SENATE HEALTH AND PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR
SENATE BILL 128
55th legislature - STATE OF NEW MEXICO - first session, 2021
AN ACT
RELATING TO MENTAL HEALTH CARE; ENACTING THE SUICIDE PREVENTION, RESPONSE AND TREATMENT ACT; PRESCRIBING GUIDELINES FOR TREATMENT OF AT-RISK OR SUICIDAL PATIENTS AT OUTPATIENT TREATMENT FACILITIES AND INPATIENT BEHAVIORAL HEALTH CARE FACILITIES; PROVIDING INSTRUCTIONS FOR TELEBEHAVIORAL HEALTH PROVIDERS; PROVIDING GUIDELINES FOR SUICIDE RISK ASSESSMENTS; PROVIDING SUICIDE PREVENTION COUNSELOR SERVICES IN EMERGENCY DEPARTMENTS; REQUIRING SUICIDE PREVENTION TRAINING; CREATING A SUICIDE PREVENTION RESPONSE COORDINATOR; PROVIDING PUBLIC SAFETY ANSWERING POINT PROCEDURES; PROVIDING FOR ADMINISTRATION BY THE INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE; PROVIDING FOR PENALTIES; CREATING A FUND; MAKING AN APPROPRIATION.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. [NEW MATERIAL] SHORT TITLE.--This act may be
cited as the "Suicide Prevention, Response and Treatment Act".
SECTION 2. [NEW MATERIAL] DEFINITIONS.--As used in the Suicide Prevention, Response and Treatment Act:
A. "at-risk" means a person who is currently experiencing an acute mental health crisis, is experiencing or expressing thoughts of wanting to die by suicide, is experiencing or expressing behaviors or tendencies related to dying by suicide or is assessed or observed as undertaking or contemplating actions of dying by suicide;
B. "care transition" means the transfer or transition of an at-risk or suicidal patient from one health care provider or behavioral health care provider to another;
C. "collaborative" means the interagency behavioral health purchasing collaborative;
D. "evaluation facility" means a facility capable of performing a mental status examination adequate to determine the need for involuntary treatment for an at-risk or suicidal person;
E. "inpatient behavioral health care facility" means a residential facility, including a hospital, a psychiatric unit of a hospital, a special psychiatric hospital or another residential health care facility licensed by the department of health;
F. "outpatient treatment facility" means a nonresidential behavioral health care facility licensed by the department of health;
G. "public safety answering point" means a twenty-four-hour local communications facility that receives 911 service communications and directly dispatches emergency response services or that relays communications to the appropriate public or private emergency responders, including suicide prevention response coordinators;
H. "rapid referral" means the taking of appropriate steps:
(1) by an inpatient behavioral health care facility, prior to an at-risk person's discharge from inpatient care, to facilitate the at-risk person's immediate access to an appropriate outpatient treatment facility appointment as soon as is practicable or within forty-eight hours after discharge; or
(2) by an outpatient treatment facility or telebehavioral health provider to facilitate an at-risk or suicidal person's immediate access to an appointment with another telebehavioral health provider, outpatient treatment facility or inpatient behavioral health care facility as soon as is practicable or within forty-eight hours after referral;
I. "suicide prevention counselor" means a licensed psychiatrist, licensed clinical psychologist, other licensed mental health professional or qualified crisis counselor who has specialized certification or has completed specialized training in the standardized assessment of suicide risk and suicide prevention counseling to at-risk persons;
J. "supportive contacts" means communications through postcards, letters, email messages, text messages, phone calls or the undertaking of home visits either by an at-risk person's licensed mental health care provider or suicide prevention counselor or by an outside organization coordinating with an at-risk person;
K. "telebehavioral health" means the use of electronic information imaging and communication technologies, including interactive audio, video and data communications, by a suicide prevention counselor to provide suicide prevention counseling and suicide risk assessments; and
L. "warm hand-off" means a care transition that:
(1) connects an at-risk person with a new mental health care provider before the at-risk person's first appointment with the new health care provider; or
(2) connects a person who is contemplating suicide to an evaluation facility to determine whether involuntary commitment is warranted pursuant to involuntary commitment laws of this state.
SECTION 3. [NEW MATERIAL] INPATIENT BEHAVIORAL HEALTH CARE FACILITIES AND OUTPATIENT TREATMENT FACILITIES--SUICIDE PREVENTION COUNSELORS--POLICIES--DUTIES.--
A. A suicide prevention counselor employed by an inpatient behavioral health care facility shall:
(1) assess each person's level of suicide risk pursuant to Section 5 of the Suicide Prevention, Response and Treatment Act;
(2) provide immediate suicide prevention counseling to each person deemed to be at risk of suicide; and
(3) provide ongoing suicide prevention counseling to each at-risk person, on a daily basis or on a frequency proportionate to a person's suicide risk assessment, for the duration of inpatient care or until that person is deemed to be no longer at risk of suicide.
