To repeal sections 630.110, 630.115, 630.125, 630.140, 630.155, 630.160, 630.165, 630.167, 630.168, 630.170, 630.175, 630.192, 630.200, 631.110, 631.115, 631.120, 631.135, 631.140, 631.145, 631.150, 631.165, 632.005, 632.300, 632.305, 632.330, 632.335, 632.340, 632.345, 632.350, 632.355, 632.360, 632.365, 632.370, 632.375, 632.380, 632.390, 632.400, 632.410, 632.415, 632.440, 632.455, 633.125 and 633.160, RSMo 1994, and section 630.005, RSMo Supp. 1995, relating to mental health and to enact in lieu thereof fifty-two new sections relating to the same subject, with penalty provisions.

Be it enacted by the General Assembly of the State of Missouri, as follows:

Section A. Sections 630.110, 630.115, 630.125, 630.140, 630.155, 630.160, 630.165, 630.167, 630.168, 630.170, 630.175, 630.192, 630.200, 631.110, 631.115, 631.120, 631.135, 631.140, 631.145, 631.150, 631.165, 632.005, 632.300, 632.305, 632.330, 632.335, 632.340, 632.345, 632.350, 632.355, 632.360, 632.365, 632.370, 632.375, 632.380, 632.390, 632.400, 632.410, 632.415, 632.440, 632.455, 633.125 and 633.160, RSMo 1994, and section 630.005, RSMo Supp. 1995, are repealed and fifty-two new sections enacted in lieu thereof to be known as sections 630.005, 630.110, 630.115, 630.125, 630.140, 630.155, 630.160, 630.165, 630.167, 630.168, 630.170, 630.175, 630.192, 630.199, 630.200, 631.110, 631.115, 631.120, 631.135, 631.140, 631.145, 631.150, 631.165, 632.005, 632.300, 632.301, 632.305, 632.330, 632.335, 632.337, 632.340, 632.345, 632.350, 632.355, 632.360, 632.365, 632.370, 632.375, 632.380, 632.390, 632.392, 632.400, 632.410, 632.415, 632.440, 632.455, 633.125, 633.160, 208.309, 208.311, 208.313 and 208.315, to read as follows:

630.005. As used in chapters 630, 631, 632, and 633, RSMo, unless the context clearly requires otherwise, the following terms shall mean:

(1) Administrative entity , a provider of specialized services other than transportation to clients of the department on behalf of a division of the department;

(2) Alcohol abuse , the use of any alcoholic beverage, which use results in intoxication or in a psychological or physiological dependency from continued use, which dependency induces a mental, emotional or physical impairment and which causes socially dysfunctional behavior;

(3) Chemical restraint , medication administered with the primary intent of restraining a patient who presents a likelihood of serious physical injury to himself or others, and not prescribed to treat a person s medical condition;

(4) Client , any person who is placed by the department in a facility or program licensed and funded by the department or who is a recipient of services from a regional center, as defined in section 633.005, RSMo;

(5) Commission , the state mental health commission;

(6) Consumer , a person:

(a) Who qualifies to receive department services; or

(b) Who is a parent, child or sibling of a person who receives department services; or

(c) Who has a personal interest in services provided by the department. A person who provides services to persons affected by mental retardation, developmental disabilities, mental disorders, mental illness, or alcohol or drug abuse shall not be considered a consumer;

(7) Day program , a place conducted or maintained by any person who advertises or holds himself out as providing prevention, evaluation, treatment, habilitation or rehabilitation for persons affected by mental disorders, mental illness, mental retardation, developmental disabilities or alcohol or drug abuse for less than the full twenty-four hours comprising each daily period;

(8) Department , the department of mental health of the state of Missouri;

(9) Developmental disability , a disability:

(a) Which is attributable to:

a. Mental retardation, cerebral palsy, epilepsy, head injury or autism, or a learning disability related to a brain dysfunction; or

b. Any other mental or physical impairment or combination of mental or physical impairments; and

(b) Is manifested before the person attains age twenty-two; and

(c) Is likely to continue indefinitely; and

(d) Results in substantial functional limitations in two or more of the following areas of major life activities:

a. Self-care;

b. Receptive and expressive language development and use;

c. Learning;

d. Self-direction;

e. Capacity for independent living or economic self-sufficiency;

f. Mobility; and

(e) Reflects the person s need for a combination and sequence of special, interdisciplinary, or generic care, habilitation or other services which may be of lifelong or extended duration and are individually planned and coordinated;

(10) Director , the director of the department of mental health, or his designee;

(11) Domiciled in Missouri , a permanent connection between an individual and the state of Missouri, which is more than mere residence in the state; it may be established by the individual being physically present in Missouri with the intention to abandon his previous domicile and to remain in Missouri permanently or indefinitely;

(12) Drug abuse , the use of any drug without compelling medical reason, which use results in a temporary mental, emotional or physical impairment and causes socially dysfunctional behavior, or in psychological or physiological dependency resulting from continued use, which dependency induces a mental, emotional or physical impairment and causes socially dysfunctional behavior;

(13) Habilitation , a process of treatment, training, care or specialized attention which seeks to enhance and maximize the mentally retarded or developmentally disabled person s abilities to cope with the environment and to live as normally as possible;

(14) Habilitation center , a residential facility operated by the department and serving only persons who are mentally retarded, including developmentally disabled;

(15) Head of the facility , the chief administrative officer, or his designee, of any residential facility;

(16) Head of the program , the chief administrative officer, or his designee, of any day program;

(17) Individualized habilitation plan , a document which sets forth habilitation goals and objectives for mentally retarded or developmentally disabled residents and clients, and which details the habilitation program as required by law, rules and funding sources;

(18) Individualized rehabilitation plan , a document which sets forth the care, treatment and rehabilitation goals and objectives for patients and clients affected by alcohol or drug abuse, and which details the rehabilitation program as required by law, rules and funding sources;

(19) Individualized treatment plan , a document which sets forth the care, treatment and rehabilitation goals and objectives for mentally disordered or mentally ill patients and clients, and which details the treatment program as required by law, rules and funding sources;

(20) Investigator , an employee or contract agent of the department of mental health who is performing an investigation regarding an allegation of abuse or neglect or an investigation at the request of the director of the department of mental health or his designee;

(21) Least restrictive environment , a reasonably available setting or mental health program where care, treatment, habilitation or rehabilitation is particularly suited to the level and quality of services necessary to implement a person s individualized treatment, habilitation or rehabilitation plan and to enable the person to maximize his functioning potential to participate as freely as feasible in normal living activities, giving due consideration to potentially harmful effects on the person. For some mentally disordered or mentally retarded persons, the least restrictive environment may be a facility operated by the department, a private facility, a supported community living situation, or an alternative community program designed for persons who are civilly detained for outpatient treatment or who are conditionally released pursuant to chapter 632, RSMo;

(22) Mental disorder , any organic, mental or emotional impairment which has substantial adverse effects on a person s cognitive, volitional or emotional function and which constitutes a substantial impairment in a person s ability to participate in activities of normal living;

(23) Mental illness , a state of impaired mental processes, which impairment results in a distortion of a person s capacity to recognize reality due to hallucinations, delusions, faulty perceptions or alterations of mood, and interferes with an individual s ability to reason, understand or exercise conscious control over his actions. The term mental illness does not include the following conditions unless they are accompanied by a mental illness as otherwise defined in this subdivision:

(a) Mental retardation, developmental disability or narcolepsy;

(b) Simple intoxication caused by substances such as alcohol or drugs;

(c) Dependence upon or addiction to any substances such as alcohol or drugs;

(d) Any other disorders such as senility, which are not of an actively psychotic nature;

(24) Mental retardation , significantly subaverage general intellectual functioning which:

(a) Originates before age eighteen; and

(b) Is associated with a significant impairment in adaptive behavior;

(25) Minor , any person under the age of eighteen years;

(26) Patient , an individual under observation, care, treatment or rehabilitation by any hospital or other mental health facility or mental health program pursuant to the provisions of chapter 632, RSMo;

(27) Psychosurgery ,

(a) Surgery on the normal brain tissue of an individual not suffering from physical disease for the purpose of changing or controlling behavior; or

(b) Surgery on diseased brain tissue of an individual if the sole object of the surgery is to control, change or affect behavioral disturbances, except seizure disorders;

(28) Rehabilitation , a process of restoration of a person s ability to attain or maintain normal or optimum health or constructive activity through care, treatment, training, counseling or specialized attention;

(29) Residence , the place where the patient has last generally lodged prior to admission or, in case of a minor, where his family has so lodged; except, that admission or detention in any facility of the department shall not be deemed an absence from the place of residence and shall not constitute a change in residence;

(30) Resident , a person receiving residential services from a facility, other than mental health facility, operated, funded or licensed by the department;

(31) Residential facility , any premises where residential prevention, evaluation, care, treatment, habilitation or rehabilitation is provided for persons affected by mental disorders, mental illness, mental retardation, developmental disabilities or alcohol or drug abuse; except the person s dwelling;

(32) Specialized service , an entity which provides prevention, evaluation, transportation, care, treatment, habilitation or rehabilitation services to persons affected by mental disorders, mental illness, mental retardation, developmental disabilities or alcohol or drug abuse;

(33) Vendor , a person or entity under contract with the department, other than as a department employee, who provides services to patients, residents or clients.

