Printer image  Print       

The Rights of People with Mental Illness in Connecticut

- Table of Contents -
 

 i  Preface

A. Inpatient Hospitals: Getting In / Getting Out
         Voluntary Admission
         Involuntary Admission
           a. Emergency Certification
           b. Civil Commitment

B. Patients' Rights
         In General
         Medication / Medical Treatment
         Restraints and Seclusion
         Discharge and Treatment Planning

C. Patients with Criminal Charges
         Voluntary Transfer
         Involuntary Transfers
         Acquittal by Reason of Mental Disease or Defect
         Incompetence to Stand Trial

D. Rights of Non-Hospitalized Individuals

E. Sources of Further Assistance


Credits:
This booklet was written by Yale law student Carl Riehl with the assistance of Attorneys Edward Mattison and Thomas Behrendt. It updates the earlier booklet, The Rights of Mental Patients in Connecticut, written by Attorney Mary F. Keller.




i. Preface

This booklet describes the legal rights of people with mental illness in Connecticut. It presents suggestions on how those rights can be protected. The laws may change or, if laws and regulations remain the same, interpretations of them by the courts and administrative officials may vary. If, After reading this booklet, you believe your rights may have been violated, you should seek legal assistance.

Being a patient in a psychiatric hospital is often a confusing experience. You may not want to stay in the hospital. You may not know why you are there or whether you want the treatment the hospital provides. This booklet will help you understand what grounds the hospital has to keep you and what rights you have while hospitalized in Connecticut. It will also help you understand how to protect your rights when you are not in the hospital.

This booklet does not provide complete legal guidance. This booklet can never replace advice from a lawyer or legal advocate whom you trust, but we hope it will help you identify those situations when you do need a lawyer or legal advocate, and those you can handle for yourself.

If you have further questions or problems, you may want too contact the groups listed under the section, " Sources of Further Assistance."

Joe Grabarz
Executive Director
Connecticut Civil Liberties Union



A. Inpatient Hospitals: Getting In / Getting Out

If you ask to be treated at an inpatient psychiatric facility, the hospital may decide to admit you. This is called Voluntary Admission ( C.G.S. 17a-506 ) ("C.G.S." refers to the Connecticut General Statutes). You may also be sent to a hospital even though you do not want to go. This can happen in two ways. a medical doctor can sign an emergency certificate if the doctor thinks you need immediate treatment. This is called Emergency Certification ( C.G.S. 17a-502 ). You may also be sent to the hospital by a judge after a hearing in probate court. This is called Civil Commitment ( C.G.S. 17a-498).

How long you can be kept in a hospital if you do not want to be there depends on whether you got there through Voluntary Admission, Emergency Certification, or Civil Commitment. Each of these is discussed separately in the next three sections. If you do not know your admission status, ask your social worker or an advocate to tell you.

If you have had any criminal charges brought against you , you may be hospitalized in ways other than those listed here. These are discussed in the " Patients with Criminal Charges" section later in this booklet.

Voluntary Admission

Q. How can I get into a hospital voluntarily?

A. You may request treatment at an inpatient psychiatric facility. It may accept you as a voluntary patient if the hospital agrees that you need treatment. The hospital may require you to sign a written request for hospital treatment. This is called a voluntary paper.

Q. How can I get out of the hospital if I am a voluntary patient?

A. If you were admitted to the hospital voluntary, you may ask to leave at any time. If you did not sign a voluntary paper, the hospital must release you when you ask to leave ( C.G.S. 17a-5066(b)).

If you did sign a voluntary paper, your request to leave must be made in writing. The hospital can keep you for 5 days ( not counting Saturdays, Sundays, and Holidays ) after you request to leave (C.G.S. 17a-506(a)). During this time the hospital may file an application for civil commitment with the probate court. The hospital may then keep you for up to 10 more days commitment with the probate court. The hospital may not continue to hold you unwilling if the probate judge rules that you do not meet the standards for civil commitment.

