Bill > S322

Introduced Session

This bill would amend and supplement the law to improve the suicide assessment, response, and treatment system in the State and strengthen the obligations of health care providers, law enforcement officers, and insurers with respect to suicide prevention, response, and care. The bill would provide, in particular, for each psychiatric facility, each outpatient mental health treatment provider, and each suicide or crisis hotline operating in the State to have specially trained suicide prevention counselors on staff, during all hours of operation, to assess patients' suicide risk and provide suicide prevention counseling to patients who are deemed to be at risk of suicide. The bill would further require the attending physician at a hospital emergency department to have an on-site suicide prevention counselor assess and provide assistance to any emergency room patient who is or may be suicidal, and it would additionally provide for the governing body of each county to appoint a local suicide prevention response coordinator, who will be responsible for deploying at least one qualified and locally available suicide prevention counselor to assist law enforcement at any emergency scene involving a person who is or may be suicidal. Finally, the bill would require all health insurance carriers to provide coverage for the costs that are associated with the suicide prevention assessments performed and counseling services rendered pursuant to the bill's provisions. The bill provides for suicide prevention counselors to perform a formal suicide risk assessment of a patient at the following times: 1) immediately upon a patient's initial admission to a psychiatric facility or upon a patient's first clinical encounter with an outpatient treatment provider; 2) whenever there is reason for attending staff at a psychiatric facility or outpatient treatment provider to believe that a patient is developing new suicidal ideations, behaviors, or tendencies while under the care of the facility or provider; 3) within three days prior to the discharge of an apparently non-suicidal patient from inpatient care; and 4) whenever a suicide prevention counselor is called to assess a patient in a hospital emergency department or at the scene of an emergency, as provided by the bill. Each suicide risk assessment conducted under the bill is to be performed using a standardized tool, methodology, or framework, and is to be based on data obtained from the patient, as well as pertinent observations made by the attending clinician, assigned suicide prevention counselors, and other staff members having direct contact with the patient, and, to the extent practicable, any other information about the patient's history, the patient's past, recent, and present suicidal ideation and behavior, and the factors contributing thereto that is available from all other relevant sources, including outside treatment professionals, caseworkers, caregivers, family members, guardians, and any other persons who are significant in the patient's life. The suicide risk assessment is to include an evaluation of the patient's current living situation, housing status, existing support systems, and close relationships, and is to indicate whether there is any evidence that the patient is being subjected to abuse, neglect, exploitation, or undue influence by family members, caregivers, or other persons. The results of a patient's suicide risk assessment and notes regarding the progress of suicide prevention counseling provided to an at-risk patient are to be documented in the patient's health record. The bill further specifies that any counseling and treatment provided to address an at-risk patient's suicidal ideations, behaviors, or tendencies is to be supplemental to any other treatment that is received by the patient for the patient's other mental health issues. If a suicide prevention counselor, when assessing a patient outside of an inpatient psychiatric setting, determines that inpatient treatment may be necessary to address an at-risk patient's suicidal ideations, behaviors, or tendencies, the counselor will be required to either effectuate the voluntary admission and warm hand-off of the at-risk patient to an inpatient psychiatric facility or, if the patient refuses voluntary inpatient admission, effectuate a warm hand-off of the patient to a screening service or mental health screener to determine whether involuntary commitment to treatment is warranted. In cases where the counselor is providing on-site assistance at an emergency scene or in a hospital's emergency department, the on-scene law enforcement officers or attending physician may assist in the warm hand-off of the patient for these purposes. For any at-risk patient remaining in outpatient care, suicide prevention counselors at the outpatient treatment provider will be required to reengage and provide individualized, one-on-one counseling to each such patient, commensurate with the results of the patient's suicide risk assessment, whenever the patient has a subsequent clinical encounter with the outpatient treatment provider. The bill provides that, whenever a law enforcement officer is dispatched in response to a request for emergency services that involves a person who is or may be suicidal, the police dispatcher will be responsible for notifying the local suicide prevention response coordinator, appointed by the county's governing body under the bill, and the suicide prevention response coordinator will be responsible for ensuring the contemporaneous deployment of a suicide prevention counselor to the scene of the emergency. A 9-1-1 call-taker is to determine whether each request for emergency services involves a person who is or may be suicidal, and the bill provides for call-takers to undergo training to enable them to make this determination. Upon deployment to an emergency scene, a suicide prevention counselor will be required to: 1) provide assistance to law enforcement on the scene, as may be necessary to facilitate the non-violent de-escalation of the emergency situation; 2) perform an on-site