B. A suicide prevention counselor employed by an outpatient treatment facility shall:
(1) assess a person's level of suicide risk pursuant to Section 5 of the Suicide Prevention, Response and Treatment Act;
(2) provide immediate suicide prevention counseling to each person deemed to be at risk of suicide;
(3) provide a warm hand-off of a person deemed to be at-risk of suicide to an evaluation facility; and
(4) provide suicide prevention counseling to each at-risk person for whom involuntary commitment to an inpatient behavioral health care facility is not warranted in a manner and frequency that is proportionate to the at-risk person's suicide risk assessment.
C. Inpatient behavioral health care facilities and outpatient treatment facilities shall ensure that suicide prevention counselors are available, either at the facility or through telebehavioral health access.
D. Inpatient behavioral health care facilities and outpatient treatment facilities shall establish policies to provide for the care transition of at-risk persons using warm hand-offs, rapid referrals and supportive contacts.
E. An inpatient behavioral health care facility or outpatient treatment facility may enter into contracts or memoranda of understanding with outside organizations, including telebehavioral health providers or other inpatient behavioral health care facilities and outpatient treatment facilities, to facilitate the care transition of at-risk persons.
F. Staff of inpatient behavioral health care facilities and outpatient treatment facilities shall not:
(1) discharge an at-risk person who lacks a fixed residence or that is otherwise homeless; or
(2) arrange an at-risk person's arrest or incarceration, unless the at-risk person poses an otherwise uncontrollable risk to others or if failure to do so would violate a law of this state.
SECTION 4. [NEW MATERIAL] TELEBEHAVIORAL HEALTH PROVIDERS.--A telebehavioral health provider acting pursuant to the Suicide Prevention, Response and Treatment Act shall:
A. assess a person's level of suicide risk pursuant to Section 5 of the Suicide Prevention, Response and Treatment Act;
B. provide immediate suicide prevention counseling to at-risk or suicidal persons;
C. provide a warm hand-off of an at-risk person to an evaluation facility; and
D. provide suicide prevention counseling to each at-risk person for whom involuntary commitment to an inpatient behavioral health care facility is not warranted in a manner and frequency that is proportionate to the at-risk person's suicide risk assessment.
SECTION 5. [NEW MATERIAL] SUICIDE RISK ASSESSMENT.--
A. A suicide risk assessment shall be conducted:
(1) upon a person's admission to an emergency room or inpatient behavioral health care facility, upon a person's first appointment with an outpatient treatment facility, during a telebehavioral health provider encounter and during a physical health care setting appointment;
(2) when there is reason for attending staff
of a facility or provider listed under Paragraph (1) of this subsection to believe that a person is developing new suicidal ideation, behaviors or tendencies;
(3) within three days prior to the discharge of an at-risk person from an inpatient behavioral health care facility;
(4) when a suicide prevention counselor or a telebehavioral health encounter is requested to assess an at-risk person in a hospital emergency department pursuant to Section 6 of the Suicide Prevention, Response and Treatment Act; and
(5) when a suicide prevention counselor is dispatched or a telebehavioral health encounter is requested pursuant to Section 9 of the Suicide Prevention, Response and Treatment Act to assess a person at an emergency scene.
B. A suicide risk assessment shall be performed using standardized tools, methodologies or frameworks and:
(1) data obtained from the at-risk person by the attending physician, nurse practitioner or nurse, assigned suicide prevention counselors and other staff having direct contact with the at-risk person; and
(2) available information regarding the past and present suicidal ideation and behavior, obtained with the person's consent from the person's licensed mental health care providers, caseworkers, caregivers, family members, guardians and other persons.
C. The suicide risk assessment shall include an evaluation of the person's current housing status, existing support systems and close relationships and shall indicate whether the person has been subjected to abuse, neglect, exploitation or undue influence by family members, caregivers or other persons, to the extent practicable.
D. Counseling and treatment provided to an at-risk person shall be supplemental to treatment that the person receives to treat other mental health conditions, if any.
E. The results of a suicide risk assessment and notes regarding the progress of suicide prevention counseling shall be documented in the person's health record.