630.110. 1. Each person admitted to a residential facility or day program [operated, funded or licensed by the department,] and each person admitted on a voluntary or involuntary basis to any mental health facility or mental health program where people are civilly detained pursuant to chapter 632, RSMo, except to the extent that the head of the residential facility or day program determines that it is inconsistent with the person s therapeutic care, treatment, habilitation or rehabilitation, shall be entitled to the following:

(1) To wear his own clothes and to keep and use his own personal possessions;

(2) To keep and be allowed to spend a reasonable sum of his own money for canteen expenses and small purchases;

(3) To communicate by sealed mail or otherwise with persons including agencies inside or outside the facility;

(4) To receive visitors of his own choosing at reasonable times;

(5) To have reasonable access to a telephone both to make and receive confidential calls;

(6) To have access to his mental and medical records;

(7) To have opportunities for physical exercise and outdoor recreation;

(8) To have reasonable, prompt access to current newspapers, magazines and radio and television programming.

2. Any limitations imposed by the head of the residential facility or day program or his designee on the exercise of the rights enumerated in subsection 1 of this section by a patient, resident or client and the reasons for such limitations shall be documented in his clinical record.

3. Each patient, resident or client shall have an absolute right to receive visits from his attorney, physician or clergyman, in private, at reasonable times.

4. Notwithstanding any limitations authorized under this section on the right of communication, every patient, resident or client shall be entitled to communicate by sealed mail with the department, his legal counsel and with the court, if any, which has jurisdiction over the person.

630.115. 1. Each patient, resident or client shall be entitled to the following without limitation:

(1) To humane care and treatment;

(2) To the extent that the facilities, equipment and personnel are available, to medical care and treatment in accordance with the highest standards accepted in medical practice;

(3) To safe and sanitary housing;

(4) To not participate in nontherapeutic labor;

(5) To attend or not attend religious services;

(6) To receive prompt evaluation and care, treatment, habilitation or rehabilitation about which he is informed insofar as he is capable of understanding;

(7) To be treated with dignity as a human being;

(8) To not be the subject of experimental research without his prior written and informed consent or that of his parent, if a minor, or his guardian; except that no involuntary patient shall be subject to experimental research, except as provided within this chapter;

(9) To have access to consultation with a private physician at his own expense;

(10) To be evaluated, treated or habilitated in the least restrictive environment;

(11) To not be subjected to any hazardous treatment or surgical procedure unless he, his parent, if he is a minor, or his guardian consents; or unless such treatment or surgical procedure is ordered by a court of competent jurisdiction;

(12) In the case of hazardous treatment or irreversible surgical procedures, to have, upon request, an impartial review prior to implementation, except in case of emergency procedures required for the preservation of his life;

(13) To a nourishing, well-balanced and varied diet;

(14) To be free from verbal and physical abuse.

2. Notwithstanding any other sections of this chapter, each patient, resident or client shall have the right to an impartial administrative review of alleged violations of the rights assured under this chapter. The impartial administration review process shall be a mechanism for:

(1) Reporting alleged violations of rights assured under this chapter;

(2) Investigating alleged violations of these rights;

(3) Presenting patient, resident or client grievances on the record to a neutral decision maker; and

(4) Requiring that the neutral decision maker issue findings of fact, conclusions and recommendations.

3. The impartial administrative review process shall be completed within a timely manner after the alleged violation is reported.

4. This impartial review process shall not apply to investigations of alleged patient, resident or client abuse or neglect conducted pursuant to section 630.167.

630.125. 1. At the time of admission, either on a voluntary or involuntary basis, a mental health facility or mental health program in which people may be civilly detained pursuant to chapter 632, RSMo, or a residential facility or day program operated, funded or licensed by the department shall give each patient, resident or client written information which sets forth, in lay language, the following:

(1) A description of the facility, its services and its costs;

(2) Information as to how to seek conditional release or discharge;

(3) A statement of rights assured by this chapter or the department in its rules and regulations;

(4) A description of a patient grievance procedure.

2. Unless the patient, resident or client can read the information with understanding, the facility personnel shall explain it to him.

3. The facility or program shall prominently post a list of patient or residential rights in residential and activity areas.

4. The facility shall provide prompt notification of the next-of-kin of the person being admitted within 8 hours of the time admission.

630.140. 1. Information and records compiled, obtained, prepared or maintained by the residential facility, [or] day program operated, funded or licensed by the department or otherwise, specialized service, or by any mental health facility or mental health program in which people may be civilly detained pursuant to chapter 632, RSMo, in the course of providing services to either voluntary or involuntary patients, residents or clients shall be confidential.

2. The facilities or programs shall disclose information and records to the following upon their request:

(1) The parent of a minor patient, resident or client;

(2) The guardian or other person having legal custody of the patient, resident or client;

(3) The attorney of a patient, resident or client who is a ward of the juvenile court, an alleged incompetent, an incompetent ward or a person detained under chapter 632, RSMo, as evidenced by court orders of the attorney s appointment;

(4) An attorney or personal physician as authorized by the patient, resident or client;

(5) The entity or agency authorized to implement a system to protect and advocate the rights of persons with developmental disabilities under the provisions of 42 USC 6042. The entity or agency shall be able to obtain access to the records of a person with developmental disabilities who is a client of the entity or agency if such person has authorized the entity or agency to have such access; and the records of any person with developmental disabilities who, by reason of mental or physical condition is unable to authorize the entity or agency to have such access, if such person does not have legal a guardian, conservator or other legal representative, and a complaint has been received by the entity or agency with respect to such person or there is probable cause to believe that such person has been subject to abuse or neglect. The entity or agency obtaining access to a person s records shall meet all requirements for confidentiality as set out in this section;

(6) The entity or agency authorized to implement a system to protect and advocate the rights of persons with mental illness under the provisions of 42 USC 10801 shall be able to obtain access to the records of a patient, resident or client who by reason of mental or physical condition is unable to authorize the system to have such access, who does not have a legal guardian, conservator or other legal representative and with respect to whom a complaint has been received by the system or there is probable cause to believe that such individual has been subject to abuse or neglect. The entity or agency obtaining access to a person s records shall meet all requirements for confidentiality as set out in this section. The provisions of this subdivision shall apply to a person who has a significant mental illness or impairment as determined by a mental health professional qualified under the laws and regulations of the state;

(7) To mental health coordinators, but only to the extent necessary to carry out their duties under chapter 632, RSMo.

3. The facilities or services may disclose information and records under any of the following:

(1) As authorized by the patient, resident or client;

(2) To persons or agencies responsible for providing health care services to such patients, residents or clients;

(3) To the extent necessary for a recipient to make a claim or for a claim to be made on behalf of a recipient for aid or insurance;

(4) To qualified personnel for the purpose of conducting scientific research, management audits, financial audits, program evaluations or similar studies; provided, that such personnel shall not identify, directly or indirectly, any individual patient, resident or client in any report of such research, audit or evaluation, or otherwise disclose patient, resident or client identities in any manner;

(5) To the courts as necessary for the administration of chapter 211, RSMo, 475, RSMo, 552, RSMo, or 632, RSMo;

(6) To law enforcement officers or public health officers, but only to the extent necessary to carry out the responsibilities of their office, and all such law enforcement and public health officers shall be obligated to keep such information confidential;

(7) Pursuant to an order of a court or administrative agency of competent jurisdiction;

(8) To the attorney representing petitioners [and to mental health coordinators], but only to the extent necessary to carry out their duties under chapter 632, RSMo;

(9) To the department of social services as necessary to report or have investigated abuse, neglect, or rights violations of patients, residents, or clients;

(10) To a county board established pursuant to sections 205.968 to 205.972, RSMo 1986, but only to the extent necessary to carry out their statutory responsibilities. The county board shall not identify, directly or indirectly, any individual patient, resident or client.

4. The facility or program shall document the dates, nature, purposes and recipients of any records disclosed under this section and sections 630.145 and 630.150.

5. The records and files maintained in any court proceeding under chapter 632, RSMo, shall be confidential and available only to the patient, his attorney, guardian, or, in the case of a minor, to a parent or other person having legal custody of the patient, and to the petitioner and his attorney. In addition, the court may order the release or use of such records or files only upon good cause shown, and the court may impose such restrictions as the court deems appropriate.

6. Nothing contained in this chapter shall limit the rights of discovery in judicial or administrative procedures as otherwise provided for by statute or rule.

7. The fact of admission of a voluntary or involuntary patient to a mental health facility under chapter 632, RSMo, may only be disclosed as specified in subsections 2 and 3 of this section.

630.155. 1. A person commits the crime of patient, resident or client abuse or neglect against any person admitted on a voluntary or involuntary basis to any mental health facility or mental health program in which people may be civilly detained pursuant to chapter 632, RSMo, or any patient, resident or client of any residential facility, day program or specialized service operated, funded or licensed by the department if he knowingly does any of the following:

(1) [Purposely] Beats, strikes[, wounds] or injures any person, patient, resident or client [of any residential facility or day program operated, funded or licensed by the department];

(2) [In any other manner whatsoever] Mistreats or maltreats, handles or treats any such person, patient, resident or client in a brutal or inhuman manner;

(3) [In handling such patient, resident or client] Uses any more force than is reasonably [or apparently] necessary for the proper control, treatment or management of such person, patient, resident or client;

(4) Fails to provide services which are reasonable and necessary to maintain the physical and mental health of any person, patient, resident or client [of any residential facility or day program operated, funded or licensed by the department,] when such failure presents either an imminent danger to the health, safety or welfare of the person, patient, resident or client, or a substantial probability that death or serious physical harm [would] will result.

