Cal. Code Regs. Tit. 15, § 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.
Notes
Note: Authority cited: Section 5058, Penal Code. Reference: Sections 2600 and 2602, Penal Code.
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