SECTION 6. [NEW MATERIAL] TREATMENT OF AT-RISK PERSONS IN EMERGENCY OR URGENT CARE.--
A. A physician, nurse practitioner, nurse or other licensed or certified health care provider, or other administrative, support or facility staff who have observed concerns, treating a person in a hospital's emergency department who has reason to believe that a person is at risk shall ensure that the person is evaluated by a suicide prevention counselor prior to that person's discharge from the emergency department.
B. A suicide prevention counselor pursuant to this section shall:
(1) perform a suicide risk assessment;
(2) counsel the person prior to the person's discharge from the emergency department or urgent care facility; and
(3) direct at-risk persons to appropriate treatment facilities, programs and services through the use of warm hand-offs and supportive contacts, as deemed by the suicide prevention counselor to be appropriate based on the results of that person's suicide risk assessment.
C. If a suicide prevention counselor concludes that inpatient treatment is necessary to address an at-risk person, the suicide prevention counselor shall, with the assistance of an attending emergency room physician, nurse practitioner, nurse or other licensed or certified health care provider, facilitate the person's voluntary admission to an inpatient behavioral health care facility and a warm hand-off to an evaluation facility.
D. If an at-risk person refuses to be admitted to an inpatient behavioral health care facility, the attending emergency room physician, nurse practitioner, nurse or other licensed or certified health care professional shall provide a warm hand-off of that person to an evaluation facility.
SECTION 7. [NEW MATERIAL] COMMUNICATION WITH AT-RISK PERSONS--TRAINING.--
A. Inpatient behavioral health care facilities, outpatient treatment facilities, emergency rooms, telebehavioral health providers, behavioral health care providers, physical health care setting providers, public safety officials and public safety answering point staff shall adopt practices for staff communication with at-risk persons. Practices adopted by a facility pursuant to this section shall maintain the dignity of an at-risk person, promote respect and compassion and reduce existing stigma related to suicide; provided that the adoption of such a practice or procedure shall not impede the professional standards of care for a health care practitioner licensed or certified in this state or state or federal law providing standards for hospital operations.
B. Pursuant to this section, a suicide prevention counselor shall:
(1) encourage the at-risk person to use available services and resources offered within the inpatient behavioral health care facility or outpatient treatment facility or refer the person to resources outside of the inpatient behavioral health care facility or outpatient treatment facility, including telebehavioral health services;
(2) refrain from performing psychological testing, other than suicide risk assessments, if the at-risk person is in crisis or has recently recovered from a crisis incident; and
(3) avoid perpetuating stigma related to suicide.
C. Inpatient behavioral health care facilities, outpatient treatment facilities, emergency rooms, telebehavioral health providers, behavioral health care providers, physical health care setting providers, public safety officials and public safety answering point staff shall administer and require staff to complete two training sessions each year, addressing:
(1) suicide prevention policies at the facilities;
(2) suicide care policies that are relevant to each staff member's role and responsibilities;
(3) the signs and symptoms that can be used by staff to identify existing persons of concern who may be developing new at-risk ideation, behaviors or tendencies;
(4) methods and principles to be used in
discharge and care transition of at-risk persons of concern; and
(5) methods for respectful treatment of and effective communication with at-risk persons.
SECTION 8. [NEW MATERIAL] LAW ENFORCEMENT--SUICIDE
RESPONSE TRAINING REQUIRED.--
A. The New Mexico law enforcement academy, in coordination with the collaborative, shall provide or approve training for police officers that shall consist of two hours of in-service training on the appropriate response to emergencies that involve an at-risk person.
B. The in-service training course required pursuant to this section shall:
(1) include instruction on:
(a) calm, gentle and respectful interactions with an at-risk person;
(b) avoidance of the use of unnecessary force;
(c) verbal methods of communication and other nonviolent means to stabilize an emergency involving an at-risk person; and
(d) specific techniques, means and methods, consistent with the principles identified under this subsection, to facilitate law enforcement officer interactions with an at-risk person; and
(2) require training program participants to engage in simulated role-playing scenarios to demonstrate the participants' ability to effectively interact with and stabilize an at-risk person.
C. Each instructor who is assigned to teach the courses required by this section shall have received at least forty hours of training in mental health crisis intervention from a nationally recognized organization that educates law enforcement officers in the use of appropriate emergency response methods.
SECTION 9. [NEW MATERIAL] SUICIDE PREVENTION RESPONSE AGENCY--DUTIES.--
A. The collaborative shall:
(1) contract with a suicide prevention response agency to dispatch suicide prevention counselors to emergency scenes involving an at-risk person; and
(2) compensate the suicide prevention response agency.