2. Patient, resident or client abuse or neglect is a class A misdemeanor unless committed under subdivision (2) or (4) of subsection 1 of this section in which case such abuse or neglect shall be a class D felony.

630.160. 1. A person commits the crime of furnishing unfit food to patients, residents or clients if he does any of the following:

(1) Knowingly furnishes or delivers any diseased, putrid or otherwise unwholesome meat from any animal or fowl that was diseased or otherwise unfit for food to any person admitted on a voluntary or involuntary basis to any mental health facility or mental health program in which people may be civilly detained pursuant to chapter 632, RSMo, or to any residential facility or day program operated, funded or licensed by the department;

(2) Knowingly furnishes or delivers any other unwholesome food, vegetables or provisions whatsoever to such facilities or programs to be used as food by the patients, residents, clients or employees thereof;

(3) Knowingly receives or consents to receive as an employee of such facility or program any diseased or unwholesome meat, food or provisions.

2. Furnishing unfit food to patients, residents or clients is a class A misdemeanor.

630.165. 1. When any physician, dentist, chiropractor, optometrist, podiatrist, intern, nurse, medical examiner, social worker, psychologist, minister, Christian Science practitioner, peace officer, pharmacist, physical therapist, facility administrator, nurse s aide or orderly in a residential facility, day program or specialized service operated, funded or licensed by the department or in a mental health facility or mental health program in which people may be admitted on a voluntary basis or are civilly detained pursuant to chapter 632, RSMo, or employee of the department has reasonable cause to believe that a patient, resident or client of a facility, program or service has been abused or neglected, he shall immediately report or cause a report to be made to the department or the department of health, if such facility or program is licensed pursuant to chapter 197, RSMo.

2. The report shall contain the name and address of the residential facility, day program or specialized service; the name of the patient, resident or client; information regarding the nature of the abuse or neglect; the name of the complainant, and any other information which might be helpful in an investigation.

3. Any person required in subsection 1 of this section to report or cause a report to be made to the department who fails to do so within a reasonable time after the act of abuse or neglect is guilty of an infraction.

4. In addition to those persons required to report under subsection 1 of this section, any other person having reasonable cause to believe that a resident has been abused or neglected may report such information to the department.

630.167. 1. Upon receipt of a report, the department or its agents, contractors or vendors or the department of health, if such facility or program is licensed pursuant to chapter 197, RSMo, shall initiate an investigation within twenty-four hours.

2. If the investigation indicates possible abuse or neglect of a patient, resident or client, the investigator shall refer the complaint together with his report to the department director for appropriate action. If, during the investigation or at its completion, the department has reasonable cause to believe that immediate removal from a facility not operated or funded by the department is necessary to protect the residents from abuse or neglect, the department or the local prosecuting attorney may, or the attorney general upon request of the department shall, file a petition for temporary care and protection of the residents in a circuit court of competent jurisdiction. The circuit court in which the petition is filed shall have equitable jurisdiction to issue an ex parte order granting the department authority for the temporary care and protection of the resident for a period not to exceed thirty days.

3. (1) Reports shall be confidential, shall not be deemed a public record, and shall not be subject to the provisions of section 109.180, RSMo, or chapter 610, RSMo; except that, all such reports shall be open to the parents or other guardian of the patient, resident, or client who is the subject of such report. The name of the complainant or any person mentioned in the reports shall not be disclosed unless such complainant or person specifically requests such disclosure or unless a judicial proceeding results therefrom;

(2) Except as otherwise provided in this section, the proceedings, findings, deliberations, reports and minutes of investigators or of committees of health care professionals as defined in section 537.035, RSMo, or mental health professionals as defined in section 632.005, RSMo, who have the responsibility to evaluate, maintain, or monitor the quality and utilization of mental health services, or to investigate reports of abuse or neglect or incident reports or complaints of substandard, inadequate or inappropriate care are privileged and shall not be subject to the discovery, subpoena or other means of legal compulsion for their release to any person or entity or be admissible into evidence into any judicial or administrative action for failure to provide adequate or appropriate care. Such committees may exist, either within department facilities or its agents, contractors, or vendors, as applicable. Except as otherwise provided in this section, no person who was in attendance at any investigation or committee proceeding shall be permitted or required to disclose any information acquired in connection with or in the course of such proceeding or to disclose any opinion, recommendation or evaluation of the committee or board or any member thereof; provided, however, that information otherwise discoverable or admissible from original sources is not to be construed as immune from discovery or use in any proceeding merely because it was presented during proceedings before any committee or in the course of any investigation, nor is any member, employee or agent of such committee or other person appearing before it to be prevented from testifying as to matters within their personal knowledge and in accordance with the other provisions of this section, but such witness cannot be questioned about the testimony or other proceedings before any investigation or before any committee;

(3) Nothing in this section shall limit authority otherwise provided by law of a health care licensing board of the state of Missouri to obtain information by subpoena or other authorized process from investigation committees or to require disclosure of otherwise confidential information relating to matters and investigations within the jurisdiction of such health care licensing boards; provided, however, that such information, once obtained by such board and associated persons, shall be governed in accordance with the provisions of this subsection;

(4) Nothing in this section shall limit authority otherwise provided by law in subdivisions (5) and (6) of subsection 2 of section 630.140 concerning access to records by the entity or agency authorized to implement a system to protect and advocate the rights of persons with developmental disabilities under the provisions of 42 U.S.C. 6042 and the entity or agency authorized to implement a system to protect and advocate the rights of persons with mental illness under the provisions of 42 U.S.C. 10801. In addition, nothing in this section shall serve to negate assurances that have been given by the governor of Missouri to the U.S. Administration on Developmental Disabilities, Office of Human Development Services, Department of Health and Human Services concerning access to records by the agency designated as the protection and advocacy system for the state of Missouri. However, such information, once obtained by such entity or agency, shall be governed in accordance with the provisions of this subsection.

4. Anyone who makes a report pursuant to this section or who testifies in any administrative or judicial proceeding arising from the report shall be immune from any civil liability for making such a report or for testifying unless such person acted in bad faith or with malicious purpose.

5. Within five working days after a report required to be made under this section is received, the person making the report shall be notified in writing of its receipt and of the initiation of the investigation.

6. No person who directs or exercises any authority in a residential facility, day program or specialized service shall evict, harass, dismiss or retaliate against a patient, resident or client or employee because he or any member of his family has made a report of any violation or suspected violation of laws, ordinances or regulations applying to the facility which he has reasonable cause to believe has been committed or has occurred.

7. Any person who is discharged as a result of an administrative substantiation of allegations contained in a report of abuse or neglect may, after exhausting administrative remedies as provided in chapter 36, RSMo, appeal such decision to the circuit court of the county in which such person resides within ninety days of such final administrative decision. The court may accept an appeal up to twenty-four months after the party filing the appeal received notice of the department s determination, upon a showing that:

(1) Good cause exists for the untimely commencement of the request for the review;

(2) If the opportunity to appeal is not granted it will adversely affect the party s opportunity for employment; and

(3) There is no other adequate remedy at law.

630.168. If it is alleged or suspected that any patient, resident or client who has been admitted on a voluntary or involuntary basis to a mental health facility or mental health program in which people are detained pursuant to chapter 632, RSMo, or any patient, resident or client in a residential facility, [or] day program or specialized service operated, funded or licensed by the department is being or has been subjected to patient or resident abuse which results in physical injury, and in cases of sexual abuse, the head of the facility, [or] program or service shall[, as specified in the department s rules and regulations,] promptly notify local law enforcement authorities and cooperate fully with any investigation by them.

630.170. 1. A person convicted of any crime under section 630.155, 630.160 or 630.165 shall be disqualified from holding any position in any public or private facility or day program operated, funded or licensed by the department or in any mental health facility or mental health program in which people are admitted on a voluntary or involuntary basis or are civilly detained pursuant to chapter 632, RSMo.

2. A person convicted of any felony offense against persons as defined in chapter 565, RSMo; of any felony sexual offense as defined in chapter 566, RSMo; of any felony offense defined in section 568.050, 568.060, 569.020, 569.030, 569.040 or 569.050, RSMo, or of an equivalent felony offense shall be disqualified from holding any direct-care position in any public or private facility, day program, residential facility or specialized service operated, funded or licensed by the department or any mental health facility or mental health program in which people are admitted on a voluntary basis or are civilly detained pursuant to chapter 632, RSMo.

630.175. 1. No person admitted on a voluntary or involuntary basis to any mental health facility or mental health program in which people are civilly detained pursuant to chapter 632, RSMo, and no patient, resident or client of a residential facility or day program operated, funded or licensed by the department shall be subject to physical or chemical restraint, isolation or seclusion unless it is determined by the head of the facility or the attending licensed physician that the chosen intervention is [to be] imminently necessary to protect the health and safety of the patient, resident, client or others and that it provides the least restrictive environment.

2. Every use of physical or chemical restraint, isolation or seclusion and the reasons therefor shall be made a part of the clinical record of the patient, resident or client under the signature of the head of the facility or the attending licensed physician.

3. Physical or chemical restraint, isolation or seclusion shall not be considered standard treatment or habilitation and shall cease as soon as the circumstances causing the need for such action have ended.

