SB 928
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
First Reader
Senate Bill 928 (Senator Ready)
Finance
Mental Health Law - Reform of Laws and Delivery of Service
This bill modifies the standard for involuntary admission to require that an individual is
reasonably expected, if not hospitalized, to present a danger to the life or safety of the
individual or of others (rather than that the individual presents a danger to the life or safety
of the individual or of others). The bill also defines “danger to the life or safety of the
individual or of others.” The Maryland Police Training and Standards Commission
(MPTSC) must provide information regarding the new definition of “danger to the life or
safety of the individual or of others” to all schools that conduct police entrance-level and
in-service training courses, including State, regional, county, and municipal training
schools. The bill takes effect July 1, 2021.
Fiscal Summary
State Effect: General fund expenditures increase by an indeterminate but potentially
significant amount in FY 2022 and potentially in subsequent years, to the extent that more
emergency petitions are filed and more involuntary admissions occur, as discussed below.
To the extent the bill accelerates involuntary admissions and ultimately reduces the length
of stay, readmissions, and criminal involvement for certain individuals, expenditures may
decrease over time. MPTSC can provide the specified information to all training schools
as required using existing budgeted resources. Revenues are not affected.
Local Effect: To the extent that additional emergency petitions are filed in circuit courts,
expenditures may increase. Revenues are not affected.
Small Business Effect: None.
 Analysis
Bill Summary: “Danger to the life or safety of the individual or of others” means a
substantial risk, in consideration of the individual’s current condition and, if available,
personal and medical history, that as a result of the mental disorder the individual will
(1) cause bodily harm to the individual or another individual; (2) be unable, except for
reasons of indigence, to provide for the individual’s basic needs, including food, clothing,
shelter, health, or safety; or (3) suffer substantial deterioration of the individual’s judgment,
reasoning, or ability to control behavior, provided that the individual is currently unable to
make a rational and informed decision as to whether to submit to treatment.
Current Law:
Involuntary Admission
Under the Health-General Article, an application for involuntary admission of an
individual to a facility or Veterans’ Administration hospital may be made by any person
who has a legitimate interest in the welfare of the individual. In addition to other
requirements, the application must (1) state the relationship of the applicant to the
individual for whom admission is sought; (2) be signed by the applicant; and (3) be
accompanied by the certificates of one physician and one psychologist, two physicians, or
one physician and one psychiatric nurse practitioner.
Additionally, within 12 hours of receiving notification from the health care practitioner
who has certified an individual for involuntary admission, the Maryland Department of
Health (MDH) must receive and evaluate the individual for involuntary admission if certain
requirements are met, including that the health care practitioner is unable to place the
individual in a facility not operated by MDH.
A facility or Veterans’ Administration hospital may not admit an individual under
involuntary admission unless (1) the individual has a mental disorder; (2) the individual
needs inpatient care or treatment; (3) the individual presents a danger to the life or safety
of the individual or of others; (4) the individual is unable or unwilling to be admitted
voluntarily; and (5) there is no available, less restrictive form of intervention that is
consistent with the welfare and safety of the individual.
Specified health professionals and other interested parties may petition for an emergency
evaluation of an individual, which may result in the involuntary admission of the individual
to a mental disorder treatment facility, if the petitioner has reason to believe that the
individual (1) has a mental disorder and (2) presents a danger to the life or safety of the
individual or of others. Petitions for an emergency evaluation must contain specified
additional information. If an emergency evaluee meets the requirements for an involuntary
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admission and is unable or unwilling to agree to a voluntary admission, the examining
physician must take the steps needed for involuntary admission of the emergency evaluee
to an appropriate facility, which may be a general hospital with a licensed inpatient
psychiatric unit. If the examining physician is unable to have the emergency evaluee
admitted to a facility, the physician must notify MDH, which must provide for the
admission of an emergency evaluee to an appropriate facility within six hours of receiving
notification.
At any time, a court may order an emergency evaluation of an individual who has been
arrested, if the court finds probable cause to believe that the individual has a mental
disorder and the individual presents a danger to the life or safety of the individual or of
others.
Within 12 hours after initial confinement to a facility, the facility must provide the
individual with a form, provided by the Behavioral Health Administration, which explains
the individual’s rights, including the right to consult with a lawyer. An individual who is
proposed for involuntary admission must be afforded a hearing to determine whether the
individual should be involuntarily admitted or released, which must be conducted within
10 days of initial confinement. The hearing officer must consider all the evidence and
testimony of record and order the release of the individual from the facility unless the
record demonstrates by clear and convincing evidence that, at the time of the hearing, each
of the following elements exists: (1) the individual has a mental disorder; (2) the individual
needs inpatient care or treatment; (3) the individual presents a danger to the life or safety
of the individual or of others; (4) the individual is unable or unwilling to be voluntarily
admitted to the facility; and (5) there is no available less restrictive form of intervention
that is consistent with the welfare and safety of the individual. Additional findings must be
made if the individual to be admitted is at least age 65.
