SOP_NUMBER: 508.26-att-5 TITLE: Mental Health Due Process Committee Involuntary Medication Review REFERENCE_CODE: VG66-0001 DIVISION: Mental Health Administration TOPIC_AREA: 508 Policy - Mental Health Administration/Staff/Certification EFFECTIVE_DATE: 2023-08-08 WORD_COUNT: 432 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/290547 URL: https://gps.press/sop-data/508.26-att-5/ 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 ATTACHMENTS: 1. Involuntary Medication Order Check Sheet URL: https://gps.press/sop-data/508.26-att-1/ 2. Physician Opinion for Involuntary Medication URL: https://gps.press/sop-data/508.26-att-2/ 3. Notification of Involuntary Medication Due Process Committee Hearing URL: https://gps.press/sop-data/508.26-att-3/ 4. Involuntary Medication Rights of Offender URL: https://gps.press/sop-data/508.26-att-4/ 5. Mental Health Due Process Committee Involuntary Medication Review URL: https://gps.press/sop-data/508.26-att-5/ 6. Involuntary Medication Hearing Log URL: https://gps.press/sop-data/508.26-att-6/ 7. Notification of Involuntary Medication Due Process Committee Decision URL: https://gps.press/sop-data/508.26-att-7/ ======================================================================== 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.

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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.
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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.