630.192. No biomedical or pharmacological research shall be conducted in any mental health facility or mental health program in which people may be civilly detained pursuant to chapter 632, RSMo, or in any public or private residential facilities or day programs operated, funded or licensed by the department for persons affected by mental retardation, developmental disabilities, mental illness, mental disorders or alcohol or drug abuse unless such research is intended to alleviate or prevent the disabling conditions or is reasonably expected to be of direct therapeutic benefit to the participants. Without a specific court order, no involuntary patient shall consent to participate in any biomedical or pharmacological research. The application for the order shall be filed in the court having probate jurisdiction in the county in which the mental health facility is located, provided, however, that if the patient requests that the hearing be held by the court which has committed the patient, or if the court having probate jurisdiction deems it appropriate, the hearing on the application shall be transferred to the committing court.

630.199. Sections 630.194, 630.196 and 630.198 shall apply to all proposed biomedical or pharmacological research that involves persons civilly detained.

630.200. In accordance with state and federal law, no mental health facility or mental health program in which people may be civilly detained pursuant to chapter 632, RSMo, and no residential facility, day program or specialized service operated, funded or licensed by the department shall deny admission or other services to any person because of his race, sex, creed, marital status, national origin, [handicap] disability or age.

631.110. 1. The head of an alcohol or drug abuse facility may discharge any voluntary client whose continued involvement in the program is determined to be either no longer beneficial to the client or an ineffective use of the facility.

2. The head of an alcohol or drug abuse facility shall release any client who requests his release in writing or whose release is requested by his guardian or parent, if the parent applied for admission; except that, if the head of the facility believes the client is presenting a likelihood of serious [physical] harm as a result of the alcohol or drug abuse, the head of the facility may deny the request for release. If the request for release is denied, the head of the facility may detain the client only if he immediately initiates the involuntary detention procedure set out in this chapter.

631.115. 1. Any adult person may file an application in the probate division of the circuit court for detention, treatment, and rehabilitation in an alcohol or drug abuse facility of a person presenting a likelihood of serious [physical] harm to himself or others as a result of alcohol or drug abuse, or both.

2. The procedures of section 632.305, RSMo, apply to the disposition of the application and entry of an order by the court for detention, treatment, and rehabilitation for up to ninety-six hours unless further authorized by the court, for a person found, upon probable cause, to be presenting a likelihood of serious [physical] harm to himself or others as a result of alcohol or drug abuse, or both.

631.120. 1. A mental health coordinator, mental health professional, peace officer, registered nurse, licensed physician, or qualified counselor may complete an application for detention, treatment, or rehabilitation for up to ninety-six hours under the procedures of section 632.305, RSMo, for a person presenting an imminent likelihood of serious [physical] harm to himself or others as a result of alcohol or drug abuse, or both.

2. If a peace officer has reasonable cause to believe that unless a person is taken into custody the likelihood of serious [physical] harm is imminent as a result of alcohol or drug abuse, or both, the officer may take the person into custody and convey him to an alcohol or drug abuse facility. The officer shall complete an application for detention indicating the facts upon which the belief is based.

631.135. If a respondent is accepted for treatment and rehabilitation pursuant to this chapter, he shall be advised, orally and in writing, of the information contained in subdivisions (1) to (11) of this section. The respondent s guardian, if any, and, with the respondent s consent, a responsible member of his immediate family shall be advised if possible, either orally or in writing, of his admission to the facility. The personnel of the alcohol or drug abuse facility to which the respondent is taken shall advise the respondent that unless the respondent is released or voluntarily admits himself within ninety-six hours of the initial detention:

(1) He may be detained for ninety-six hours from the time of his initial detention to receive treatment and rehabilitation;

(2) Within the ninety-six hours, the head of the alcohol or drug abuse facility or the mental health coordinator may file a petition to have him detained, after a court hearing, for an additional period not to exceed thirty days;

(3) He will be given a judicial hearing within two judicial days after the day the petition for additional detention is filed, unless continued for good cause;

(4) An attorney has been appointed who will represent him before and after the hearing and who will be notified as soon as possible; except that, he also has the right to private counsel of his own choosing and at his own expense;

(5) He has the right to communicate with counsel at all reasonable times and to have assistance in contacting such counsel;

(6) Anything he says to personnel at the alcohol or drug abuse facility may be used in making a determination regarding detention, may result in involuntary detention proceedings being filed concerning him, and may be used at the court hearing;

(7) He has the right to present evidence and to cross-examine witnesses who testify on behalf of the petitioner at the hearing;

(8) During the period prior to being examined by a licensed physician, he may refuse medication unless he presents an imminent likelihood of serious [physical injury] harm to himself or others;

(9) He has the right to refuse medication except for lifesaving treatment beginning twenty-four hours prior to the hearing for thirty-day detention;

(10) He has the right to request that the hearing be held in his county of residence if he is a resident of this state;

(11) He has the right to have an interpreter assist him to communicate at the facility or during the hearing, or both, if he has impaired hearing [or does not speak English];

(12) He has the right to have an interpreter, at his own expense, assist him to communicate at the facility or during the hearing, or both, if he does not speak English.

631.140. 1. At the expiration of the ninety-six-hour period, the respondent may be detained and treated involuntarily for an additional two judicial days only if the head of the alcohol or drug abuse facility or a mental health coordinator has filed a petition for additional detention not to exceed thirty days.

2. Within ninety-six hours following initial detention, the head of the facility or the mental health coordinator may file, or cause to be filed, a petition for a thirty-day involuntary detention, treatment, or rehabilitation period provided he has reasonable cause to believe that the person abuses alcohol or drugs and presents a likelihood of serious [physical] harm to himself or others as a result of alcohol or drug abuse, or both. The court shall serve the petition and list of prospective witnesses for the petitioner upon the respondent and his attorney at least twenty-four hours before the hearing. The head of the facility shall also notify the mental health coordinator if the petition is not filed by the mental health coordinator. The petition shall:

(1) Allege that the respondent, by reason of alcohol or drug abuse, or both, presents a likelihood of serious [physical] harm to himself or to others;

(2) Allege that the respondent is in need of continued detention, treatment, and rehabilitation;

(3) Allege the specific behavior of the respondent or the facts which support such conclusion;

(4) Allege that an alcohol or drug abuse facility which is appropriate to handle the respondent s condition has agreed to accept the respondent; and

(5) Be signed by a licensed physician who has examined the respondent.

631.145. 1. The petition for thirty-day involuntary detention, treatment, and rehabilitation shall be filed with the probate division of the circuit court. At the time of filing the petition, the court clerk shall set a date and time for the hearing which shall take place within two judicial days of the filing of the petition. The clerk shall promptly notify the respondent, his attorney, the petitioner and the petitioner s attorney of the date and time for the hearing. The court shall not grant continuances except upon a showing of good and sufficient cause. If a continuance is granted, the court, in its discretion, may order the person released pending the hearing upon conditions prescribed by the court. The court may order the continued detention, treatment, and rehabilitation of the person at an alcohol or drug abuse facility pending the continued hearing, and a copy of such order shall be furnished to the facility.

2. The hearing shall be conducted in as informal a manner as may be consistent with orderly procedure and in a physical setting not likely to have a harmful effect on the respondent. In addition to all rights specified elsewhere, the respondent shall have the right to:

(1) Be represented by an attorney;

(2) Present evidence on his own behalf;

(3) Cross-examine witnesses who testify on behalf of the petitioner;

(4) Remain silent;

(5) View and copy all petitions and reports in the court file of his case;

(6) Have the hearing open or closed to the public as he elects;

(7) Have the hearing conducted according to the rules of evidence applicable to civil judicial proceedings.

3. The respondent shall be present at the hearing unless he refuses to be present, his physical condition is such that he cannot be present in the courtroom, or the court determines that the respondent s conduct in the courtroom is so disruptive that the proceedings cannot reasonably continue with him present.

4. At the conclusion of the hearing, if the court finds, based upon clear and convincing evidence, that the respondent, as the result of alcohol or drug abuse, or both, presents a likelihood of serious [physical] harm to himself or to others, the court shall order that the respondent be detained for involuntary treatment and rehabilitation in the least restrictive environment for a period not to exceed thirty days.

631.150. 1. Before the expiration of the thirty-day period of detention, treatment, and rehabilitation ordered pursuant to section 631.145, the court may order the respondent to be detained for treatment and rehabilitation for an additional period not to exceed ninety days; provided that:

(1) The respondent, as the result of alcohol or drug abuse, or both, continues to present a likelihood of serious [physical] harm to himself or to others; and

(2) The court, after a hearing, orders the respondent detained for treatment and rehabilitation for the additional period.

2. If, within twenty-five days of the court hearing described in section 631.145, the head of the alcohol or drug abuse facility or the mental health coordinator has reasonable cause to believe that the respondent, as the result of alcohol or drug abuse, or both, presents a likelihood of serious [physical] harm to himself or others, and believes that further detention and treatment is necessary, he shall file, or cause to be filed, with the court a petition for ninety days additional detention, treatment, and rehabilitation. The court shall immediately set a date and time for a hearing on the petition, which shall take place within four judicial days of the date of the filing of the petition. The court shall serve a copy of the petition and the notice of the date and time of the hearing upon the petitioner, the respondent, and their attorneys as promptly as possible, but not later than two judicial days after the filing of the petition. The petitioner shall also file with the court, for the court to serve upon the respondent s attorney not later than two days after the filing of the petition, a list of the proposed witnesses for the petitioner. The head of the alcohol or drug abuse facility shall notify the mental health coordinator if the petition is not filed by the mental health coordinator. The petition shall comply with the requirements of section 631.140, and an individualized treatment and rehabilitation plan for the respondent shall be attached thereto.

