Section 3999.345 - Involuntary Medication Definitions and Criteria(a) Definitions: (1) Serious Mental Disorder means an illness or disease or condition that substantially impairs the person's thought, perception of reality, emotional process, or judgment; or grossly impairs behavior; or demonstrates evidence of an acute brain syndrome for which prompt remission, in the absence of treatment, is unlikely.(2) Danger to Others means the patient has inflicted, attempted to inflict, or made a credible threat of inflicting physical harm upon the person of another and, as a result of a serious mental disorder, the patient presents a demonstrated danger of inflicting physical harm upon others. Demonstrated danger may be based on an assessment of the patient's present mental condition, including consideration of the patient's historical course of a serious mental disorder, to determine if the patient currently presents an elevated chronic risk or an imminent risk of harming another person.(3) Danger to Self means the patient has made a credible threat or has attempted to engage in an act of self-harm and the threat is ongoing; or has threatened, attempted, or inflicted serious physical injury to self, and, as a result of a serious mental disorder, the patient presents as a demonstrated danger to self. Demonstrated danger to self may be based on an assessment of the patient's present mental condition, including consideration of the patient's historical course of a serious mental disorder, to determine if the patient currently presents an elevated chronic risk or an imminent risk to his or her own safety.(4) Gravely Disabled means that there is a substantial probability, due to a serious mental disorder and incapacity to accept or refuse psychiatric medication, that serious harm to the physical or mental health of the patient will result. Serious harm means significant psychiatric deterioration, debilitation or serious illness as a consequence of his or her inability to function in a correctional setting without the supervision or assistance of others, inability to satisfy his or her need for nourishment, and/or inability to attend to needed personal or medical care, seek shelter, and/or attend to self-protection or personal safety. The probability of harm to the physical or mental health of the patient requires evidence that the patient is presently suffering adverse effects to his or her physical or mental health, or evidence that the patient has previously suffered these effects in the historical course of his or her mental disorder and that his or her psychiatric condition is again deteriorating. The fact that a patient has a diagnosis of a mental disorder does not alone establish probability of serious harm to the physical or mental health of the patient.(5) Informed Consent means that the patient, without duress or coercion, is able to clearly give consent for the proposed psychiatric medication to the treating Psychiatrist. In order to demonstrate that a patient has given informed consent, the following criteria shall apply:A. The patient has been advised by the Psychiatrist or a Psychologist regarding the nature and seriousness of his or her mental illness or disorder, and has communicated a willingness to pursue a recommended course of treatment.B. A Psychiatrist has explained the nature of the medication to be used in the proposed treatment, including its probable frequency and duration, and the patient, using a rational thought process, has communicated his or her understanding of the fundamental meaning of the information provided.C. The Psychiatrist has stated the probable degree and duration (temporary or permanent) of improvement or remission of the patient's condition to be expected, with or without medication, and the patient has communicated a choice.D. The patient has been advised by a Psychiatrist of how the medication is thought to work and the nature, degree, duration, and probability of risk and/or side effects commonly associated with the medication. In addition, this would include advising the patient of how the medication acts to prevent, reduce, or address a particular mental health condition. The patient has communicated a basic understanding of the information provided.E. The patient has been advised by a Psychiatrist if there is a difference of opinion within community standards as to the effectiveness of the proposed medication and the patient has communicated a basic understanding of the information.F. The patient has been advised of reasonable alternative treatments, if any, and why the Psychiatrist is recommending a particular medication, and the patient has communicated a basic understanding of the information.G. The patient has been advised by a Psychiatrist of his or her right to accept or refuse the proposed medication, and of their right to revoke consent for any reason, at any time, prior to or between medications, and is able to articulate by means of a rational thought process the basis for accepting or rejecting the recommended course of treatment.H. The patient exhibits a reasonable understanding of his or her current condition and symptoms.I. The patient demonstrates capacity to consent to treatment, as defined in section 3999.98.(6) Involuntary Medication means the administration of any psychiatric medication or drug to a patient by the use of force, discipline, or restraint, including administration upon a patient who lacks capacity to accept or refuse medication. Involuntary psychiatric medications may be utilized after less restrictive non-pharmaceutical alternatives have been deemed unavailable or clinically inappropriate, or in a medical emergency. If psychiatric medication is administered during an emergency, the medication shall only be that which is required to treat the emergency condition and shall be administered for only so long as the emergency exists.(7) Psychiatric Medication means drugs or medications used in the treatment of a serious mental disorder, mental disease, or mental defect, or utilized to treat side effects caused by these medications or any medications used to augment or temper the effects of psychiatric medications. The drugs include, but are not limited to, antipsychotics, antidepressants, sedatives, or mood stabilizers, in both their short-acting and long-acting formulations.(8) Elevated Chronic Risk means the serious and persistent presentation of clinical factors that suggests an inability to adequately navigate within society or inability to effectively navigate within a structured environment such that, based on historical course of mental disorder, there is a reasonably foreseeable elevated risk of self-harm, violence, or grave disability.(9) Imminent Risk means the presence of clinical and situational factors that suggest a significant risk of violence toward others, self, or grave disability and requires immediate intervention.Cal. Code Regs. Tit. 15, § 3999.345
1. Change without regulatory effect renumbering portions of former section 3364.1 to new section 3999.345, including amendment of section and NOTE, filed 4-15-2019 pursuant to section 100, title 1, California Code of Regulations (Register 2019, No. 16). Note: Authority cited: Section 5058, Penal Code. Reference: Sections 2600 and 2602, Penal Code.
1. Change without regulatory effect renumbering portions of former section 3364.1 to new section 3999.345, including amendment of section and Note, filed 4-15-2019 pursuant to section 100, title 1, California Code of Regulations (Register 2019, No. 16).