Involuntary Admission

   a). Emergency Certification

Q. When can a doctor send me to the hospital involuntarily?

A. You may be sent to the hospital by a medical doctor who thinks you need immediate treatment. The doctor must examine you and sign an emergency certificate. In order to send you to the hospital the doctor must certify three things:

1). You are mentally ill. This means that you have a mental or emotional condition which substantially limits your ability to function;
2). Either you are dangerous to yourself or others - this means that there is substantial risk that you will physically harm yourself or someone else) or you are "gravely disabled" - this means that you are in danger of serious harm because you cannot provide for your basic needs such as food, clothing, shelter, or safety because of mental illness;
3). You need immediate treatment for mental illness ( C.G.S. 17a-502).

The police may take you to a general hospital for examination and emergency certification if they believe you are mentally ill and meet the other requirements (C.G.S. 17a-503(a)). A psychologist may also request that the police pick you up and take you to a hospital for an examination. Anyone else who thinks you need immediate treatment, such as your family or friends, may apply to the probate court. The probate judge may then order the police to bring you before the judge to determine whether you should be examined by a doctor (C.G.S. 17a-503(b)).

Q. How long can I be kept in the hospital involuntarily under an emergency certificate?

A. When an emergency certificate is issued, a hospital may keep you for treatment against your will for up to 15 days (C.G.S. 17a-502(a)). The hospital must release you after fifteen days unless an application for civil commitment has been filed with the probate court. If a civil commitment application has been filed, the hospital may keep you for up to 15 more days until the civil commitment hearing is held in probate court (C.G.S. 17a-502(a)). The hospital may not continue to hold you involuntarily if the probate judge rules that you do not meet the standards for civil commitment ( C.G.S. 17a-502(a)).

Q. What can I do if I have been hospitalized even though I don't need to be?

A. If you are being kept in a hospital under an emergency certificate and you do not think you need to be hospitalized, you may make a written request for a hearing before the probate judge. ( However, this is not always your best choice. The next paragraph discusses another method that may get you out of the hospital sooner in some cases.) You will be given a hearing within three days of when you submit your written request (not counting Saturdays, Sundays, and holidays) (C.G.S. 17a-502(d)). You have the right to have a lawyer represent you at this hearing. If you can not afford a lawyer, the court will appoint one for you (C.G.S. 17a-502(d)). At the hearing, The judge will determine whether there is "probable cause" to conclude that you meet the requirements for emergency certification. "Probable cause" means that it is more likely than not that you meet the requirements. If the judge rules that there is not a "probable cause" , you must be released from the hospital immediately. (C.G.S. 17a-502(f)). This hearing is not the same as a civil commitment hearing. If you are not released after the probable cause hearing , the hospital still may not hold you for longer than 15 days from when you were first hospitalized without applying for civil commitment.

Another method that may get you out of the hospital sooner is to choose voluntary admission status instead of emergency certification status (C.G.S. 17a-506(a)). At the same time give the hospital written notice that you want to leave. The hospital must the request a civil commitment hearing than at a probable cause hearing. A lawyer can help you decide which of these methods is better for you. You should ask to speak to a lawyer before you decide on which method to use.

   b). Civil Commitment

Q. What is civil commitment?

A. You may be sent to the hospital by a judge following a hearing in probate court. This is called civil commitment.

Q. Who can apply to have me civilly committed?

A. If you are already in the hospital on an emergency certificate, the hospital may apply for a civil commitment hearing to keep you in the hospital. The hospital may also apply for a civil commitment hearing if you entered the hospital voluntarily, but then decided you wanted to leave. If you are not already in the hospital, any interested person may file an application with the probate court to have you civilly committed.

Q. Can I be hospitalized as soon as an application for civil commitment is filed?

A. NO. You can not be hospitalized immediately just because a civil commitment application has been filed. However, you can be forced to submit to a psychiatric examination. You must then be released until the hearing is held, unless the psychiatrist determines that you meet the standards for emergency certification (C.G.S. 17a-498d).

Q. How does the probate judge decide whether or not to commit me to the hospital?

A. After a civil commitment application has been filed, the probate judge will appoint a psychiatrist and one other physician to examine you. This examination is very important. The doctors will advise the probate judge whether or not you need to be hospitalized. It is very important for you to be polite and diplomatic to the doctors. If you are not already hospitalized and try to refuse the examination, the judge may send the police to take you to the hospital for the examination (C.G.S. 17a-498(d)). This may hurt your chances of getting a favorable report from the doctors.