631.165. If the head of the alcohol or drug abuse facility finds that a person who is detained for treatment and rehabilitation is presenting a likelihood of serious [physical] harm as a result of mental disorder other than alcohol or drug abuse, or both, the head of the facility shall arrange for the transfer of the person to a mental health facility through a mental health coordinator, or through a licensed physician, registered professional nurse, qualified counselor or mental health professional designated by the mental health facility. The person may be detained for up to ninety-six hours for evaluation and treatment, under the procedures of sections 632.310, 632.315, 632.320 and 632.325, RSMo, before filing a petition for further detention under sections 632.330 and 632.335, RSMo.

632.005. As used in chapter 631, RSMo, and this chapter, unless the context clearly requires otherwise, the following terms shall mean:

(1) Comprehensive psychiatric services , any one, or any combination of two or more, of the following services to persons affected by mental disorders other than mental retardation or developmental disabilities: inpatient, outpatient, day program or other partial hospitalization, emergency, diagnostic, treatment, liaison, follow-up, consultation, education, rehabilitation, prevention, screening, transitional living, medical prevention and treatment for alcohol abuse, and medical prevention and treatment for drug abuse;

(2) Council , the Missouri advisory council for comprehensive psychiatric services;

(3) Court , the court which has jurisdiction over the respondent or patient;

(4) Division , the division of comprehensive psychiatric services of the department of mental health;

(5) Division director , director of the division of comprehensive psychiatric services of the department of mental health, or his designee;

(6) Head of mental health facility , superintendent or other chief administrative officer of a mental health facility, or his designee;

(7) Judicial day , any Monday, Tuesday, Wednesday, Thursday or Friday when the court is open for business, but excluding Saturdays, Sundays and legal holidays;

(8) Licensed physician , a physician licensed pursuant to the provisions of chapter 334, RSMo, or a person authorized to practice medicine in this state pursuant to the provisions of section 334.150, RSMo;

(9) Likelihood of serious [physical] harm means any one or more of the following but does not require actual physical injury to have occurred:

(a) A substantial risk that serious physical harm will be inflicted by a person upon his own person, as evidenced by recent threats, including verbal threats, or attempts to commit suicide or inflict physical harm on himself. Evidence of substantial risk may also include information about patterns of behavior that historically have resulted in serious harm previously being inflicted by a person upon himself;

(b) A substantial risk that serious physical harm to a person will result because of an impairment in his capacity to make decisions with respect to his hospitalization and need for treatment as evidenced by his inability to provide for his own basic necessities of food, clothing, shelter, safety or medical or mental health care. Evidence of that substantial risk may also include information about patterns of behavior that historically have resulted in serious harm to the person previously taking place because he was unable to provide for his basic necessities of food, clothing, shelter, safety or medical or mental health care; or

(c) A substantial risk that serious physical harm will be inflicted by a person upon another as evidenced by recent overt acts, behavior or threats, including verbal threats, which have caused such harm or which would place a reasonable person in reasonable fear of sustaining such harm. Evidence of that substantial risk may also include information about patterns of behavior that historically have resulted in physical harm previously being inflicted by a person upon another person;

(10) Mental health coordinator , a mental health professional who has knowledge of the laws relating to hospital admissions and civil commitment and who is appointed by the director of the department, or his designee, to serve a designated geographic area or mental health facility and who has the powers, duties and responsibilities provided in this chapter;

(11) Mental health facility , any residential facility, public or private, or any public or private hospital, which can provide evaluation, treatment and, inpatient care to persons suffering from a mental disorder or mental illness and which is recognized as such by the department or any outpatient treatment program certified by the department of mental health. No correctional institution or facility, jail, regional center or mental retardation facility shall be a mental health facility within the meaning of this chapter;

(12) Mental health professional , a psychiatrist, resident in psychiatry, psychologist, psychiatric nurse or psychiatric social worker;

(13) Mental health program , any public or private residential facility, public or private hospital, public or private specialized service or public or private day program that can provide care, treatment, rehabilitation or services, either through its own staff or through contracted providers, in an inpatient or outpatient setting to persons with a mental disorder or mental illness or with a diagnosis of alcohol abuse or drug abuse which is recognized as such by the department. No correctional institution or facility or jail may be a mental health program within the meaning of the chapter;

[(13)] (14) Ninety-six hours shall be construed and computed to exclude Saturdays, Sundays and legal holidays which are observed either by the court or by the mental health facility where the respondent is detained;

[(14)] (15) Peace officer , a sheriff, deputy sheriff, county or municipal police officer or highway patrolman;

[(15)] (16) Psychiatric nurse , a registered professional nurse who is licensed under chapter 335, RSMo, and who has had at least two years of experience as a registered professional nurse in providing psychiatric nursing treatment to individuals suffering from mental disorders;

[(16)] (17) Psychiatric social worker , a person with a master s or further advanced degree from an accredited school of social work, practicing pursuant to chapter 337 and with a minimum of one year training or experience in providing psychiatric care, treatment or services in a psychiatric setting to individuals suffering from a mental disorder[, or a degree from a graduate school deemed equivalent under rules and regulations adopted by the director];

[(17)] (18) Psychiatrist , a licensed physician who in addition has successfully completed a training program in psychiatry approved by the American Medical Association, the American Osteopathic Association or other training program certified as equivalent by the department;

[(18)] (19) Psychologist , a person [qualified] licensed to practice psychology under chapter 337, RSMo, with a minimum of one year training or experience in providing treatment or services to mentally disordered or mentally ill individuals;

[(19)] (20) Resident in psychiatry , a licensed physician who is in a training program in psychiatry approved by the American Medical Association, the American Osteopathic Association or other training program certified as equivalent by the department;

[(20)] (21) Respondent , an individual against whom involuntary civil detention proceedings are instituted pursuant to this chapter;

[(21)] (22) Treatment , any effort to accomplish a significant change in the mental or emotional conditions or the behavior of the patient consistent with generally recognized principles or standards in the mental health professions.

632.300. 1. When a mental health coordinator receives information alleging that a person, as the result of a mental disorder, presents a likelihood of serious [physical] harm to himself or others, he shall:

(1) Conduct an investigation;

(2) Evaluate the allegations and the data developed by investigation; and

(3) Evaluate the reliability and credibility of all sources of information.

2. If, as the result of personal observation or investigation, the mental health coordinator has reasonable cause to believe that such person is mentally disordered and, as a result, presents a likelihood of serious [physical] harm to himself or others, the mental health coordinator may file an application with the court having probate jurisdiction pursuant to the provisions of section 632.305; provided, however, that should the mental health coordinator have reasonable cause to believe, as the result of personal observation or investigation, that the likelihood of serious [physical] harm by such person to himself or others as a result of a mental disorder is imminent unless the person is immediately taken into custody, the mental health coordinator shall request a peace officer to take or cause such person to be taken into custody and transported to a mental health facility in accordance with the provisions of subsection 3 of section 632.305.

3. If the mental health coordinator determines that involuntary commitment is not appropriate, he should inform either the person, his family or friends about those public and private agencies and courts which might be of assistance.

632.301. When a mental health coordinator receives information pursuant to Section 632.300, the person considered for involuntary commitment shall be evaluated according to the likelihood of serious physical harm to himself or others. Where such person has been previously clinically diagnosed with a serious mental illness, such involuntary commitment may occur if there is reasonable cause to believe that such person is mentally disordered and, as a result, presents likelihood of harm to himself or others.

632.305. 1. An application for detention for evaluation and treatment may be executed by any adult person, who need not be an attorney or represented by an attorney, including the mental health coordinator, on a form provided by the court for such purpose, and must allege under oath that the applicant has reason to believe that the respondent is suffering from a mental disorder and presents a likelihood of serious [physical] harm to himself or to others. The application must specify the factual information on which such belief is based and should contain the names and addresses of all persons known to the applicant who have knowledge of such facts through personal observation.

2. The filing of a written application in court by any adult person, who need not be an attorney or represented by an attorney, including the mental health coordinator, shall authorize the applicant to bring the matter before the court on an ex parte basis to determine whether the respondent should be taken into custody and transported to a mental health facility. The application may be filed in the court having probate jurisdiction in any county where the respondent may be found. If the court finds that there is probable cause, either upon testimony under oath or upon a review of affidavits, to believe that the respondent may be suffering from a mental disorder and presents a likelihood of serious [physical] harm to himself or others, it shall direct a peace officer to take the respondent into custody and transport him to a mental health facility for detention for evaluation and treatment for a period not to exceed ninety-six hours unless further detention and treatment is authorized pursuant to this chapter. Nothing herein shall be construed to prohibit the court, in the exercise of its discretion, from giving the respondent an opportunity to be heard.

3. A mental health coordinator may request a peace officer to take or a peace officer may take a person into custody for detention for evaluation and treatment for a period not to exceed ninety-six hours only when such mental health coordinator or peace officer has reasonable cause to believe that such person is suffering from a mental disorder and that the likelihood of serious [physical] harm by such person to himself or others is imminent unless such person is immediately taken into custody. Upon arrival at the mental health facility, the peace officer or mental health coordinator who conveyed such person or caused him to be conveyed shall either present the application for detention for evaluation and treatment upon which the court has issued a finding of probable cause and the respondent was taken into custody or complete an application for initial detention for evaluation and treatment for a period not to exceed ninety-six hours which shall be based upon his own personal observations or investigations and shall contain the information required in subsection 1 of this section.

