OUTPATIENT MENTAL HEALTH TREATMENT S.B. 915 (S-1) - 918 (S-1):
SUMMARY AS PASSED BY THE SENATE
Senate Bills 915 through 918 (Substitute S-1 as passed by the Senate)
Sponsor: Senator Kevin Hertel (S.B. 915)
Senator Sylvia Santana (S.B. 916)
Senator Jeff Irwin (S.B. 917)
Senator Paul Wojno (S.B. 918)
Committee: Health Policy
Date Completed: 12-30-24
CONTENT
Senate Bill 915 (S-1) would amend Chapter 4 (Civil Admission and Discharge
Procedures: Mental Illness) of the Mental Health Code to do the following:
-- Require a patient to be referred to a community mental health services program
if a psychiatrist certified that the patient required assisted outpatient treatment
(AOT).
-- Modify the type of health professional that could testify to a patient's need for
AOT.
-- Modify the duration of second and third consecutive court orders for involuntary
mental health treatment.
-- Allow a court, without a hearing, to convene a conference with an individual who
was out of compliance with a court order for AOT and the individual's supervising
agency to review compliance with the order.
-- Allow a peace officer to take an individual into protective custody for
examination for mental health intervention if the officer had reasonable cause
to believe the individual required treatment, instead of if the officer observed
conduct that caused the officer to believe such.
Senate Bill 916 (S-1) would amend the Mental Health Code to do the following:
-- Allow a prosecuting attorney, defendant, or defense counsel to bring a motion
for an assessment to determine if a defendant met the criteria for misdemeanor
diversion to AOT at the time a misdemeanor was charged, or any later time
before trial.
-- Require a petition for diversion to AOT to be dismissed upon objection by a
prosecuting attorney or defendant.
-- Allow a court to enter an order for diversion to AOT for up to 180 days.
-- Allow a court to modify a diversion to AOT, such as by diverting to inpatient
hospitalization, if a defendant failed to comply with the AOT.
-- Require misdemeanor charges to remain pending upon diversion to AOT and to
be dismissed as a condition of release from AOT.
Senate Bill 917 (S-1) would amend the Mental Health Code to allow an individual
permitted to file a petition asserting that another individual required mental health
treatment to request and access mediation to resolve a dispute between the
individual requiring treatment and the appropriate community mental health
services program related to planning and providing services or support to the
individual requiring treatment. In addition, if an individual were required by a court
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order to receive mental health services due to a petition, the bill would require a
hospital to detain that individual for up to 24 hours.
Senate Bill 918 (S-1) would amend the Mental Health Code to allow a hospital
director, agency, physician, psychologist, qualified mental health professional, or
individual to file a petition for a second or continuing order of involuntary mental
health treatment at least 14 days before the expiration of a current order of AOT if
the individual receiving treatment were likely to refuse voluntary treatment and
needed continued treatment.
Senate Bill 916 is tie-barred to Senate Bill 915.
Senate Bill 915 (S-1)
Referring Patients to Assisted Outpatient Treatment
Section 423 of the Code requires a hospital to admit an individual who is presented to the
hospital if a petition or clinical certificate had been executed, pending the receipt of a
psychiatrist stating that the individual requires treatment. Section 430 requires the
psychiatrist to examine the individual within 24 hours of hospitalization, excluding legal
holidays. If a psychiatrist certifies a patient’s need for treatment, the patient's hospitalization
may continue pending hearings.
Under the bill, if the psychiatrist certified that the patient was a person requiring treatment
in the form of AOT, a referral would have to be made to the community mental health services
program serving the community where the patient resided and hearings could be convened
under Sections 451 to 465, which govern court hearings in Chapter 4 of the Code. 1
Petitions Requesting Assisted Outpatient Treatment
Currently, Section 461 of the Code prohibits an individual from being found to need treatment
unless at least one physician or licensed psychologist who has personally examined that
individual testifies in person or by written deposition at the hearing. Under the bill, this
requirement would apply specifically to a petition that asserted a patient required treatment.
For a petition that does not seek hospitalization but only assisted outpatient treatment, the
Code specifies that an individual may not be found to require treatment unless a psychiatrist
who has personally examined that individual testifies. A psychiatrist's testimony is not
necessary if a psychiatrist signs the petition. If a psychiatrist signs the petition, at least one
physician or licensed psychologist who has personally examined that individual must testify.
The bill would delete this language, and instead, for a petition that did not seek hospitalization
but only AOT, an individual could be found to require treatment if the following were met:
-- Except as otherwise provided, a physician, psychologist, or qualified health professional
had personally examined the individual and testified that the individual required
treatment, unless this requirement was waived by the subject of the petition.
