Section He-M 609.06 - Revocation of Conditional Discharge(a) Pursuant to RSA 135-C:51, a psychiatrist, APRN, or PA at a CMHP or THPS providing continuing treatment on an outpatient basis to a person conditionally discharged pursuant to RSA 135-C:50 may conduct, or cause to be conducted by a treatment team member or an emergency service staff member, an examination of the person to determine if the conditional discharge should be revoked.(b) An examination pursuant to (a) above shall only be conducted if the psychiatrist, APRN, or PA reasonably believes that:(1) The person has violated a condition of the discharge by:a. Failing or refusing to take medications prescribed by a psychiatrist, APRN, PA, or emergency physician, PA, or APRN as defined in RSA 135-C:2, II-a, to treat his or her psychiatric illness, provided that the psychiatrist, APRN, PA, or emergency physician, PA, or APRN as defined in RSA 135-C:2, II-a is on the list of physicians, PAs, and APRNs as defined in RSA 135-C:2, II-a, maintained by the commissioner pursuant to RSA 135-C:28, who are approved by either a designated receiving facility or a community mental health program approved by the commissioner, whether on behalf of a CMHP, THPS, NH Hospital, DRF, or a hospital emergency room receiving a patient who is on a conditional discharge;b. Failing or refusing to attend scheduled appointments, which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment. This shall not apply to peer support which shall be voluntary;c. Failing or refusing to communicate with the CMPH or THPS, which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment;d. Failing or refusing to immediately participate in lab screenings following a documented verbal request or written request, which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment;e. Using alcohol or other non-prescription medications/illicit drugs, to the extent it adversely affects or is likely to adversely affect the person's ability to meaningfully participate in treatment; orf. Failing to comply with a condition specifically written to address patient-specific behaviors that interfere with treatment or continued ability to live in the community; or(2) A condition or circumstance exists which might create a potentially serious likelihood of danger to the person or to others established by demonstrating that: a. The person has inflicted serious bodily injury on themselves or has attempted serious self-injury and there is a likelihood that the act or attempted act will reoccur if the conditional discharge is not revoked;b. The person has threatened to inflict serious bodily injury on themselves and there is a likelihood that an act or attempt of serious self-injury will occur if the conditional discharge is not revoked;c. The person's behavior demonstrates that they lack the capacity to care for their own welfare;d. The person is a danger to others, which is established by demonstrating that the person has inflicted, attempted to inflict, or threatened to inflict seriously bodily harm on another; ore. The person's mental status has deteriorated from the person's usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given.(c) Before an examination is conducted, the CMHP or THPS shall prepare a written notice identifying the belief, and the reasons therefor, that a violation of the conditional discharge has occurred to include the following:(1) How the violation interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment;(2) Any other circumstances or conditions exist which might create a potentially serious likelihood of danger to the person or to others; and(3) How the person's mental health status has deteriorated from the person's usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given.(d) Pursuant to RSA 135-C:51, I(b), a CMHP or THPS representative shall offer and explain the written notice to the person prior to the examination provided such notice can be provided safely, without significant possibility of bodily harm.(e) If it is unsafe to provide and explain the written notice to the person, a description of the circumstances indicating such risk shall be placed in the file.(f) The CMHP or THPS shall make a reasonable effort to locate the person, if they are not immediately available.(g) If the person cannot be located or if consent to an examination cannot be obtained, the psychiatrist or other representative of the CMHP or THPS may sign a complaint to compel examination.(h) Upon issuance of such a complaint, any law enforcement officer shall take custody of the person and immediately deliver him or her to the place specified in the complaint.(i) Following the examination, the psychiatrist, APRN, or PA may temporarily revoke the conditional discharge if they find that:(1) The person has either violated a condition of the discharge which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment;(2) The person is in such a mental condition as a result of a mental illness as to create a potentially serious likelihood of danger to himself or herself or to others; or(3) The person's mental status has deteriorated from their usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given.(j) If the conditional discharge is temporarily revoked then: (1) The psychiatrist, APRN, or PA, or his or her designee, shall prepare, offer and explain to the person a written notice giving the reasons for the revocation so long as is can be done safely, without significant possibility of bodily harm. If this cannot be done safely, a description of the circumstances indicating such risk shall be placed in the file; and(2) The written notice shall include the name of the receiving facility to which the person is to be transported upon the facility location being identified. The person shall not be transported to the facility without having received a verbal and written notification identifying the facility to which the person is being transported.(k) A law enforcement officer or ambulance personnel shall take custody of the person whose conditional discharge has been temporarily revoked and shall deliver him or her, together with a copy of the notice, to the receiving facility identified by the psychiatrist, APRN, or PA.(l) The administrator of the facility to which a person has been returned, or his or her designee, shall: (1) Personally examine such person;(2) Review the reasons for temporary revocation of the conditional discharge so long as it can be done safely, without significant possibility of bodily harm. If this cannot be done safely, a description of the circumstances indicating such risk shall be placed in the file; and(3) Revoke absolutely the conditional discharge if he or she finds that the person either: a. Has violated a condition of the discharge which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; orb. Is, at the time of examination, in such a mental condition as a result of mental illness as to create a potentially serious likelihood of danger to self or to others or the person's mental status has deteriorated from the person's usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given.