OAR 309-033-0222: Need for Treatment Considerations

(1) When a certified mental health investigator is making a hearing recommendation, or a certified mental health examiner is making a commitment recommendation, they must consider whether the person is a person with mental illness and is in need of treatment because the person: (a) Is a danger to self; (b) Is a danger to others; (c) Is unable to provide for basic personal needs; or (d) Has a chronic mental disorder. (2) A danger to self, danger to others, or risk of serious physical harm due to inability to provide for basic personal needs must be reasonably foreseeable in the near future but need not be imminent. (3) When a certified mental health investigator or examiner are preparing a report or testifying at a civil commitment hearing regarding the issue of whether the person is a person with mental illness and in need of treatment because they are a danger to themselves, they should consider: (a) The person’s recent overt acts causing or attempting to cause serious physical harm to self; (b) Recent acts placing the person in circumstances that resulted in or were likely to result in serious physical harm to self; (A) The person’s recent threats to cause serious physical harm to self and the severity of the harm threatened; (B) Absent treatment, the likelihood of such threats being carried out; and (C) Absent treatment, the likelihood of such threats reoccurring. (c) Any past behavior and patterns of deterioration resulting from a mental disorder that contributed to prior involuntary hospitalizations for being a danger to self, how recently the past behavior occurred and the frequency and severity of the past behavior. (4) When a certified mental health investigator or examiner are preparing a report or testifying at a civil commitment hearing regarding the issue of whether the person is a person with mental illness and in need of treatment because they are a danger to others, they should consider: (a) Recent overt acts causing or attempting to cause physical harm to another person and (A) The frequency and severity of such acts. (B) Recent destructive acts against property that were reasonably likely to place others at risk of physical harm. (b) Recent threats to cause physical harm to another person; (A) The severity of the harm threatened; (B) Absent treatment, the likelihood of such threats being carried out; and (C) Absent treatment, the likelihood of such threats reoccurring. (c) Any past behavior and patterns of deterioration resulting from a mental disorder that contributed to prior involuntary hospitalizations for being a danger to others; (A) How recently the past behavior occurred; and (B) The frequency and severity of the past behavior. (5) An inability to meet basic personal needs is demonstrated when a person, because of a mental disorder: (a) Is unable to provide for basic personal needs that are necessary to avoid reasonably foreseeable serious physical harm in the near future; and (b) Is not receiving such care that would be necessary to avoid serious physical harm, or for persons under a court commitment or other involuntary program for mental health treatment, it is reasonably foreseeable that the person will not, upon release, receive such care that would be necessary to avoid serious physical harm. (6) A chronic mental disorder is demonstrated when: (a) A person has a chronic mental illness as defined in ORS 426.495; (b) Within the previous three years the person has been placed, at least twice, in a hospital or an approved inpatient unit as directed by the Authority or a CMHP director under ORS 426.060. (c) The person is exhibiting symptoms or behaviors substantially similar to those that preceded and led to one or more of the placements; and (d) To a reasonable medical probability, the person will, without treatment, continue to deteriorate physically or mentally so that the person will become a danger to self, a danger to others, or be unable to provide for the person’s basic personal needs. (7) Certified mental health investigators and certified mental health examiners, when determining whether a person is in need of treatment because the person is a danger to self or a danger to others, are to consider: (a) The person’s insight into their psychiatric needs and current circumstances; (b) The person’s ability to, with their level of insight, follow a treatment plan; and (c) How likely the person may become a danger to self, danger to others, or unable to provide for basic personal needs without sufficient and available mental health treatment. (8) A need for assisted outpatient treatment (AOT) is demonstrated when: (a) A person is at least 18 years old (b) Has a mental disorder (c) Cannot provide informed consent for mental health treatment, and (d) Will not access mental health treatment on a voluntary basis and as a result: (A) Is unable to safely live in the community without mental health treatment; and (B) Must receive mental health treatment to prevent further deterioration or becoming a person who is a danger to self, is a danger to others, is unable to provide for basic personal needs, or has a chronic mental disorder. (e) When determining whether a person has a need for AOT, a certified civil commitment investigator or a certified mental health examiner may consider: (A) The person’s ability to access finances in order to get food or medicine. (B) The person’s ability to obtain treatment for the person’s medical condition. (C) The person’s ability to access necessary resources in the community without assistance. (D) The degree to which there are risks to the person’s safety. (E) The likelihood that the person will decompensate without immediate care or treatment. (F) The person’s previous attempts to inflict physical injury on self or others. (G) The person’s history of mental health treatment in the community. (H) The person’s patterns of decompensation in the past. (I) The person’s risk of being victimized or harmed by others. (J) The person’s access to the means to inflict harm on self or others. (f) The person’s history of accessing and engagement in mental health treatment in the community, including previous patterns of decompensation and the likelihood that the person will decompensate without immediate care or treatment.