4. If a person presents himself or is presented by others to a mental health facility and a licensed physician, a registered professional nurse or a mental health professional designated by the head of the facility and approved by the department for such purpose has reasonable cause to believe that the person is mentally disordered and presents an imminent likelihood of serious [physical] harm to himself or others unless he is accepted for detention, the licensed physician, the mental health professional or the registered professional nurse designated by the facility and approved by the department may complete an application for detention for evaluation and treatment for a period not to exceed ninety-six hours. The application shall be based on his own personal observations or investigation and shall contain the information required in subsection 1 of this section.

632.330. 1. At the expiration of the ninety-six hour period, the respondent may be detained and treated involuntarily for an additional two judicial days only if the head of the mental health facility or a mental health coordinator either has filed a petition for additional inpatient detention and treatment not to exceed twenty-one days or has filed a petition for outpatient detention and treatment for a period not to exceed one hundred and eighty days.

2. Within ninety-six hours following initial detention, the head of the facility or the mental health coordinator may file or cause to be filed either a petition for a twenty-one-day inpatient involuntary detention and treatment period or a petition for outpatient detention and treatment for a period not to exceed one hundred eighty days, provided he has reasonable cause to believe that the person is mentally ill and as a result presents a likelihood of serious [physical] harm to himself or others. The court shall serve the petition and list of prospective witnesses for the petitioner upon the respondent and his attorney at least twenty-four hours before the hearing. The head of the facility shall also notify the mental health coordinator if the petition is not filed by the mental health coordinator. The petition shall:

(1) Allege that the respondent, by reason of mental illness, presents a likelihood of serious [physical] harm to himself or to others;

(2) Allege that the respondent is in need of continued detention and treatment either on an inpatient basis or on an outpatient basis;

(3) Allege the specific behavior of the respondent or the facts which support such conclusion;

(4) Affirm that attempts were made to provide necessary care, treatment and services in the least restrictive environment to the respondent on a voluntary basis, but either the petitioner believes that the respondent lacks the capacity to voluntarily consent to care, treatment and services or the respondent refuses to voluntarily consent to care, treatment and services such that proceeding with a petition for the respondent s civil detention in the least restrictive environment is necessary;

(5) Allege that there will be appropriate support from family, friends, case managers or others during the period of outpatient detention and treatment in the community if such commitment is sought;

[(4)] (6) [Allege that a] Specify the mental health [facility which] program that is appropriate to handle the respondent s condition and that has agreed to accept the respondent; [and]

(7) Specify the range of care, treatment and services that shall be provided to the respondent if the petition for further detention is sustained by the court;

(8) Name the entities that have agreed to fund and provide the specified interventions; and

[(5)] (9) Be verified by a psychiatrist or by a licensed physician and a mental health professional who have examined the respondent.

3. The petitioner shall consider whether based on the respondent s condition and treatment history, the respondent meets the criteria in chapter 475, RSMo, so that appointment of a full or limited guardian or conservator is appropriate for the court to consider, and if deemed so, the petitioner than shall proceed as specified in subsection 4 of this section.

4. If the head of the mental health facility, or his designee, or the mental health coordinator believes that the respondent, because of a mental illness or mental disorder, may be incapacitated or disabled as defined in chapter 475, RSMo, the head of the mental health facility or mental health coordinator shall cause a petition to be filed pursuant to section 475.060, and section 475.061, RSMo, if applicable, with the court having probate jurisdiction as determined by section 475.035, RSMo. In addition, if the head of the mental health facility, his designee or the mental health coordinator believes it appropriate, he shall proceed with obtaining an order for the respondent s temporary emergency detention as provided for in section 475.355, RSMo. Furthermore, the hearing on the petition filed pursuant to chapter 475, RSMo, shall be conducted pursuant to the requirements of section 475.075, RSMo, and other appropriate sections of chapter 475, RSMo, and shall be held within two judicial days after termination of the ninety-six hour civil detention period unless continued for good cause shown. Nothing contained in this subsection shall restrict or prohibit the head of the mental health facility, his designee or the mental health coordinator from proceeding under the appropriate provisions of this chapter if the petition for guardianship or conservatorship is denied.

632.335. 1. The petition for [twenty-one-day involuntary detention and treatment] additional inpatient detention and treatment not to exceed twenty- one days or the petition for outpatient detention and treatment not to exceed one hundred and eighty days shall be filed with the court having probate jurisdiction. At the time of filing the petition, the court clerk shall set a date and time for the hearing which shall take place within two judicial days of the filing of the petition. The clerk shall promptly notify the respondent, his attorney, the petitioner and the petitioner s attorney of the date and time for the hearing. The court shall not grant continuances except upon a showing of good and sufficient cause. If a continuance is granted, the court, in its discretion, may order the person released pending the hearing upon conditions prescribed by the court. The court may order the continued detention and treatment of the person at a mental health facility pending the continued hearing, and a copy of such order shall be furnished to the facility.

2. The hearing shall be conducted in as informal a manner as may be consistent with orderly procedure and in a physical setting not likely to have a harmful effect on the respondent. Due consideration shall be given by the court to holding a hearing at the mental health facility. The respondent shall have the following rights in addition to those specified elsewhere:

(1) To be represented by an attorney;

(2) To present evidence on his own behalf;

(3) To cross-examine witnesses who testify against him;

(4) To remain silent;

(5) To view and copy all petitions and reports in the court file of his case;

(6) To have the hearing open or closed to the public as he elects;

(7) To be proceeded against according to the rules of evidence applicable to civil judicial proceedings;

(8) [To request] A hearing before a jury if requested by the patient or his attorney.

3. The respondent shall be present at the hearing, unless the respondent s physical condition is such that he cannot be present in the courtroom or if the court determines that the respondent s conduct in the courtroom is so disruptive that the proceedings cannot reasonably continue.

4. At the conclusion of the hearing, if the court finds, based upon clear and convincing evidence, that the respondent, as the result of mental illness, presents a likelihood of serious [physical] harm to himself or to others, and that a [facility] mental health program appropriate to handle the respondent s condition has agreed to accept him, the court shall order either that the respondent be detained for inpatient involuntary treatment in the least restrictive environment for a period not to exceed twenty-one days or be detained for outpatient detention and treatment under the supervision of a mental health program in the least restrictive environment for a period not to exceed one hundred and eighty days.

632.337. 1. When the court has ordered up to one hundred eighty days of outpatient detention and treatment pursuant to sections 632.335 or 632.350 or 632.355, and the supervisory mental health program has good cause to believe that immediate detention in a more appropriate least restrictive environment is required because the respondent presents a likelihood of serious harm due to mental illness, the supervisory mental health program may direct that the respondent be detained for up to ninety-six hours at an appropriate mental health program that has agreed to accept the respondent and may authorize the sheriff to detain and transport the respondent to that mental health program. Detention for more than ninety-six hours shall be pursuant to section 632.330.

2. Evidence of detention for ninety-six hour periods during the one hundred eighty-day outpatient detention and treatment may be considered by the court in determining additional periods of detention and treatment.

632.340. 1. Before the expiration of the twenty-one-day inpatient detention and treatment period ordered pursuant to section 632.335, the court may order the respondent to be detained and treated involuntarily for an additional period not to exceed ninety inpatient days or may order the respondent to be detained for outpatient detention and treatment for a period not to exceed one hundred and eighty days; provided, that:

(1) The respondent is mentally ill and continues to present a likelihood of serious [physical] harm to himself or others; and

(2) The court, after a hearing, orders the respondent detained and treated for the additional period.

2. If, within seventeen days of the court hearing described in section 632.335, the head of the mental health [facility] program or the mental health coordinator has reasonable cause to believe that the respondent is mentally ill and as a result presents a likelihood of serious [physical] harm to himself or others, and believes that further detention and treatment is necessary, he shall file, or cause to be filed, with the court a petition for ninety days additional detention and treatment or a petition for outpatient detention and treatment for a period not to exceed one hundred and eighty days. The court shall immediately set a date and time for a hearing on the petition, which shall take place within four judicial days of the date of the filing of the petition. The court shall serve a copy of the petition and the notice of the date and time of the hearing upon the petitioner, the respondent, and their attorneys as promptly as possible, but not later than two judicial days after the filing of the petition. The petitioner shall also file with the court, for the court to serve upon the respondent s attorney not later than two judicial days after the filing of the petition, a list of the proposed witnesses for the petitioner. The head of the mental health [facility] program shall notify the mental health coordinator if the petition is not filed by the mental health coordinator. The petition shall comply with the requirements of section 632.330, and an individualized treatment plan for the respondent shall be attached thereto.

632.345. 1. If requested by the respondent, the court shall appoint an available licensed physician to examine him and testify at the respondent s request. If the respondent or his counsel so request, the court shall not appoint a physician who is on the staff of the [facility] program wherein the person is detained, and if the respondent is detained in a [facility] program operated by the department and respondent or his counsel so request, the court shall not appoint a physician who is an employee of the department.

2. The court may grant continuances but shall do so only upon a showing of good and sufficient cause.

3. The respondent shall continue to be detained and treated pending the hearing unless released by order of the court. If a continuance is granted, the court, in its discretion, may order respondent released upon conditions described by the court pending the hearing. If no order has been made within thirty days after the filing of the petition, not including extensions of time requested by the respondent and granted, the respondent shall be released.