After the doctors give their report to the judge, a hearing will be held. At the hearing the judge will decide whether or not you should be hospitalized, based on the doctors' reports and any testimony given at the hearing. The judge's own impressions of you are very important, so you should cooperate with the judge and your lawyer, and be polite at the hearing.

Q. What rights do I have at the civil commitment hearing?

A. You have the right to be present at your commitment hearing (C.G.S. 17a-498(f)). You have the right to be represented by a lawyer. If you can not afford a lawyer, the probate judge will appoint one for you ( C.G.S. 17a-498(a)). You(and your lawyer) have the right to ask questions of any witnesses at the hearing, including any doctors (C.G.S. 17a-498(c)). Before the hearing you have the right to look at any psychiatric records about you, including any hospital records(C.G.S. 17a-498(b)).

Q. What are the criteria for civil commitment?

A. At the civil commitment hearing, the judge will order you to be hospitalized (committed) if:

    1. You are mentally ill. This means that you have a mental or emotional condition that substantially limits your ability to function.
    2. Either you are dangerous to yourself or others - this means that there is a substantial risk that you will physically harm yourself or someone else or you are "gravely disabled" - this means that you are in danger of serious harm because you cannot provide for your basic needs such as food, clothing, shelter or safety because of your mental illness.

Few people are committed because they are dangerous to themselves or others. Most people who are committed are found to be "gravely disabled". Therefore, it is important to show the judge that you have a place to live and that you can provide for your basic needs. Make sure you tell your lawyer and the judge if you have family or friends who will let you live with them or who will help take care of you. These people are allowed to come to your hearing and testify.

Q. Can I go to the hospital voluntarily after a civil commitment application has been filed?

A. Yes. At any time before the hearing, you may choose to go to the hospital voluntarily instead of going through the hearing (C.G.S. 17a-498(e)). Your lawyer can help you decide if this would be to your advantage.

Q. How can I get a new hearing after I've been committed?

A. If you are hospitalized after a civil commitment hearing, you have the right to request a new hearing at any time (C.G.S. 17a-510). To request a new hearing, you must write to the probate court. If you cannot afford the costs of the hearing, the state will pay for at least two hearings each year. If you do not request a hearing, the probate judge will order a new psychiatric examination every year if you remain hospitalized, regardless of whether you request it. A new probate hearing will be held at least once every two years. You will not have to pay for any of these hearings or examinations. A lawyer will be appointed to represent you if you cannot afford to hire one (C.G.S 17a-498a).



B. Patients' Rights

In General

Q. What rights do I have when I am in the hospital?

A. When you are in a hospital, you do not lose any of your rights unless a particular right is taken away by a judge or by the head of the hospital. Unless a judge orders otherwise, you have the right:
       - to vote
       - to own and sell property
       - to make contracts (C.G.S. 17a-541)

Unless the head of the hospital determines that it would be medically harmful, you have the right:
       - to receive visitors ( C.G.S. 17a-547)
       - to wear your own clothing (C.G.S. 17a-548(a)
       - to keep and use personal possessions (C.G.S. 17a-548a)

If your family is unable to visit you during regular visiting hours, the head of the hospital must allow them to visit at some other time at least once a week (C.G.S. 17a-547(b)). You have the right to make and receive telephone calls unless the head of the hospital determines that it is medically harmful to you or that you have made obscene or threatening phone calls ( C.G.S 17a-546(d)-(f)).

You have the right to send and receive letters. However, if the head of the hospital receives a complaint from persons who establish that they receive threatening or harassing mail, the hospital may --after providing a reasonable opportunity for you to respond-- restrict outgoing mail to the complainant. In addition, the hospital must notify you of your right to advocacy services ( C.G.S. 17a-542).

While your in the hospital you have the right to receive treatment under a specialized treatment plan suited to your needs. The must be a discharge plan with your active participation in planning for discharge, there must be a reasonable notice to the you of an upcoming discharge, and there must be planning for appropriate aftercare for you when you leave the hospital (C.G.S. 17a-542).

You are to be treated in a humane and dignified manner: "Every patient treated in any facility for treatment of persons with a mental illness shall receive humane and dignified treatment at all times, with full respect for his personal dignity and right to privacy" (C.G.S. 17a-542).