(m) The examination, review, and determination shall be made within 72 hours, excluding Sundays and state legal holidays, of delivery of a person to a facility pursuant to (j) above.(n) If the administrator of the facility, or his or her designee, determines that an absolute revocation is warranted, he or she shall immediately prepare, offer, and explain to the person the information in a written notice of the revocation and the reasons for the revocation, and notice of the person's right to appeal and right to legal counsel as set forth in He-M 609.07 so long as it can be done safely, without significant possibility of bodily harm. If this cannot be done safely, a description of the circumstances indicating such risk shall be placed in the file.(o) Any administrator, of any facility, may absolutely revoke a person's conditional discharge, regardless of which facility initially executed the conditional discharge with the person.(p) The person shall be subject to the terms and conditions of the order of involuntary admission made pursuant to RSA 135-C:34-54 from which conditional discharge was granted as if such conditional discharge had not been granted.(q) If the administrator of the facility, or his or her designee, determines that an absolute revocation is not warranted, the facility shall return the person to the location where he or she was taken into custody.(r) If the person is returned, he or she shall then be subject to the term and provisions of conditional discharge that were in effect prior to the temporary revocation of the conditional discharge.(s) A person conditionally discharged may be admitted to a facility through an involuntary emergency admission (IEA) under RSA 135-C:27-33.(t) When a person conditionally discharged has been admitted to a facility by an IEA, the finding of probable cause for IEA by the district court shall authorize the person's admission for not longer than a 10-day period as provided in RSA 135-C:32, unless during the period of IEA the person's conditional discharge is absolutely revoked pursuant to (u) below.(u) A facility administrator shall absolutely revoke a person's conditional discharge when the person has been admitted to a facility by an IEA, so long as the revocation occurs within 10 days of the IEA physician's certification being signed, and the administrator of the facility, or his or her designee, has personally examined the individual and found that the person either: (1) Has violated a condition of the discharge which interferes with the responsibility of the CMHP or THPS to provide monitoring or treatment; or(2) Is, at the time of examination, in such a mental condition as a result of mental illness as to create a potentially serious likelihood of danger to self or others or the person's mental status has deteriorated from the person's usual mental status, such that the person is exhibiting an exacerbation of psychiatric symptoms that potentially endanger self or others, lead to severe self-neglect, or lead to a failure to function in a less restrictive environment, and the likelihood of stabilizing and reversing such deterioration would be substantially improved if treatment were to be given.(v) If a conditional discharge is absolutely revoked pursuant to (u) above, the administrator, or his or her designee, shall first prepare, offer, and explain to the person, if it can be done safely without significant possibility of bodily harm, a written notice of the revocation and the reasons therefor and notice of the person's right to appeal and right to legal counsel as set forth in He-M 609.07.(w) If the written notice in (v) above cannot be explained in person safely, a description of the circumstances indicating such risk shall be placed in the file within 24 hours of the patient receiving notice of absolute revocation of his or her conditional discharge and the right to appeal such revocation, or of the patient requesting an appeal of the absolute revocation, whichever comes first.(x) New Hampshire Hospital (NHH) shall send written notice as required by (v) above by first-class mail, fax, email, or other written or electronic methods to the patient's guardian.(y) NHH shall make a good-faith effort to reach the guardian to provide oral notice of the patient's absolute revocation, right to an appeal, and, as applicable, the patient's decision to request an appeal.(z) If a conditional discharge is absolutely revoked, in addition to the notice given in (v) above, the department shall:(1) Provide legal counsel who are not directly employed by the department, and who contract with the department to represent persons for involuntary emergency admission proceedings at no cost to the person;(2) Provide patient contact information to the assigned private attorney in order for the attorney to: a. Meet with the person, and the person's guardian if he or she requests, to discuss the implications of the person's initial decision not to appeal the absolute revocation and the avenues of legal recourse available to the person, including an appeal, and either: 1. Obtain a written waiver of appeal signed by the person; or2. Notify the department of the person's final decision to appeal the absolute revocation so that the matter may be referred to the administrative appeals unit and scheduled for a hearing;(3) Provide legal counsel from a list of private attorneys, maintained by the department's bureau of behavioral health who are not directly employed by the department, and who contract with the department to represent persons in administrative appeals hearings at no cost to the person if: a. The person appeals the absolute revocation; orb. The person's guardian or the guardian's attorney appeals the absolute revocation of the conditional discharge; and(4) Provide notice to the person's guardian, if any, of the person's decision to waive or exercise his or her option to appeal the absolute revocation of the conditional discharge and provide the guardian with an opportunity to participate in the hearing with or without his or her attorney of choice.(aa) If the written notices of revocation as referenced in (d), (j), (n), and (v) above cannot be offered to and explained to the person safely without significant possibility of bodily harm, a description of the circumstances indicating such risk shall be provided to the person's guardian, if any, and placed in the person's file for each notice.N.H. Admin. Code § He-M 609.06
#2748, eff 6-14-84; ss by #4205, eff 1-15-87; ss by #4810, eff 5-1-90; ss by #5554 eff 1-15-93, EXPIRED: 1-15-99
New. #7228, eff 3-31-00; amd by #7627, eff 2-1-02; ss by #9113, INTERIM, eff 3-25-08, EXPIRES: 9-21-08; ss by #9240, eff 8-23-08; ss by #10386, eff 7-24-13
Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12014, Effective 10/25/2016, Expires 10/25/2026.Amended by Volume XLI Number 36, Filed September 9, 2021, Proposed by #13250, Effective 8/6/2021, Expires 2/2/2022 (EMERGENCY).Amended by Volume XLII Number 6, Filed February 10, 2022, Proposed by #13332, Effective 1/25/2022, Expires 1/25/2032.