632.350. 1. The hearing for a ninety-day inpatient detention and treatment period or for outpatient detention and treatment for a period not to exceed one hundred and eighty days shall be conducted in as informal a manner as may be consistent with orderly procedure and in a physical setting not likely to have a harmful effect on the mental health of the respondent. If a jury trial is not requested, due consideration shall be given by the court to holding a hearing at the mental health [facility] program. The hearing shall be held in accordance with the provisions set forth in section 632.335.

2. The burden of proof at the hearing shall be by clear and convincing evidence and shall be upon the petitioner.

3. If the matter is tried before a jury, the jury shall determine and shall be instructed only upon the issues of whether or not the respondent is mentally ill and, as a result, presents a likelihood of serious [physical] harm to himself or others. The remaining procedures for the jury trial shall be as in other civil matters.

4. The respondent shall not be required to file an answer or other responsive pleading.

5. At the conclusion of the hearing, if the court or jury finds that the respondent, as the result of mental illness, presents a likelihood of serious [physical] harm to himself or to others, and the court finds that a [facility] program appropriate to handle the respondent s condition has agreed to accept him, the court shall order the respondent to be detained for involuntary treatment in the least restrictive environment for a period not to exceed ninety days or for outpatient detention and treatment under the supervision of a mental health program in the least restrictive environment for a period not to exceed one hundred and eighty days.

632.355. 1. At the expiration of the ninety-day inpatient commitment period ordered by the court pursuant to section 632.350, the respondent may be detained and treated as an involuntarily inpatient for an additional period of time not to exceed one year or such lesser period of time as determined by the court or may be detained for outpatient detention and treatment for a period of time not to exceed one hundred and eighty days; provided, that:

(1) The respondent is mentally ill and continues to present a likelihood of serious [physical] harm to himself or to others; and

(2) The court after a hearing orders the person detained and treated for the additional period.

2. Within the ninety-day commitment period, the head of the mental health [facility] program or the mental health coordinator may file or cause to be filed [a petition], in compliance with the requirements of section 632.330, a petition for a one-year inpatient detention and treatment period or a petition for outpatient detention and treatment for a period not to exceed one hundred and eighty days if he has reasonable cause to believe that the respondent is mentally ill and as a result presents a likelihood of serious [physical] harm to himself or others, and that further detention and treatment is necessary pursuant to an individualized treatment plan prepared by the [facility] program and filed with the court. Procedures specified in sections 632.340, 632.345 and 632.350 shall be followed.

3. At the conclusion of the hearing, if the court or jury finds that the respondent, as the result of mental illness, presents a likelihood of serious [physical] harm to himself or others, and the court finds that a [facility] program appropriate to handle the respondent s condition has agreed to accept him, the court shall order that the respondent be detained for involuntary treatment in the least restrictive environment for a period not to exceed one year or for outpatient detention and treatment under the supervision of a mental health program in the least restrictive environment for a period not to exceed one hundred and eighty days.

632.360. At the end of any detention period ordered by the court under this chapter, the respondent shall be discharged unless a petition for further detention is filed and heard in the same manner as provided herein. Successive one-year detention periods, or successive one hundred and eighty day outpatient detention periods, are permissible on the same grounds and pursuant to the same procedures as the initial [one-year] detention period. No order of civil detention under this chapter may exceed one year for an inpatient detention period or one hundred and eighty days for an outpatient detention period.

632.365. Notwithstanding any other provision of the law to the contrary, whenever a court orders a person detained for involuntary treatment in a mental health [facility] program operated by the department, the order of detention shall be to the custody of the director of the department, who shall determine where detention and involuntary treatment shall take place in the least restrictive environment, be it an inpatient or outpatient setting.

632.370. 1. The department may transfer, or authorize the transfer of, an involuntary patient detained under this chapter, chapter 211, RSMo, chapter 475, RSMo, or chapter 552, RSMo, from one mental health [facility] program to another if the department determines that it would be consistent with the medical needs of the patient to do so. If a minor is transferred from a ward for minors to an adult ward, the department shall conduct a due process hearing within six days of such transfer during which hearing the head of the [facility] program shall have the burden to show that the transfer is appropriate for the medical needs of the minor. Whenever a patient is transferred, written notice thereof shall be given after obtaining the consent of the patient, his parent if he is a minor or his legal guardian to his legal guardian, parents and spouse, or, if none be known, his nearest known relative or friend. In all such transfers, due consideration shall be given to the relationship of the patient to his family, legal guardian or friends, so as to maintain relationships and encourage visits beneficial to the patient. The head of the mental health [facility] program shall notify the court ordering detention or commitment, the patient s last known attorney of record and the mental health coordinator for the region of such transfer. In the case of a patient committed under chapter 211, RSMo, the court, on its own motion, may hold a hearing on the transfer to determine whether such transfer is appropriate to the medical needs of the patient.

2. Upon receipt of a certificate of an agency of the United States that facilities are available for the care or treatment of any individual heretofore ordered involuntarily detained, treated and evaluated pursuant to this chapter in any facility for the care or treatment of the mentally ill, mentally retarded or developmentally disabled and that such individual is eligible for care or treatment in a hospital or institution of such agency, the department may cause his transfer to such agency of the United States for hospitalization. Upon effecting any such transfer, the court ordering hospitalization, the legal guardian, spouse and parents, or, if none be known, his nearest known relative or friend shall be notified thereof immediately by the department. No person shall be transferred to an agency of the United States if he is confined pursuant to a conviction for any felony or misdemeanor or if he has been acquitted of any felony or misdemeanor solely on the ground of mental illness, unless prior to transfer the court originally ordering confinement of such person enters an order for the transfer after appropriate motion and hearing. Any person transferred to an agency of the United States shall be deemed to be hospitalized by such agency pursuant to the original order of hospitalization.

632.375. 1. At least once every one hundred eighty days, the head of each mental health [facility] program shall have each respondent who is detained at the [facility] program for a one-year period under this chapter examined and evaluated to determine if the respondent continues to be mentally ill, and as a result presents a likelihood of serious [physical] harm to himself or others. The court, the mental health coordinator for the region, the respondent and the respondent s attorney shall be provided copies of the report of the examination and evaluation described by this section and the respondent s individualized treatment plan.

2. Upon receipt of the report, the court may, upon its own motion, or shall, upon the motion of the respondent, order a hearing to be held as to the need for continued detention and involuntary treatment. At the conclusion of the hearing, the court may order:

(1) The discharge of the respondent; or

(2) An appropriate least restrictive course of detention and involuntary treatment; or

(3) The respondent to be remanded to the mental health [facility] program for the unexpired portion of the original commitment order.

632.380. Persons who are mentally retarded, developmentally disabled, senile or impaired by alcoholism or drug abuse shall not be detained judicially under this chapter, unless they are also mentally ill and as a result present likelihood of serious [physical] harm to themselves or to others. Such persons may, however, be committed upon court order under this chapter and the provisions of chapter 475, RSMo, relating to incapacitated persons, pursuant to chapter 211, RSMo, relating to juveniles, or may be admitted as voluntary patients under section 632.105 or 632.120.

632.390. 1. The head of a mental health [facility] program shall release any person who is involuntarily detained under this chapter when, in his opinion, the person is no longer mentally ill or, although mentally ill, does not present a likelihood of serious [physical] harm to himself or others, even though the detention period has not expired.

2. Whenever the head of a mental health [facility] program discharges a person prior to the expiration of the detention order, he shall notify in writing the court and the mental health coordinator.

3. Whenever a respondent voluntarily admits himself and the head of a mental health [facility] program accepts the admission application submitted by respondent in good faith under section 632.105, the respondent s involuntary detention shall cease, and the head of the [facility] program shall notify, in writing, the court and the mental health coordinator.

632.392. 1. Notwithstanding the provisions of subsection 1 of section 630.140, a mental health program and any treating physician, upon release of a patient who was committed or who is civilly detained and consents to voluntary treatment during the course of the inpatient stay pursuant to sections 632.150, 632.155, 632.300, 632.305, 632.330, 632.335, 632.340, 632.350, 632.355 or 632.375:

(1) Shall provide to the patient and his care provider a written packet of educational information developed and supplied by the department of mental health describing symptoms of common mental illnesses, early warning signs of decompensation, and availability of other education, community and statewide services. The packet shall also include the telephone number of the department of mental health information line and information specific to the laws and procedures addressing civil detention and guardianship;

(2) May disclose confidential treatment information to the primary care provider or care providers, when such information is medically necessary for the provision of appropriate health care or treatment by the care provider or is related to the safety of the patient or care provider.

2. Prior to disclosure of the information specified under subdivision (2) of subsection 1 of this section, the mental health facility shall provide written notice to the patient; request in writing the consent of the patient; work with the patient and care provider to encourage and secure appropriate patient authorization; function as a mediator, negotiating the boundaries of confidentiality to meet the needs of the client and care provider; and work with the client to stress the importance of keeping the care provider informed and involved with his treatment process. If the patient refuses to consent and the treating physician deems the information is medically necessary for the appropriate provision of health care or treatment by the care provider or is related to the safety of the patient or care provider, the information may still be released to the appropriate care provider. The reason for the intended disclosure, the specific information to be released and the persons to whom the disclosure is to be made, even if consent has not been obtained, will be provided to the client and care provider. All these procedures shall be documented by the treating physician in the client record, including a specific notation as to whether client consent was given.

