Interstate Compact on Mental Health

1
Interstate Compact onMental Health

• Bonnie Lee
• Legal Issues Coordinator
• State Operated Services
• Scottsdale, Arizona

2
HISTORY

• Residency determined treatment and financial
  responsibility.
• Residency strictly defined by court decisions and
  statutory provisions.

3
HISTORY

• Persons often ineligible for treatment if not a
  resident or citizen.
• Families often separated during treatment and
  aftercare.

4
HISTORY

• Persons immediately transferred to state of
  residency, even if no ongoing connections to
  state of origin.
• Improved patients unable to be discharged to
  states where family lived.

5
HISTORY

• 1955-The start of change.
• Governors Conference recommended further
  meetings to discuss treatment of persons with
  mental illness.
• Representatives from New York, New Jersey,
  Connecticut, Pennsylvania met in April, 1955.

6
HISTORY

• Meeting Intent Each state would agree to accept
  transfer of any residents hospitalized in another
  state.
• Legal Difficulties immediately identified.

7
HISTORY

• No common denominator of residence and settlement
  among the four states which governed hospital
  admissions.
• CT. delegation suggested the emphasis on
  residency inconsistent with modern health care of
  the day.

8
New Approach

• Focus on clinical needs of the patient.
• Focus on interstate cooperation.
• Require minimum dependency on legal definitions
  of residency.

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Recommendation

• Recommendations made to the NE State Government
  Conference on Mental Health held in Wilmington,
  Delaware.
• Pursue development of Interstate Compact.

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Council of State Government

• Several drafts and two meetings later language
  approved.
• A resolution adopted and Council of State
  Government asked to establish a ten state
  committee to draft a compact.

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Resulting Recommendation

• September,1955, at a meeting in Burlington,
  Vermont, compact language approved by NE State
  Government Conference on Mental Health.
• Strong resolution urging early consideration and
  action in the NE and other parts of the country.

12
Ratification

• Iowa 1970
• Kansas 1967
• Kentucky 1958
• Louisiana 1958
• Maine 1957
• Maryland 1962
• Massachusetts 1956
• Michigan 1974
• Minnesota 1957
• Missouri 1959
• Montana 1971
• Nebraska 1969
• New Hampshire 1957

• Alabama 1975
• Alaska 1957
• Arkansas 1959
• Colorado 1965
• Connecticut 1955
• Delaware 1962
• District of Columbia
• Florida 1971
• Georgia 1973
• Hawaii 1967
• Idaho 1961
• Illinois 1965
• Indiana 1959

13
Ratification

• New Jersey 1956
• New Mexico 1969
• New York 1956
• North Carolina 1959
• North Dakota 1963
• Ohio 1959
• Oklahoma 1959
• Oregon 1957
• Pennsylvania 1961
• Rhode Island 1957

• South Carolina 1959
• South Dakota 1959
• Tennessee 1971
• Texas 1969
• Utah 1989
• Vermont 1959
• Washington 1965
• West Virginia 1957
• Wisconsin 1966
• Wyoming 1969

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Membership

• By 1968, 36 states were members.
• Today, 45 States and the District of Columbia are
  members.

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NON MEMBER STATES

• Arizona
• California
• Nevada
• Mississippi
• Virginia

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Provisions of the Compact

• Consists of 14 Articles.
• A person who is physically present in a party
  state is eligible for treatment, regardless of
  residency or citizenship.
• Treatment benefits patients, families, and
  society.

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COMPACT ARTICLES

• Controlling factors are community safety and
  availability of services.
• Defines key phrases used within the compact.

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Provisions of the Compact

• Criteria for transfer. Is the care and treatment
  of the patient facilitated or improved.
• Assessment of clinical needs.
• Location of the patients family.
• Character and duration of the illness.
• Other factors as deemed appropriate.

19
Provisions of the Compact

• Transfer requires approval of the receiving
  state.
• A member state is not obligated to accept a
  patient for transfer.

20
Provisions of the Compact

• Transferred patients have the same rights in the
  receiving state as local patients.
• Order of admission
• Financial
• Social Service

21
Provisions of the Compact

• Provides for aftercare when it is in the best
  interest of the patient and public safety will
  not be jeopardized.
• Referral and evaluation process is the same.

22
Provisions of the Compact

• Provides authority for member states to transport
  patients across state lines when transfer occurs
  in accordance with compact provisions.
• Sending state pays cost of transfer, unless other
  arrangements are made.

23
Provisions of the Compact

• A person may be considered a patient at only one
  facility. Current practice is to obtain a new
  commitment order.
• Provides for the return of committed patients on
  an unauthorized absence.

24
Provisions of the Compact

• The compact is not intended to affect duties and
  responsibilities of a guardian in any way.
• Requires appointment of a compact administrator.

25
Exemptions

• Does not apply to criminally insane.
• Does not apply to persons subject to a criminal
  charge.
• Does not apply to persons with chemical
  dependency as a primary diagnosis.

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Issues

• The language of the compact was drafted in 1955.
• Generally agreed that to amend and update the
  language and have states repeal existing language
  and pass new language not realistic.

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ISSUES

• Amending requires rewrite of original compact.
• Need consensus on what needs to be amended.
• Financial considerations.

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Where does this leave us?

• The compact was a voluntary effort to solve a
  serious problem of providing services to persons
  with mental illness or mental retardation at a
  time when there were fewer concerns and laws
  about patient rights.
• The compact established a cooperative process
  among states to provide care and treatment to the
  benefit of patients and their families.

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Why it works

• Annual conference.
• Adoption of uniform procedures and forms by the
  ICC members.
• Regular review, training, networking, and
  communication.
• Establish best practice guidelines.

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Challenges

• No appeal process.
• Cultural competency.
• Limited English proficiency.
• Registered Predatory Offenders.

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Challenges

• Status of patients civilly committed as a sex
  offender.
• Returning committed patients on an unauthorized
  absence. Including committed sex offenders.

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And More !

• Patients with special medical needs.
• Impact of shorter length of stays.
• Impact of decreasing state operated beds and
  movement to community based programs.

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And Finally

• What makes the compact work is the dedication of
  the staff who find creative ways to work
  cooperatively, and who share a common desire to
  ensure that the best interest of the client is
  served.