OAR 309-033-0940: The Investigation Report

(1) The investigator shall include in a report to the court, if relevant or available, evidence and the source of that evidence in the following areas: (a) Evidence which describes the present illness and the course of events which led to the filing of the Notice of Mental Illness (NMI) and which occurred during the investigation of the person; (b) Evidence to support or contradict the allegation that the person has a mental disorder; (c) Evidence to support or contradict the need for treatment allegation(s). (d) Any medical records that the investigator relied on to determine the presence of a mental disorder or if the PAMI has a need for treatment must be submitted with the investigation report when the investigation report is provided to the court. (2) The evidence which describes the present illness shall include: (a) The situation in which the person was found and the most recent behaviors displayed by the person which lead to and support the filing of an NMI; (b) The sequence of events affecting the person during the investigation period including dates of admission, transfer or discharge from a hospital or nonhospital facility; (c) Any change in the mental status of the person during the course of the investigation; and (d) Attempts by the investigator to engage the person in voluntary treatment in lieu of civil commitment and their outcome. (3) Documentation of mental disorder. Evidence to support or contradict the allegation that the person has a mental disorder shall include the results of a mental status examination and a psychosocial history. (a) Mental status examination. A mental status examination shall review the presence of indicators of mental disorder in the following areas: (A) Appearance. Features of the person’s dress, physical condition which may indicate the presence of a mental disorder. (B) Behavior. Features of the person’s behavior, movement or rate of speech which may indicate the presence of mental disorder. (C) Thought content. Features of the content of the person’s speech such as delusions and hallucinations which may indicate the presence of a mental disorder. (D) Thought process. Features of the person’s expressed thoughts which may indicate that the person is unable to think in a clear logical fashion and which may indicate the presence of a mental disorder. (E) Insight. Features of the person’s understanding and appreciation of his/her current mental state which may indicate the presence of a mental disorder. (F) Judgment. Features of the person’s ability to make objectively safe decisions about social situations and dangerous situations which may indicate the presence of a mental disorder. (G) Cognition. Features of the person’s ability to concentrate, ability to remember recent and historical events, ability to use abstract thinking, and ability to use or remember generally known information which may indicate the presence of a mental disorder. (H) Emotions. Features of the person’s emotions, such as being inappropriate to the situation, which may indicate the presence of a mental disorder. (b) Psychosocial History. A psychosocial history shall discuss the presence of indicators of mental disorder in the following areas: (A) Psychiatric history: (i) History of psychiatric or mental health treatment; (ii) History of commitments for mental disorder including verification from the Division if available; and (iii) Current participation in mental health treatment. (B) Family history: (i) Members of the person’s family who have a history of psychiatric or mental health treatment; (ii) Members of the person’s family who have a history of commitment for mental disorder; or (iii) Reports of family members who appear to have had an untreated mental disorder. (C) Substance use history: (i) History of alcohol or substance misuse; (ii) Behaviors which the person may have displayed during the course of the investigation, which are substantially similar to behaviors that indicate the presence of a mental disorder, that may be attributable to the use of alcohol or drugs; or (iii) If the person appears to have a mental disorder, the effect of the person’s current use of alcohol or drugs on behaviors that may indicate the presence of a mental disorder. (D) History of a loss of function. (E) Social function. (F) Personal finances: (i) Availability of financial resources to provide for basic personal needs such as food and shelter; (ii) Use of financial resources to meet needs for food and shelter; or (iii) Other features of the manner in which the person uses money which would indicate the presence of a mental disorder. (G) Medical issues: (i) Medical conditions that may produce behaviors which are substantially similar to behaviors that indicate the presence of a mental disorder; or (ii) Medical conditions which contribute to the seriousness of a mental disorder which appears to be present. (4) Documentation of one or more need for treatment. Evidence to support or contradict the need for treatment allegation(s) that the person is a danger to self, danger to others, is unable to provide for basic personal needs, or has a chronic mental illness, including, in addition to the considerations of OAR 309-033-0222: (a) A danger to self-assessment including: (A) Past and present self-harm behavior(s), and the potential and intended outcome, including death, of such behavior(s); (B) History of thoughts, plans or attempts at suicide; (C) Presence of thoughts, plans or attempts at suicide; (D) Means and ability to carry out the plans for suicide; (E) The potential lethality of the plan; (F) The probable imminence of an attempt at suicide; and (G) Available support systems which may prevent the person from acting on the plan. (b) A danger to others assessment including: (A) History of thoughts, plans, attempts or acts of assault or violence; (B) Presence of thoughts, plans, attempts or acts of assault or violence; (C) Means and ability to carry out the plans for assault or violence; (D) The potential lethality of the plan; (E) The probable imminence of an attempt at assault or violence; and (F) Available support systems which may prevent the person from attempting an assault or an act of violence. (c) An assessment of the person’s ability to provide for basic personal needs including: (A) History of the person’s ability to provide for basic personal needs; (B) The person’s current use of resources to obtain food, shelter, and health care necessary for health and safety; (C) Behaviors which may result in the person being vulnerable to danger or making others vulnerable to danger; (D) Available support systems which may provide the person care necessary for health and safety; and (E) If the person appears to be unable to care for self, the availability of a guardian or other decision-maker who can assure the provision of such care. (5) Additional report requirements. The investigation report shall also include the following: (a) The person’s consent or objection to contact with specific third parties; (b) If appropriate and if available from the Division, or as gathered by other sources in the course of the investigation, verification of the person having a chronic mental disorder; and (c) Should a hearing be recommended, the investigator’s clinical opinion on whether inpatient civil commitment or outpatient civil commitment could meet the person’s treatment needs. (6) Report availability. The investigation report shall be made available to: (a) The facility with custody of the person if the person is under civil commitment; and (b) The Authority upon request. (7) The investigation report is the record of a CMHP completing its responsibilities as outlined in its local plan and pursuant to ORS 430.630(9)(e)(M). At the conclusion of an investigation, an investigator must submit an investigation report to the court having jurisdiction of the investigation. (a) If an investigation is started, an investigation report is required. (b) If the investigator recommends a hearing in the investigation report, the investigator must file the investigation report with the circuit court at least twenty-four hours before the hearing. The investigator must appear at the civil commitment hearing for the investigation report to be entered into evidence per ORS 426.095. (c) If the investigator does not recommend a hearing in the investigation report, the investigator must file an investigation report with the circuit court within 14 calendar days of the investigated person being released from detention or the investigator having concluded the investigation, whichever is later. (d) If an investigation is ended because a valid DMHT was discovered and implemented because the person was determined to be incapable, an investigation report is still required. (e) If the PAMI agrees to and successfully completes an initial or extended diversion from commitment, an investigation report is still required to be submitted.