3. As used in this section, the term care provider means the person or persons who can demonstrate that they are primarily responsible for the health care of the person with a mental illness. The term does not apply to any person providing care through hospitals, nursing homes, group homes or any other such facility.

632.400. Any respondent ordered detained for ninety-day or one-year periods of involuntary inpatient treatment or ordered detained for a period of up to one hundred eighty days of outpatient detention and treatment under this chapter shall be entitled to a reexamination of the order for his detention on his own motion, or that of his legal guardian, parent, spouse, relative, friend or attorney to the court. Upon receipt of the motion, the court shall conduct or cause to be conducted by a special commissioner proceedings in accordance with section 632.340.

632.410. Venue for proceedings for involuntary detentions pursuant to the provisions of this chapter shall be in the court having probate jurisdiction in the county in which the mental health [facility] program is located wherein the respondent is detained; provided, however, that if the respondent is a resident of this state and makes application for the hearing to be held in his county of residence, the court shall order the proceedings, with all papers, files and transcripts of the proceedings, to be transferred to the court having probate jurisdiction in the respondent s county of residence. Once a court has assumed jurisdiction with respect to involuntary detention proceedings, no other court shall assume jurisdiction until the court having prior jurisdiction has transferred jurisdiction and all papers, files, and transcripts. If the court having jurisdiction receives notice that a respondent has been transferred to a mental health [facility] program in another county, the court shall transfer jurisdiction, along with all papers, files and transcripts, to the court in the county where the respondent has been transferred.

632.415. 1. The judge having probate jurisdiction in each county where a mental health [facility] program is located shall prepare and maintain a current register of attorneys who have agreed to be appointed to represent respondents against whom involuntary civil detention proceedings have been instituted in such county. The judge may choose lawyers who are paid by any public or private agency or other lawyers who are appointed to the register. The register shall be provided to the mental health coordinator for the area which includes the county for which the list was prepared. A new register shall be provided to the mental health coordinator each time a new attorney is added.

2. If the judge finds that the respondent is unable to pay [an] attorney s fees for the services rendered in the proceedings, the judge shall allow a reasonable attorney s fee for the services, which fee shall be assessed as costs and paid together with all other costs in the proceeding by the state, in accordance with rules and regulations promulgated by the state court administrator, from funds appropriated to the office of administration for such purposes provided that no attorney s fees shall be allowed for services rendered by any attorney who is a salaried employee of a public agency or a private agency which receives public funds.

632.440. No officer of a public or private agency, mental health facility[, nor the] or mental health program; no head, attending staff or consultant[s] of any such agency, [or] facility[, nor any] or mental health program; no mental health coordinator, registered professional nurse, licensed physician, mental health professional [or] nor any other public official performing functions necessary for the administration of this chapter[, nor any]; no peace officer responsible for detaining a person pursuant to this chapter[, nor any]; and no peace officer responsible for detaining or transporting, or both, any person upon the request of any mental health coordinator pursuant to section 632.300 or 632.305 or acting pursuant to the request of a guardian who is acting pursuant to Chapter 475, RSMo, or upon the request of the head of any supervisory mental health program who is acting pursuant to section 632.337, regardless of whether such peace officer is outside the jurisdiction for which he serves as a peace officer during the course of such detention or transportation, or both, shall be civilly liable for detaining, transporting, conditionally releasing or discharging a person pursuant to this chapter or chapter 475, RSMo, at or before the end of the period for which [he] the person was admitted or detained for evaluation or treatment[,] so long as such duties were performed in good faith and without gross negligence.

632.455. 1. If requested to do so by the head of a mental health [facility] program, the sheriff of the county where a patient absent without authorization is found shall apprehend and return him to the [facility] program.

2. The head of the [facility] program may request the return of an absent patient under subsection 1 of this section only under one or more of the following circumstances:

(1) The patient is a minor whose admission was applied for by his parent or legal custodian, who has not requested the minor patient s release;

(2) The patient is a minor under jurisdiction of the juvenile court;

(3) The patient has been declared legally [incompetent] incapacitated and his guardian has not requested his release;

(4) The patient was committed to the department under chapter 552, RSMo, or this chapter;

(5) The patient s condition is of such a nature that, for the protection of the patient or others, the head of the [facility] program determines that the patient s return to the [facility] program is necessary as noted in the patient s records, in which case civil detention procedures shall be initiated upon return to the [facility] program.

633.125. 1. A resident admitted to a mental retardation facility pursuant to section 633.120 shall be discharged immediately when the person who applied for his admission requests the release orally, in writing or otherwise from the head of the mental retardation facility; except, that if the head of the mental retardation facility regards the resident as presenting a likelihood of serious [physical] harm to himself or others, the head of the facility may initiate involuntary detention procedures pursuant to chapter 632, RSMo, if appropriate, or any individual, including the head of the facility or the mental health coordinator may initiate guardianship proceedings and, if appropriate, obtain an emergency commitment order pursuant to chapter 475, RSMo.

2. A resident shall be discharged from a department mental retardation facility if it is determined in a comprehensive evaluation or periodic review that the person is not mentally retarded or developmentally disabled, and if the resident, parent, if a minor, or guardian consents to the discharge. If consent is not obtained, the head of the facility shall initiate appeal proceedings under section 633.135, before a resident can be discharged.

3. A resident shall either be discharged from a department mental retardation facility or shall be referred to a regional center for placement in a least restrictive environment pursuant to section 630.610, RSMo, if it is determined in a comprehensive evaluation or periodic review that the following criteria exist:

(1) The resident s condition is not of such a nature that for the protection or adequate care of the resident or others the resident needs department residential habilitation or other services;

(2) The mental retardation facility does not offer a program which best meets the resident s needs; or

(3) The mental retardation facility does not provide the least restrictive environment feasible. A resident may not be discharged without his consent or the consent of his parent, if he is a minor, or guardian unless proceedings have been completed under section 633.135.

4. After a resident s discharge pursuant to subsection 3 of this section, the resident shall be referred to an appropriate regional center for assistance in obtaining any necessary services.

633.160. If a person presents himself, or is presented, to a regional center or department mental retardation facility and is determined to be mentally retarded or developmentally disabled and, as a result, presents an imminent likelihood of serious [physical] harm to himself or others as defined in chapter 632, RSMo, the regional center or mental retardation facility may accept the person for detention for evaluation and treatment for a period not to exceed ninety-six hours under the same procedures contained in chapter 632, RSMo. The head of the regional center or mental retardation facility may initiate guardianship proceedings to have the person detained beyond the ninety-six hours under chapter 475, RSMo, or may refer the person to a mental health facility, if the person is mentally ill, for further detention under the procedures in chapter 632, RSMo.

208.309. 1. Sections 208.309 to 208.315 shall be known as the Elders Volunteer for Elders Project (EVE) Act. Subject to appropriations, the department of social services, division of aging, shall review applications and award grants to at least three community provider organizations for the provisions of services which shall establish a three-year demonstration project designed to prevent the premature or unnecessary institutionalization of Missouri s low income elderly citizens in specifically defined neighborhoods located in a city not within a county, a city with a population of more than three hundred fifty thousand inhabitants which is located in more than one county and in region 2 of the Missouri area agencies on aging.

2. As used in sections 208.309 to 208.315, the following terms mean:

(1) Community Provider Organizations , any:

(a) Charitable organization as defined in section 407.453, RSMo;

(b) Not for profit corporation established pursuant to chapter 355, RSMo; or

(c) An organization that has obtained an exemption from the payment of federal income taxes as provided in section 501(c)(3), 501(c)(7) or 501(c)(8) of Title 26, United States Code, as amended.

(2) Division , division of aging of the department of social services;

(3) Elderly Low Income Person , a Missouri citizen who is sixty years of age or older and whose income is at or below one hundred and fifty percent of the federal poverty level;

(4) Project , a demonstration project directed at Missouri s low income elderly who are at risk of involuntary and unnecessary institutionalization;

(5) Recipient , any elderly low income person who is in need of assistance with at least one of the activities of daily life or assistance with instrumental activities of daily living. The highest priority will be given to those at risk of incapacity adjudication.

208.311. The purpose of the EVE projects shall be:

(1) To help low income elderly, adjudicated or not, who live within a project s geographical location to obtain access to services to retain their independence and postpone consignment to nursing homes and to improve their quality of life;

(2) To advocate for low income elderly during an incapacity adjudication hearing;

(3) To help those low income elderly who become institutionalized and who can be restored sufficiently to return home, to do so; and

(4) To train and support mostly senior volunteers and to add volunteer work opportunities for healthy senior citizens.

208.313. 1. The division shall review applications and make grant awards to three community provider organizations who meet the criteria and requirements set forth in subsection 2 of this section. One of the community provider organizations shall be located in a city not within a county and the second shall be located in a city with a population of more than three hundred fifty thousand inhabitants which is located in more than one county and the third shall be located in region 2 of the Missouri area agencies on aging.

2. In order to be considered for selection as a demonstration project site a community provider organization shall file an application with the division and present the following information:

(1) A proposed program, including the approximate number of elderly citizens that the project is designed to reach in a specifically defined neighborhood;

(2) A proposed budget;

(3) A proposed program to recruit, train and retain volunteers as case managers and advocates for the low-income elderly of the defined neighborhood;

(4) A proposed client eligibility and screening process; and

(5) A proposed format to file an annual external audit and annual comprehensive evaluation of the services provided to the low income elderly to the division of aging for consideration of potential statewide implementation.

208.315. The division of aging may continue or expand such programs within appropriations.