-- Except as otherwise provided, evidence was presented that the physician, psychologist,
or qualified health professional who examined the individual discussed their findings and
1 "Assisted outpatient treatment" means the categories of outpatient services ordered by a court.
Outpatient services are generally understood to be any medical services that do not require an overnight
visit at a hospital. The court can order any number of categories of outpatient services, such as
medication, supervision of living arrangements, or individual or group therapy.
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 the plan for treatment for the individual with a psychiatrist during or immediately after
the examination.
"Psychiatric nurse practitioner" would mean an individual who is licensed as a registered
professional nurse under Part 172 (Nursing) of the Public Health Code who has been granted
a specialty certification as a nurse practitioner by the Michigan Board of Nursing under Section
17210 (the section that authorizes the Board to grant specialty certifications to a registered
professional nurse) and who has training in the area of mental health.
"Qualified health professional" would mean a psychiatric nurse practitioner who is acting under
the delegation of a psychiatrist under Section 16215 (the section that regulates the delegation
of tasks or functions to licensed or unlicensed individuals) of the Code, or a physician's
assistant who is acting pursuant to a practice agreement with a psychiatrist under Article 15
(Occupations) of the Code.
Duration of Court Orders for Treatment
Section 472a requires that once a petition has been filed and it has been found that an
individual requires treatment, the court must issue an initial order of involuntary mental
health treatment. The hospital director, agency, or mental health professional supervising the
patient’s mental health treatment may continue to file for petitions for continuing orders of
involuntary mental health treatment if they believe the individual requires treatment and that
the individual will refuse treatment otherwise.
Currently, the second order of involuntary mental health treatment must not exceed 90 days
and the third order of involuntary mental health treatment must not exceed one year. Instead,
under the bill, the second order for involuntary mental health treatment would have to be
limited in duration as follows:
-- A second order of hospitalization could not exceed 90 days.
-- A second order of AOT could not exceed one year.
-- A second order of combined hospitalization and AOT could not exceed one year, and the
hospitalization portion of the second order could not exceed 90 days.
Under the bill, the third order for involuntary mental health treatment would have to be limited
in duration as follows:
-- A continuing order of hospitalization could not exceed one year.
-- A continuing order of AOT could not exceed one year.
-- A continuing order of combined hospitalization and AOT could not exceed one year, and
the hospitalization portion of a continuing order for combined hospitalization and assisted
outpatient treatment could not exceed 90 days.
Allow Courts to Convene Conference if Non-Compliant with Court Order
If an individual subject to an order of assisted outpatient treatment or combined
hospitalization and assisted outpatient treatment did not comply with the order, the bill would
allow the court, without a hearing and based upon the record and other available information,
to convene a status conference with the supervising agency and the individual to review the
individual’s compliance with the order.
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 Senate Bill 916 (S-1)
Testimony Determining a Need for Treatment
Generally, any person over the age of 18 may file a petition in court to assert that an individual
requires mental health treatment.
(A "person requiring treatment" means, among other things, an individual who has mental
illness, and who because of that mental illness can reasonably be expected within the near
future to intentionally or unintentionally seriously physically injure himself, herself, or another
individual, and who has engaged in an act or acts or made significant threats that are
substantially supportive of the expectation. The term also means an individual who has mental
illness, and who as a result of that mental illness is unable to attend to those of his or her
basic physical needs such as food, clothing, or shelter that must be attended to in order for
the individual to avoid serious harm in the near future, and who has demonstrated that
inability by failing to attend to those basic physical needs. Additionally, the term includes an
individual who has mental illness, whose judgment is so impaired by that mental illness, and
whose lack of understanding of the need for treatment has caused him or her to demonstrate
an unwillingness to voluntarily participate in or adhere to treatment that is necessary, on the
basis of competent clinical opinion, to prevent a relapse or harmful deterioration of his or her
condition, and presents a substantial risk of significant physical or mental harm to the
individual or others.)
Under the bill, for a petition that did not seek hospitalization but only requested that the
individual subject to the petition receive AOT, an individual could be found to require
treatment if a physician, psychologist, or psychiatric nurse practitioner or physician working
under the supervision of a psychiatrist had personally examined that individual and testified
that the individual required treatment. The subject of the petition could waive the requirement
for the testimony.
Misdemeanor Diversion to AOT
Generally, under the Code, each community mental health service provider must provide
services designated to divert individuals with serious mental illness, serious emotional
disturbance, or developmental disability from possible incarceration when appropriate.
The bill would allow a prosecuting attorney, the defendant, or defense counsel to bring a
motion that sought an assessment by a physician, psychologist, or qualified health
professional to determine if the defendant met the criteria for diversion to AOT at the time a
misdemeanor was charged or any later time before trial. Except for a physician who was a
psychiatrist, the physician, psychologist, or qualified health professional would have to discuss
the findings and plan for care with a psychiatrist during or immediately after the examination.
