Contact Information: Jonas Goldenberg, LICSW
Director of Continuing Education and Clinical Issues
NASW, MA Chapter
Goldenberg@naswma.org or 617-227-9635 ext 14
House Bill 4681, an Act to Improve Emergency Access to Mental Health Services (Section 12 Law) was passed by the legislature and signed into law by Governor Patrick. As of November 8, 2010, LICSWs in the Commonwealth of Massachusetts will be authorized to sign a Section 12(a), known as a "pink paper.” A pink paper is the mechanism by which a LICSW moves to hospitalize an individual believed to meet the criteria for civil commitment. A LICSW may order that a mentally ill individual be restrained and taken to a hospital in the belief that failure to hospitalize would create a likelihood of serious harm by reason of mental illness.
Examples of situations where a section 12 might be appropriate include:
- Markedly impaired judgment due to mental illness to such an extent that a person is unable to protect himself/herself.
Important to Remember:
Section 12 is a transportation order to a hospital. Once the patient arrives at the hospital he/she must be evaluated by a physician (psychiatrist) to determine if he/she needs to be involuntarily committed for no more than 72 hours. Only the physician can make the commitment determination.
- As a general rule, LICSWs should not sign a pink paper unless they have examined the patient or, if an examination is not possible because the patient is in an emergency situation and refuses to be examined, the LICSW has some reliable source of information on which to base his or her decision.
- The LICSW is not required to chase a patient who runs nor is the LICSW required to put himself or herself in harms way.
- The LICSW is immune from civil liability for damages for restraining, transporting, or applying for the admission of any person to a facility if the LICSW acts in accordance with Section 12(a).
- LICSWs should exercise sound clinical judgment and recognize risk factors that may cause the patient to act out aggressively either by suicidal or homicidal behavior.
- documentation supporting the bases for the decision to seek a commitment is an integral part of the process.
Section 12 Training Questions & Answers (from Barry Mintzer, ESQ.):
1. Does an LICSW need to meet with a client in person in order to sign off on a section 12?
- If you are a LICSW supervising a LCSW or LMHC, can the LICSW (without having seen the client) sign the section 12 based on the evaluation of the LCSW or LMHC?
- If you receive a call from a client and you assess/determine that the person should be "sectioned" can you authorize it even though you have not met with the client in person, but talked to them on the phone?
Answer: B ecause of the refusal of the person to consent to such examination, the...social worker on the basis of the facts and circumstances may determine that hospitalization is necessary and may apply therefore.” It is therefore not enough to rely solely on someone else’s evaluation. There must be both an emergency and the patient must explicitly refuse to be evaluated by the LICSW. If both conditions are met, and if the LICSW believes the source of information concerning the patient's condition is reliable, there would be sufficient basis for signing a section 12(a).
In circumstances where the LICSW has insufficient information on which to rely, section 12(a) has other provisions that permit any person to make application to a district court for a three-day commitment to a facility of a mentally ill person "whom the failure to confine would cause a likelihood of serious harm.”
2. If an LICSW assesses that someone is suicidal or homicidal and he/she contacts an Emergency Service Program (ESP) and if the ESP clinician(s) determine that the client does not need to be hospitalized, but the treating LICSW still feels that the client should be "sectioned", who has the final say?
- Once you refer to an ESP, have you completed your "duty"?
Answer: If the LICSW contacts an Emergency Service Program (ESP) and the ESP is staffed by a physician the LICSW’s responsibilities have been fulfilled. Section 12(b) provides: If the application [under section 12(a)] is made by someone other than a designated physician, such person shall be given a psychiatric examination by a designated physician immediately after his reception at such facility. If the physician determines that failure to hospitalize such person would create a likelihood of serious harm by reason of mental illness he may admit such person to the facility for care and treatment. Even if the ESP is not directly staffed by a physician, the programs are in hospitals and getting the patient to a hospital is the point of section 12(a). One has fulfilled one’s duty once the patient is at a hospital.
The Chapter is offering an audio podcast containing more information.