Medication / Medical Treatment

Q. Can I be forced to take medication if I don't want to?

A. Normally, the hospital cannot make you take any medication unless you give informed consent (C.G.S 17a-543(a)). Informed consent means that you voluntarily agree to take the medication after the hospital has told you why it believes you need it, what beneficial effects and what bad effects it will likely have, whether there are other medications or treatments which could be used, what risks are if you take the medication, and what the risks are if you do not take the medication ( C.G.S. 17a-540h).

You may refuse to take a medicine, the hospital staff cannot force you to take it unless they get a court order or an independent determination that the medication is necessary. However, if there is an emergency, you can be medicated without consent (C.G.S. 17a-543b).

Q. What does the hospital have to do to get a court order?

A. To obtain a court order, the head of the hospital and two physicians must show either...

     a.)  - you are mentally ill;
           - medication is medically necessary;
           - you are incapable of giving or refusing informed consent;

or...

     b.)  - there is no less intrusive treatment;
           - your mental illness will continue if you are not given the medication;
           - without the medication you pose a direct threat of causing serious physical harm to yourself or others, and you have a history of causing such harm.
(C.G.S. 17a-543(e) and (f); C.G.S. 17a-540(1))

Q. How long is the court order in effect?

A. A court order is effective for up to 120 days as long as you remain in the hospital. But it may be extended for one additional 120 day period if you remain hospitalized and the head of the hospital applies to the probate court. If such authority is extended by the court, you are to be given prompt notice, and you have the right to request a hearing.

Q. What is an independent determination?

A. The hospital can get temporary permission (for up to 30 days) to give you medication involuntarily by getting an independent determination. An independent determinations is a decision, made at or after a hearing, whether or not you need the medication made by someone who does not work for the hospital. That person must conclude that the medication is medically necessary and, without it, your condition will rapidly deteriorate. You have the right to have an advocate to help you choose who makes the decision (the hearing officer) and to represent you in any hearing about whether you need the medication ( C.G.S. 17a-543d). If you are given medication against your will because of an independent determination, you may request a hearing in probate court to review the need for medication. This hearing must be held within 15 days after you ask for it (C.G.S. 17a-543h).

Q. What if I am found incapable of giving informed consent?

A. If a judge decides that you are incapable of giving informed consent, a medication conservator will be appointed to decide whether or not to get consent for you to take the medication. The conservator is required to take into account your willingness to take the medication, the likely benefit and dangers from it, your preferences, and your religious views.

A conservator's authority regarding medication extends only through the period of your hospitalization and ends once you leave the facility. Such authority lasts for 120 days, but can be extended for one additional 120 day period if you remain in the hospital, if the head of the hospital applies to the probate court. If the court does extend such authority, you are to be given prompt notice, and you have the right to request a hearing. Conservators have no legal authority regarding consent to medications for the treatment of mental illness outside an inpatient hospital facility (C.G.S. 17a-543e).

Q. Can I be given surgery or other medical treatment without my consent?

A. Ordinarily, you cannot be given surgery or medical treatment while you are a patient in a mental hospital unless you given written informed consent. If a conservator has been appointed for you by a probate court, the conservator must give written consent before an operation may be performed. If medical treatment is needed in an emergency and you cannot consent ( because you are unconscious, for example) the treatment can be given. However, the doctor must get written informed consent from your guardian, your nearest family member, or a physician appointed by the probate court unless getting this consent would cause a harmful delay (C.G.S. 17a-543b).

Q. Can I be given shock treatment or psycho surgery without my consent?

A. You cannot be given shock treatment or psycho surgery without your consent, unless the head of the hospital and two physicians determine that you are unable to give informed consent and they get an order from the probate court allowing the treatment (C.G.S. 17a-543c). If you are receiving treatment voluntarily, you may change your mind at ant time and revoke consent. When you revoke consent, you cannot be given any more shock treatments or psycho surgery.

Restraints and Seclusion

Q. Can the hospital keep me in restraints or seclusion?

A. You may not be put in restraints or seclusion unless you would hurt yourself or someone else if restraints or seclusion were not used. Only a doctor can order restraints or seclusion (C.G.S. 17a-544) If you are placed in restraints or seclusion in a public psychiatric hospital, a staff member must check on your condition every fifteen minutes. In a public hospital, you cannot be kept in seclusion or restraints for more than three hours unless a doctor re-approves the seclusion or restraints.