The defendant or defense counsel could oppose a motion made by the prosecuting attorney
and a prosecuting attorney could oppose a motion made by the defendant or defense counsel.
If a motion were opposed by the prosecuting attorney, defendant, or defense counsel, the
defendant could not be diverted into AOT and the competency provisions of Chapter 10
(Criminal Provisions) would have to be followed, as applicable. 2
2 Under Chapter 10, a defendant of a criminal charge is presumed competent unless that individual is
incapable due to a mental health condition affecting that individual's understanding of the nature and
object of the proceeding, among other things. Defendants determined incompetent must not be
proceeded against until that person has been restored to competency. Chapter 10 requires these
individuals to undergo certain examinations and prescribes a process for hearings, determinations, and
dispositions of individuals found not guilty by reasons of insanity.
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If it were determined that the defendant met the criteria for AOT, the prosecuting attorney
would have to file a petition that did not seek hospitalization but only requested AOT.
Following that petition, the judge of the district court could request assignment from the State
Court Administrative Office as a probate judge to hear and determine the petition or direct
the prosecuting attorney to file the petition in the probate court in the defendant's county of
residence. If the petition were filed in the probate court, the probate court would have to hear
and determine the petition.
If, at the hearing on the petition for AOT, the prosecuting attorney or the defendant objected
to entry of the order for AOT, the petition would have to be dismissed and the procedures
under Section 1022 to Section 1044 would apply to the case. 3
If, at the hearing on the petition for AOT, there were no objection to entry of the order for
AOT, the court would have to enter the order.
Diversion from Criminal Prosecution
If diversion from criminal prosecution and into AOT were ordered after a hearing on such a
petition, the court that heard the petition would have to enter an order providing for AOT for
up to 180 days.
If a defendant failed to comply with the terms of the AOT order, the provisions under Section
475 would apply to the case.4 If a criminal prosecution continued during the 180-day period
provided for above, there could be no bond conditions other than that the defendant would
not violate any no contact order, would appear as required, would not leave Michigan without
permission from the court, and would not commit any crime while released. Any bond or bond
conditions would be separate from and not be included in the determination of whether the
defendant had complied with the AOT order.
The community treatment program would have the sole discretion to make decisions related
to the assessment of, treatment planning for, type, scope, frequency, intensity, and duration
of treatment for, and discharge from treatment of a defendant under an AOT order. If the
designated community treatment program did not communicate with the court as to the
treatment of the defendant under the AOT order, the court could conduct a hearing relative
to the treatment being provided by the community treatment program.
Release to AOT with Pending Charges
The misdemeanor charges against a defendant who received AOT would have to remain
pending until dismissed by the district court for purposes of enforcing conditions of release.
The conditions of release for a defendant who received AOT would have to be separate from
compliance with the treatment plan. Compliance with the AOT could not be a condition of
release. All matters that concerned noncompliance with the AOT plan would have to be
addressed in a civil proceeding under Section 475.
Except as otherwise provided, a pending misdemeanor charge would have to be dismissed by
the district court 90 days after the entry of the AOT order. If the defendant were charged with
3 Section 1022 through Section 1044 prescribe the standards for determining whether an individual is
mentally capable to stand trial, the procedures of a competency hearing, and a potential restoration of
competency.
4 Under Section 475, upon noncompliance with a court order or determination of AOT being not
appropriate, a court may consider, without a hearing, alternatives to hospitalization and modify the
order to direct hospitalization or combined hospitalization and AOT, among other things.
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a serious misdemeanor, the misdemeanor charge would have to be dismissed 180 days after
the entry of the AOT order.
Generally, "serious misdemeanor" would mean assault, breaking and entering, fourth degree
child abuse, neglect of a minor, illegal use of a firearm, indecent exposure, stalking, injuring
a worker in a work zone, leaving the scene of an accident, operating a vehicle while
intoxicated, providing alcohol to a minor, threatening a Department of Health and Human
Services (DHHS) employee with physical harm, embezzlement from a vulnerable adult, or a
moving violation causing serious impairment of a bodily function or death.
Termination of AOT
Upon the termination of the AOT, the provider of the AOT would have to notify the prosecutor,
district court, and probate court, as applicable, of the termination.
Exemptions
The bill would specify that Sections 1022 to 1044 would not apply to an individual charged
with a misdemeanor offense who had been diverted to AOT under the bill's provisions.
Senate Bill 917 (S-1)
Generally, Section 206a of the Code requires that the recipient of mental health services from
a community mental health services program or other service provider under contract with
the program or the recipient’s representative be allowed to request and access mediation