Support SB 2102 & HB 693 –Commitment Evaluator Expansion The Shortage of Physicians & Psychologists in MS is Problematic The Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services (HHS) designate certain areas as Health Professional Shortage Areas (HPSAs). Approximately 55 counties in MS have been designated as high Mental Health Professional Shortage Areas. The shortage of physicians and psychologists available to conduct commitment evaluations in rural MS specifically- has resulted in mentally ill citizens to being unreasonably held in jails awaiting evaluations. Allowing nurse practitioners to conduct the commitment evaluation when a physician is unavailable, and adding LCSWs and LPCs to the list of potential evaluators is the most effective way to address this access barrier that plague many of our rural counties. Statutory Time Limits on Restricting the Liberty of Persons Should not be Casually Disregarded. By law, evaluations in MS should be conducted within 48 hours (not including weekends) after the order of examination, with a possible 8 hour extension. It is inhumane to detain an individual over the statutory required time, simply because a physician or other professional is not available to evaluate them. It is a serious deprivation of individual liberty, as it is possible that the individual should not have been held (especially in a jail) in the first place. LCSW and LPCs are Qualified to Conduct Commitment Evaluations Due to their extensive clinical training and 2 years of required clinical supervision, LCSWs and LPCs possess the advanced knowledge and skills to conduct commitment evaluations. LPCs are licensed as independent practitioners who can diagnose and treat mental illness. Their extension, education, training, supervision in the field prepare them for assessment and diagnosis and treatment. Licensed Certified Social Workers (Clinical), LCSWs, are also licensed to practice independently. LCSWs are qualified to diagnose psychosocial dysfunction, disability, and impairment including emotional, mental, and behavioral disorders. LCSWs are also qualified to use the Diagnostic and Statistical Manual of Mental Disorders (DSM), the International Classification of Diseases (ICD), and other diagnostic classification systems in assessment, diagnosis, and other activities. Professionals Added as Evaluators Will be Required to Obtain Certification and Training As required by MS psychologists, the Social Work and Counseling Associations will be required to oversee a commitment certification process for their members. The training will provide assurance to the public that these professionals possess the appropriate skills in making a proper diagnosis of the presence or absence of mental illness. In addition, it will confirm their competence in understanding the civil commitment law, including the legal and ethical implications of involuntary civil commitment. The Legislation Does Not Change Current Nurse Practitioner Laws The NP conducting the evaluation will continue to collaborate with a physician, as presently required by state law. Even if a physician is not an evaluator, he/she will continue to play an active role in the commitment evaluation process through the collaborative agreement with the NP. Procedural Safeguards Protect From Arbitrary and Erroneous Commitments There have been arguments suggesting that expanding professionals who can conduct commitment evaluations would inevitably lead to erroneous commitments. First, these professionals are qualified to examine the patient and assess the need for commitment. However, there are sound procedural safeguards in place to make sure that the one commitment evaluator’s opinion is not the sole determination of a judicial commitment. First, MS requires two distinct evaluations. Second, mental health professionals are required to pre-screen the individual and determine if a commitment evaluation is warranted and appropriate. Last, the chancellor must also look all of the evidence presented and find by clear and convincing (a high standard of proof) that the person in in need of judicial commitment. Our Sister States Have Recognized Other Mental Health Professionals as Commitment Evaluators Alabama allows Licensed Medical Doctors and “Qualified Mental Health Professionals” to perform examinations. These professionals are required to have master’s degrees in psychology, social work, or counseling and are required to have a minimum of 3 years post-master’s relevant clinical experience: In Tennessee, the Mental Health Commissioner may designate a person to take any action authorized and perform any duty imposed on a physician if they complete a training program. These professionals include but are not limited to: psychological examiners, licensed master's social worker with two (2) years of mental health experience, licensed clinical social worker, marital and family therapist, nurse with a master's degree in nursing who functions as a psychiatric nurse, and professional counselor. Georgia requires that a physician perform the evaluation, but also allows any psychologist, clinical social worker, LPC, or clinical nurse specialist in psychiatric/mental health to conduct the commitment evaluation in place of the physician. Cost Efficiency Very often counties bear the costs associated with commitment evaluations. As counties struggle with fiscal challenges, they are searching for ways to humanely and cost-effectively treat and assess individuals with mental illnesses. Adding LPCs and LCSWs as evaluators will give counties more practical options while also increasing access to a greater number of professionals--without jeopardizing the quality of the commitment evaluation process. Inpatient Care Should Always Be the Last Resort We believe that the best treatment is the most clinically appropriate, least restrictive care that can be found in an individual’s community. The intent of this legislation is not to increase the number of individuals committed in the state. This legislative intent is to ensure access to timely commitment evaluations as well as getting mentally ill individuals access to the necessary supports as quickly as possible.
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