Discharge and Treatment Planning

Q. Will the hospital help me plan what to do when I am discharged?

A. Before you are released, the hospital staff must work with you to develop a discharge plan (C.G.S. 17a-542) . The hospital must let you know in advance that you are going to be discharged and help you plan what you will do when you are discharged and what kind of aftercare will be available to you.

Every patient must have an individualized treatment plan and has the right to active participation in the development of discharge and treatment plans (C.G.S. 17a-542).



C. Patients with Criminal Charges

Most patients at the hospital who have had criminal charges brought against them have been admitted in one of four ways:

Voluntary Transfer - Some patients are voluntarily transferred to the hospital from prison or jail (C.G.S. 17a-513).
Involuntary Transfer - Some patients are sent to the hospital from jail or prison because they need immediate treatment. They are in the hospital for emergency care only ( C.G.S. 17a-514).
Acquittal by Reason of Mental Disease or Defect - Some patients have been acquitted of crimes and sent to a hospital because they were mentally ill at the time the offense was committed ( C.G.S. 17a-582).
Incompetence to Stand Trial - Some patients are sent to the hospital because they have been declared incompetent to stand trial (C.G.S. 54-56d)

It is important that you know why you were sent to the hospital. If you do not know, ask your social worker, advocate, or attorney to tell you.

Voluntary Transfer

Q. If I'm in jail or prison, can I go to the hospital voluntarily?

A. If you are in jail or prison you may ask to be transferred to an inpatient psychiatric hospital for observation or treatment. The hospital will accept you only if a doctor chosen by the Commissioner of Correction states in writing that you are in need of hospitalization (C.G.S. 17a-513).

Q. If I've been voluntarily transferred, how long can I be kept in the hospital if I want to go back to the jail or prison?

A. You may not be kept at the hospital for more than ten days after you have asked in writing to return to prison or jail unless the hospital tries to commit you. You can be committed only after a commitment hearing in probate court. This hearing is the same as the civil commitment hearing for people who do not face criminal charges. If you are committed to the hospital as a result of the hearing, you must remain there. If the probate court does not commit you, you will be returned to jail or prison (C.G.S. 17a-515).

Involuntary Transfer

Q. If I am in jail or prison, can I be sent to a psychiatric hospital against my will?

A. A prisoner can be sent to a hospital for 15 days under an emergency order signed by a doctor.

If you are involuntarily transferred from jail or prison, the hospital may not keep you after you receive emergency care unless you have been committed by probate court in a commitment hearing which is the same as the civil commitment hearing for people who do not face criminal charges.

Patients charged with crimes, unlike other emergency patients, have no right to probable cause hearing before the commitment hearing in probate court.

Another difference is that, although the hospital may keep other emergency patients for a total of thirty days while preparing for a probate hearing, they may keep involuntary patients from jail or prison for up to forty-five days (C.G.S. 17a-514).

If an involuntary patient from prison or jail is not committed by the probate court, she or he will be returned to jail or prison (C.G.S. 17a-514).

Acquittal by Reason of Mental Disease or Defect

Q. How does the judge decide whether or not to send me to the hospital if I am acquitted of a crime by reason of mental disease or defect?

A. If you have been acquitted of a crime because you were mentally ill at the time of the offense, the court may send you to the hospital to determine whether you are mentally ill to the extent that your discharge or conditional release would constitute a danger to society (C.G.S 17a-582a). You may have a psychiatrist of your choice examine you during this period (C.G.S. 17a-582c).

If the court finds you are dangerous to society, you will be confined to the hospital for a period of time set by the judge. This period of time may not be longer than the longest sentence that the court could have given you if you had been convicted of the crime charged ( C.G.S. 17a-593c).

Q. Do I have the right to a lawyer at commitment hearings when I have been acquitted of a crime by reason of mental disease or defect?

A. Yes. At any of these court hearings you have the right to be present and to have a lawyer represent you. If you cannot afford a lawyer, the court will appoint one for you( C.G.S. 17a-598). You may also have an independent psychiatrist testify at your hearing.

Q. If I am acquitted by reason of mental disease or defect will I spend less time in the mental hospital than I would spend in jail if I were convicted?

