Requirement Provision of Local Impatient Services-Involuntary Commitments

Subject:

Requested By: Sarah T. Morrow, M.D., M.P.H. Secretary Department of Human Resources

Question: May the Department of Human Resources require Area Mental Health, Mental Retardation, and Substance Abuse Authorities to provide inpatient services to involuntarily committed patients?

Conclusion: Yes.

In dealing with the involuntary commitment of individuals meeting the statutory standards for such commitments, G.S. 122-58.8(b) authorizes the District Court to order inpatient treatment at ". . . a mental health facility, public or private, designated or licensed by the Department of Human Resources." Clearly, mental health centers or clinics operated under the supervision of an area mental health, mental retardation and substance abuse authority come within the terminology "mental health facility." See G.S. 122-58.2(5) and (7).

The Department of Human Resources is charged with the responsibility of establishing community based programs of mental health services in the various catchment areas in the State

(G.S. 122-35.37), with administering minimum standards and requirements as conditions of participation in Federal-State funding (G.S. 122-35.38), and with jurisdiction over all of the joint State-and community-sponsored mental health clinics (G.S. 122-1).

The Commission for Mental Health, Mental Retardation and Substance Abuse Services is responsible for the promulgation of rules and regulations regarding the operation of education, prevention, intervention, treatment, rehabilitation and other related services by area mental health, mental retardation and substance abuse authorities. See G.S. 143B-147(a)(1)b. The Department of Human Resources is required to enforce any rules and regulations so adopted. See

G.S. 143B-147(d).

10 N.C.A.C. 18A.0414 is an administrative regulation adopted by the Commission which mandates the provision of inpatient services by the area authority, as manifested by the following language:

"0414 — INPATIENT SERVICES

(a)

The area authority shall provide for community inpatient care either within the catchment/service area or in adjoining catchment/service areas.

(b)

The provision of inpatient care shall be met by one of the following:

(1)

operation of a free-standing psychiatric inpatient facility;

(2)

contact with a general hospital or a private hospital in the catchment/service area of the authority;

(3)

contract with a general hospital or a private hospital in another catchment/service area; or

(4)

contract with a regional psychiatric hospital if the area program is in close proximity to the hospital. The contract with the regional psychiatric hospital shall:

(A)

be approved by the regional director; and

(B)

specify the area program’s responsibility and the hospital’s responsibility with respect to admission, treatment and discharge of catchment/service area clients. Hospital and area program staff shall ensure compliance with the admission and commitment procedures as set forth in 10

N.C.A.C. 15A Section .0100 (Division publication APSR 45-4)."

As a result, it appears that the Department, acting under rules and regulations promulgated by the Commission, can require the provision of inpatient services by the area authorities.

Further, it should be noted that an area authority, acting with the Department of Human Resources, must develop an annual plan for providing a comprehensive program of mental health services for area residents; this plan must be approved by the Department of Human Resources before State funds are provided for the area authority. See G.S. 122-35.43. Thus, the North Carolina General Statutes appear to provide the authority for requiring local inpatient treatment for individuals involuntarily committed as well as means for the monitoring and enforcement of an equitable plan for the utilization of local inpatient facilities for this purpose.

Rufus L. Edmisten Attorney General

William F. O’Connell Special Deputy Attorney General