Note: Changes in the law are highlighted in bold type. Most civil-commitment procedures begin with a call to police reporting that someone is acting dangerously, seems inordinately confused or can't care for himself.

In Virginia, few police departments have been trained to handle people who are mentally ill; many mentally unstable individuals are simply jailed for petty crimes such as loitering, trespassing or theft.

A magistrate, taking into account the person's mental condition and any other statements of conduct or past history, must determine whether probable cause exists to hold the individual under an emergency custody order.

A person can be held for four hours, but revisions effective Tuesday allow a two-hour extension. Delays most often occur waiting for available bed space or for a clinician to initially assess the person.

The magistrate then can issue a temporary-detention order based on a medical determination that the person represents a substantial likelihood of harm in the near future because of mental illness, or that the person lacks the ability to provide for himself. The Virginia standard previously required imminent danger.

The detention order allows transfer of the person by police to a hospital, generally for up to 48 hours, for a more complete assessment.

The person can agree to be voluntarily admitted for care for at least three days.

More often, a commitment hearing is held before a special justice and the person is provided a lawyer. At that hearing, according to the revisions, a representative of the local Community Services Board must be present, and the assessing physicians must present written findings of the person's condition or appear in person to testify.

The judge can then order the person committed to a hospital based on the assessment, past histories, and if there is a substantial likelihood of danger to himself or others or if the person is unable to care for himself.

The judge also must determine that all less-restrictive possibilities of care other than hospitalization have been examined and deemed inappropriate.

The initial commitment cannot last longer than 30 days but can be extended for up to 180 days after a new assessment process.

If appropriate, the person also can be ordered to receive mandatory outpatient treatment for up to 90 days. That period can be extended if a new hearing is held.

Types of outpatient treatment must be specified and arranged in advance, and for the first time, a plan must be developed with the person's full involvement and must reflect the person's wishes for care.

New code sections also spell out provisions for what happens when a person is noncompliant with outpatient orders; the changes also introduce mandatory reporting by monitors and allow a judge to redetermine whether a noncompliant outpatient should be involuntarily committed.

Caregivers can petition the court to end treatment.

A person's condition must be reassessed by a special justice every 180 days, and a new determination must be made regarding the need for continued confinement or outpatient care.
Contact Bill McKelway at (804) 649-6601 or bmckelway@timesdispatch.com.