suicide risk assessment of the person in crisis; and 3) immediately use warm hand-offs and the assistance of law enforcement, as needed, to link the at-risk person to appropriate treatment facilities, programs, and services, including voluntary or involuntary inpatient treatment, where warranted. Under the bill's provisions, each county and municipal law enforcement officer in the State will be required to complete at least two hours of in-service training in identifying the signs of mental illness and appropriate response techniques to be followed when interacting with a person who is or may be suicidal. The training is required to include: (1) the importance of approaching a suicidal person in a calm, gentle, and respectful manner; (2) the importance of avoiding the use of unnecessary force and the importance of using verbal methods of communication and other non-violent means to de-escalate an emergency situation involving a person who is or may be suicidal; and (3) specific techniques, means, and methods, consistent with the principles identified in the bill, that are to be employed by law enforcement officers when approaching, communicating with, engaging in physical contact or the use of force with, and de-escalating a situation involving, a person who is or may be suicidal. The in-service training is also to include simulated role-playing scenarios, which will allow trainees to demonstrate their ability to effectively interact with, and de-escalate emergency situations involving, a person who is or may be suicidal. The bill would require each inpatient psychiatric facility and each outpatient mental health treatment provider to establish policies and protocols to provide for the effective, compassionate, and responsible discharge of at-risk patients from care and the smooth transition of at-risk patients through the continuum of care using warm hand-offs, rapid referrals, and supportive contacts. Each outpatient provider will additionally be required to adopt policies and protocols providing for the warm hand-off of an at-risk patient to an inpatient psychiatric facility or to a screening service or mental health screener, as appropriate, in any case where the patient's suicide prevention counselor or attending clinician has reason to believe that the patient may require voluntary or involuntary commitment to inpatient treatment to address the patient's suicidal ideations, behaviors, and tendencies or associated mental health issues. The bill authorizes a facility or provider to enter into contracts or memoranda of understanding with outside organizations, including local crisis centers and other psychiatric facilities and providers, in order to facilitate the smooth and effective care transition of at-risk patients as provided by the bill. The bill also requires a psychiatric facility or outpatient treatment provider to facilitate the biennial training of all staff on the following issues: 1) the fundamentals of the facility's suicide prevention policies and protocols; 2) the particular suicide care policies and protocols that are relevant to each staff member's role and responsibilities; 3) the signs and symptoms that can be used by both clinical and non-clinical staff to identify existing patients who may be developing new suicidal ideations, behaviors, or tendencies; 4) the importance of, and methods and principles to be used in, ensuring the safe and responsible discharge and care transition of at-risk patients; and 5) the respectful treatment of, effective communication with, and de-stigmatization of, at-risk patients. The bill would prohibit a staff member of a psychiatric facility or outpatient treatment provider from: 1) discharging an at-risk patient into a homeless situation; or 2) having an at-risk patient arrested or incarcerated in a jail or prison, unless the at-risk patient poses an otherwise uncontrollable risk to others. The bill would additionally require a suicide prevention counselor and any other staff member employed by a psychiatric facility, by an outpatient treatment provider, or by a suicide or crisis hotline, as well as any other health care professional, when interacting with an at-risk patient, to: 1) treat the at-risk patient with the same dignity and respect that is shown to other patients; 2) adopt a stance that reflects empathy, compassion, and an understanding of the ambivalence the at-risk patient may feel in relation to the patient's desire to die; 3) treat the at-risk patient in an age-appropriate manner and using methods of communication that the patient can understand; 4) attempt to engender confidence in the at-risk patient that there is an alternative to suicide, and encourage the patient to use all available services and resources to empower the patient to choose such an alternative; 5) not engage in activities or communication methods that may result in the increased traumatization or re-traumatization of the at-risk patient; 6) not engage in the psychological testing of an at-risk patient who is in crisis or who has recently been lifted out of a crisis situation (except in the case of a suicide risk assessment performed pursuant to the bill); and 7) not engage in behavior that discriminates against or stigmatizes the patient. Any person who violates these minimum standards of compassionate care will be personally liable to pay a civil penalty of not more than $500 for a first offense, not more than $1,000 for a second offense, and not more than $2,500 for a third or subsequent offense, to be collected in a summary proceeding. Such person will also be subject to: 1) potential criminal liability and civil lawsuits, including lawsuits for punitive damages, for any injury that is proximately caused thereby; 2) the suspension or revocation of the person's professional license or certification; 3) the revocation of the person's mental health accreditation; and 4) the termination of the person's employment.

Committee Categories

Patrick Diegnan (D)*,  Linda Greenstein (D)*,  Vin Gopal (D),  Nellie Pou (D), 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 01/09/2024)

Official Document