Maryland Police Training and Standards Commission
Chapter 519 of 2016 reconstituted the former Police Training Commission as MPTSC, an
independent commission within the Department of Public Safety and Correctional
Services. MPTSC operates approved police training schools and prescribes standards for
and certifies schools that offer police and security training. In consultation and cooperation
with various entities, it also sets minimum qualifications for instructors and certifies
qualified instructors for approved training schools.
State Expenditures: There is an operational and fiscal impact on the Judiciary from
increased caseloads to review emergency petitions in the District Court. Additionally,
general fund expenditures for MDH, the Office of Administrative Hearings (OAH), and
the Office of the Public Defender (OPD) increase in fiscal 2022 and potentially in
subsequent years to the extent that more involuntary admissions occur under the bill.
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However, to the extent the bill accelerates involuntary admissions and ultimately reduces
the length of stay, readmissions, and criminal involvement for certain individuals,
expenditures may decrease over time.
Judiciary
Under the bill, if a petitioner for an emergency evaluation is not a specified health care
professional, health officer, or peace officer, the petitioner must present the petition to the
court for immediate review, and the court must review the case to make a probable cause
determination that the emergency evaluee has shown the symptoms of a mental disorder
and that the individual is reasonably expected, if not hospitalized, to present a danger to
the life or safety of the individual or of others. As such, the caseloads for the District Court
could be greatly increased. The Judiciary advises that the number of additional cases cannot
be reasonably determined; in fiscal 2020, 3,799 emergency petitions were filed in the
District Court. Thus, expenditures increase to the extent that additional emergency petitions
are filed under the bill.
Maryland Department of Health
The modified standard for involuntary admission to a State facility for treatment expands
the number of individuals who may be subject to involuntary admission. Thus, to the extent
that additional involuntary admissions occur as a result of the bill, general fund
expenditures increase to cover the cost of additional admissions.
To the extent the bill accelerates involuntary admissions and ultimately reduces the length
of stay and readmissions for certain individuals, these expenditures may decrease over
time.
Office of Administrative Hearings
Individuals who are involuntarily admitted are entitled to a hearing within 10 days of the
initial admission. OAH advises it employs administrative law judges (ALJs) who preside
over all involuntary admission hearings. Currently, OAH conducts hearings for
34 different behavioral health units divided among 19 different dockets; each docket is
conducted once a week for a total of 988 dockets each year. Additionally, OAH advises
that, in fiscal 2020, 1,345 cases were heard. OAH further advises that it may need to hire
one additional ALJ for every 4 additional dockets per week (208 dockets per year). Thus,
expenditures for OAH increase to hire at least one additional ALJ for every additional
283 involuntary admission hearings resulting from the bill.
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In addition, OAH advises there would be an operational impact to train its ALJs on the
substantive aspects of the bill. The Department of Legislative Services (DLS) advises that
the training can be implemented using existing budgeted resources.
To the extent the bill accelerates involuntary admissions and ultimately reduces
readmissions for certain individuals, these expenditures may decrease over time.
Office of the Public Defender
Individuals who are involuntarily admitted are entitled to representation by counsel, almost
exclusively provided by OPD, for the required hearing following initial admission. OPD
advises that it could need an additional four new attorneys to handle the increased caseload
that may result from the expanded grounds for involuntary admission under the bill.
According to its 2019 annual report, OPD had eight attorneys and supervisors within its
mental health division. In 2019, OPD’s mental health division handled 7,356 involuntary
commitment matters and 52 commitment reviews (attorneys in OPD’s mental health
division also handle other case types such as competency and not criminally responsible
hearings). Furthermore, the 2019 annual report indicated that the current caseload standard
for the mental health division was approximately 900 cases per attorney each year.
Therefore, DLS advises that expenditures for OPD increase to hire at least one additional
attorney for every 900 additional case that require an involuntary admission under the bill.
To the extent the bill accelerates involuntary admissions and ultimately reduces the length
of stay to less than 10 days and readmissions for certain individuals, these expenditures
may decrease over time.
Local Expenditures: The Judiciary advises that there were 340 emergency petitions filed
in circuit courts during fiscal 2020. Thus, local expenditures may increase to the extent that
additional emergency petitions are filed in circuit courts.
Additional Comments: The 2020 final report of the Commission to Study Mental and
Behavioral Health, chaired by Lieutenant Governor Boyd K. Rutherford, recommended
development of a clear statutory definition of danger of harm to self or others.
Additional Information
Prior Introductions: None.
Designated Cross File: HB 1344 (Delegate Kipke) - Health and Government Operations.
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Information Source(s): Montgomery County; Judiciary (Administrative Office of the
Courts); Office of Administrative Hearings; Office of the Public Defender; Maryland
Department of Health; Department of Public Safety and Correctional Services; Department
of State Police; Department of Legislative Services
Fiscal Note History: First Reader - March 24, 2021
an/jc
Analysis by: Amber R. Gundlach Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 928/ Page 6


Statutes affected:
Text - First - Mental Health Law - Reform of Laws and Delivery of Service: 10-601 Health General, 10-617 Health General, 10-622 Health General, 10-623 Health General, 10-626 Health General, 10-632 Health General