Offender (574 words)
  5. Mental Health Due Process Committee Involuntary Medication Review (432 words)
  6. Involuntary Medication Hearing Log (54 words)
  7. Notification of Involuntary Medication Due Process Committee Decision (195 words)
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