New law modifies Oklahoma’s definition of “person requiring treatment”

Oklahoma will soon have an updated definition to determine when someone may be held in protective custody for a mental health evaluation to determine whether they need to be involuntarily hospitalized. On April 23, Gov. Kevin Stitt signed into law House Bill 3451, which clarifies how the deterioration of a person’s mental health can be taken into account in these situations.

Also known as civil commitment, involuntary hospitalization is used to treat individuals with severe mental illness as a last resort when community-based treatment falls short. The potential for civil commitment arises when someone experiences a severe and persistent mental illness that impairs their functioning and puts themself and potentially others around them at risk of harm — in Oklahoma statute, someone in such a circumstance is defined as a “person requiring treatment.”  

While people deemed to require treatment may seek care voluntarily, it is not uncommon for them to refuse or not recognize they have a mental illness, a condition known as anosognosia. Families often see civil commitment as a last resort to get a loved one into treatment, sometimes for their own safety.  

In cases where someone cannot or will not enter treatment voluntarily, civil commitment is often used after exhausting all other avenues as a final attempt to stabilize a person through hospitalization and medication.
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Oklahoma’s laws for “requiring treatment”

Having clear language around the definition of a “person requiring treatment” helps protect an individual’s rights while also recognizing the need to ensure a person’s safety when they cannot do so themselves. Many states have similarly worded statutes to define a person requiring treatment. Federal courts have set parameters on these definitions through a history of case law dating back to the formation of the country’s community mental health system. These precedents establish that, in the absence of danger, individuals should receive care in the least restrictive setting possible, and that clear and convincing evidence — including an individual’s relevant mental health history — should inform decisions about involuntary hospitalization.

Oklahoma’s definition was codified with the Mental Health Law of 1986, which says that if, due to a person’s behavioral health, they pose a “substantial risk of immediate physical harm” to themself or to another person, or another person is in reasonable fear of physical harm due to immediate threats, they may be deemed a “person requiring treatment.” Additionally, someone may meet this definition if their mental health deteriorates at a severe rate or if they are unable to provide for their basic needs to an extent that would result in a severe risk of injury or death without immediate intervention.  

An individual’s behavioral health history may be used as evidence to determine whether they fit the definition of a person requiring treatment, but the determination cannot be made solely on this history. A person living with dementia, Alzheimer’s disease, an intellectual or developmental disability, a seizure disorder, traumatic brain injury, or someone experiencing homelessness may not be deemed a person requiring treatment unless they also meet the criteria above.  

House Bill 3451, by Rep. Jeff Boatman (R-Tulsa), clarifies what counts as “severe deterioration” when determining whether someone meets the “person requiring treatment” definition. Under the new law, severe deterioration is defined as continuing and “observed within the previous 72-hour period.” When the law takes effect, officers and other professionals who make determinations in the civil commitment process will have clearer guidelines around how to take a person's recent mental health history into account when deciding whether they meet the definition.
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Applying the definition in the civil commitment process

Law enforcement officers, mental health professionals, and judges rely on the legal definition of a “person requiring treatment” to make determinations about civil commitment and involuntary treatment — when someone can be detained, given an emergency mental health assessment, or ordered into treatment by a court. An inconsistent application of the definition can leave friends and family frustrated when they struggle to access emergency mental health treatment for a loved one.

Law enforcement officers

Law enforcement officers are designated in state law for immediate emergency action to take someone into protective custody if they reasonably believe the individual meets the definition of a “person requiring treatment.” In doing so, the officer must document the basis for their belief that the individual requires treatment and the circumstances under which they were detained. If medically stable, the individual is transported to the nearest mental health facility for an initial assessment; otherwise, they will be transported for medical care. At this point, if emergency detention is deemed warranted, the individual will again be transported by an officer to a facility with beds available.  

Officers typically use the “person requiring treatment” statutory definition when responding to dispatch calls, emergencies, or patrolling within communities. A potential impact of HB 3451 is that officers may be able to detain an individual they believe requires treatment when the individual is no longer in immediate danger; for example, if a person with suicidal ideation has a knife next to them rather than in their hand.  

Mental health professionals

Licensed mental health professionals also use the “person requiring treatment” definition in instances of emergency detention. These professionals conduct an initial assessment at a mental health facility of someone placed in emergency detention. If the licensed mental health professional determines a person requires treatment, they must prepare documentation that outlines their determination, and the individual may be held for no longer than five days, excluding weekends and holidays.  

With HB 3451, licensed mental health professionals may initiate more of these assessments and petition courts for the required treatment. Initial assessments can be conducted in-office during a scheduled appointment and not just during a period of emergency detention. Furthermore, clinicians will likely have a more thorough knowledge of an individual’s previous 72 hours before a crisis incident, especially if the individual is in their care.

Judges

Last, district court judges ultimately determine, based on a petition for an order to require treatment, whether an individual is a “person requiring treatment,” and if so, the most appropriate and least restrictive treatment they are required to participate in. Judges also have the power to grant pretrial detention before the hearing on the petition if there is probable cause. Petitions for an order to require treatment are decided solely by judges, which must be done so through clear and convincing evidence.  

The district court has continuing jurisdiction over an individual during their required treatment. While receiving treatment, individuals are required to receive a review of their civil commitment status at least once every three months, or upon request by the individual or their attorney.
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New definition’s impact on Oklahomans

Having a clear definition of a “person requiring treatment” is important to determine when it is appropriate to involuntarily hospitalize someone for mental health treatment, balancing a person’s rights with the need to ensure individuals’ safety when they cannot do so themselves. When HB 3451 takes effect on Nov. 1, 2024, the updated definition will allow officers, judges, and licensed mental health professionals to better navigate complex decisions around civil commitment.