A. In most cases, acquittal by reason of mental disease or defect will be worse for you than conviction. Usually you will spend more time in a psychiatric hospital than you would spend in jail if you were convicted. If you are facing criminal charges and you believe you need psychiatric treatment, you can request a voluntary transfer to a psychiatric hospital after you are convicted. You should discuss your options with your criminal defense lawyer.

Q. What rights do I have if I am committed to the Psychiatric Security Review Board?

A. Under the Consent Decree in the federal case of Roe vs.. Hogan, you have the right to an individualized treatment plan which limits your freedom only as required by the risk of harm to yourself and others.

Incompetence to Stand Trial

If you have been declared incompetent to stand trial the court may send you to the hospital until you are competent to stand trial (C.G.S. 54-56d).

Q. How long can I be kept in the hospital if I am incompetent to stand trial?

A. If you have been charged with a crime or crimes for which the maximum sentence is shorter than eighteen months, you may be kept in the hospital for as long as the maximum possible sentence. If the maximum sentence is longer than eighteen months, you may only be kept in the hospital for eighteen months (C.G.S. 54-56d,i,1).

Q. Can I be committed to the hospital if I remain incompetent to stand trial?

A. If you have not became competent to stand trial during your confinement at the hospital, the hospital must apply to a probate court to have you committed to the hospital (C.G.S. 54-56d(M)). This civil commitment hearing is described earlier in this booklet. If the court commits you, you will be sent back to the hospital as a civilly committed patient. If you are not committed to the hospital by probate court, you will be released. However, until the statute of limitations for the alleged time expires, you may be re-arrested for the crime if the prosecutor thinks you are competent to stand trial.



D. Rights of Non-Hospitalized Individuals

Q. What rights do I have when I am not in the hospital?

A. You have the same rights as anyone else. You cannot be denied employment, housing, civil service rank, any license or permit, or any other right just because you have a psychiatric disability or because you have been in a hospital (C.G.S. 17a-549(a); Conn. Const. art.I, 20). If you believe your rights have been violated because of a current or prior psychiatric disability or because you have been in a psychiatric facility, you should contact the Office of Protection and Advocacy for Persons with Disabilities or the Connecticut Legal Rights Project.

Q. Can I choose someone to make decisions about medications, health care, and finances for me if I am found incompetent to make these decisions?

A. If you believe you may be hospitalized and you are concerned about being forced to take medication or otherwise losing the ability to make treatment decisions, you may make an advance directive for mental health care agent to act on your behalf if you become incompetent. Your wishes as stated in the advance directive should be followed. Foe more information on advance directives and for forms and instructions, you may contact the Connecticut Legal Rights Project or Office of Protection and advocacy (addresses below).

You can also apply to the probate court for voluntary appointment of conservator (C.G.S. 45a-646). There are three types of conservators. A conservator of the estate is someone who manages your money and financial affairs. A conservator of the person is someone who can make decisions for you about your personal care. For example, a conservator of the person would decide whether or not to consent to your having surgical or medical treatment performed. A medication conservator (C.G.S. 17a-543(e)) will decide if you have to take medication for a mental illness(when you are hospitalized) even if you do not want it. Requesting appointment of a conservator is a serious decision. If a conservator is appointed, you will give up control over important decisions. However, these decisions will be made by someone you have chosen if you have voluntarily requested a conservator or indicated your preference in advance directive. If you do not have a conservator and the court finds that you are incompetent (in a hearing about involuntary medication, for example) the judge will appoint a conservator for you (C.G.S. 45a-650d). If you voluntarily request a conservator, you should choose someone who knows you well and whom you trust. You should talk to this person in advance directive about what decisions you want him or her to make and make sure that he or she will do what you want. This advice also applies to the selection of a health care agent named in an advance directive.

If you have appointed a health care agent, signed an advance directive or executed a living will, and you are determined to be incompetent, your wishes as you have stated them should be followed. If you would like more information about these documents, ask your advocate or lawyer.



E. Sources of Further Assistance

Connecticut Legal Rights Project:
    Connecticut Legal Rights Project
    P.O. Box 351, Silver St.
    Middletown, CT 06457
    (860) 262-5030     Toll Free in CT: 1-877-402-2299

Office of Protection and Advocacy for Persons with Disabilities:
    60B Weston St.
    Hartford, CT 06120
    1-800-842-7303

Statewide Legal Services:  1-800-453-3320
 
 

Print | Top of Page | Previous Page