B. The suicide prevention response agency shall utilize a list of suicide prevention counselors and telebehavioral health providers available in this state and dispatch a suicide prevention counselor and telebehavioral health providers to an emergency.
C. A suicide prevention counselor dispatched to an emergency scene pursuant to this section shall:
(1) coordinate with ongoing emergency response to a nonviolent emergency involving an at-risk person to facilitate the stabilization of that person;
(2) perform a suicide risk assessment of an at-risk person pursuant to Section 5 of the Suicide Prevention, Response and Treatment Act;
(3) direct an at-risk person to appropriate treatment facilities, programs and services through the use of warm hand-offs and supportive contacts, based on the results of the on-site suicide risk assessment;
(4) facilitate admission of an at-risk person to an outpatient treatment facility or warm hand-off to an inpatient behavioral health care facility if the suicide prevention counselor believes that person poses harm to the person's own self; or
(5) facilitate the warm hand-off of an at-risk person to an evaluation facility if that person refuses to be admitted to an inpatient behavioral health care facility.
D. The collaborative shall establish:
(1) the necessary qualifications for a suicide prevention response coordinator pursuant to this section; and
(2) guidelines to be used by the suicide prevention response agency and coordinator, including:
(a) working with state agencies and behavioral health providers to maintain a list of qualified and locally available suicide prevention counselors pursuant to Subsection B of this section; and
(b) ensuring the coordination of a suicide prevention counselor to each emergency scene involving an at-risk person.
SECTION 10. [NEW MATERIAL] PUBLIC SAFETY ACCESS POINT--PROCEDURES.--
A. When the staff of a public safety access point determines that a request for emergency services involves an at-risk or suicidal person, the staff shall notify the suicide prevention response agency to facilitate the appropriate response for that person.
B. Notice shall be provided to the suicide prevention response agency, pursuant to Subsection A of this section, at the time of dispatch or prior to the dispatch of law enforcement to the emergency scene.
SECTION 11. [NEW MATERIAL] COLLABORATIVE TO PROMULGATE RULES--AGENCY AND COLLABORATIVE COOPERATION.--
A. The collaborative shall promulgate rules as are necessary to implement and enforce the provisions of the Suicide Prevention, Response and Treatment Act.
B. State agencies shall cooperate with the collaborative to carry out the provisions of the Suicide Prevention, Response and Treatment Act.
SECTION 12. [NEW MATERIAL] ADMINISTRATIVE PENALTIES--APPROPRIATION.--
A. If the collaborative has reason to believe that an outpatient treatment facility or an inpatient behavioral health care facility, or other facility providing care to an at-risk person, is failing to comply with the provisions of the Suicide Prevention, Response and Treatment Act, the collaborative shall order the facility to take corrective action within a reasonable time frame as may be deemed by the collaborative to be necessary to ensure future compliance with the Suicide Prevention, Response and Treatment Act.
B. The collaborative may assess an administrative penalty of:
(1) not more than two thousand five hundred dollars ($2,500) for a first offense and not more than five thousand dollars ($5,000) for a second or subsequent offense on an inpatient behavioral health care facility or outpatient treatment facility, or other facility providing care to an at-risk person, that fails to comply with an order of the collaborative issued pursuant to Subsection A of this section;
(2) not more than five hundred dollars ($500) for a first offense, not more than one thousand dollars ($1,000) for a second offense and not more than two thousand five hundred dollars ($2,500) for a third or subsequent offense on an outpatient treatment facility or an inpatient behavioral health care facility, or other facility providing care to an at-risk person, that violates the provisions of Paragraph (4) of Subsection B of Section 3 of the Suicide Prevention, Response and Treatment Act; or
(3) not more than five hundred dollars ($500) for a first offense, not more than one thousand dollars ($1,000) for a second offense and not more than two thousand five hundred dollars ($2,500) for a third or subsequent offense on an outpatient treatment facility or an inpatient behavioral health care facility, or other facility providing care to an at-risk person, that violates the provisions of Subsection A of Section 7 of the Suicide Prevention, Response and Treatment Act.
C. The administrative penalties imposed pursuant to this section shall be retained by the collaborative and are appropriated to the human services department for the purpose of administering and enforcing the Suicide Prevention, Response and Treatment Act.
SECTION 13. [NEW MATERIAL] SUICIDE PREVENTION, RESPONSE AND TREATMENT FUND--CREATED.--
A. The "suicide prevention, response and treatment fund" is created in the state treasury. The fund consists of money appropriated to the human services department from fines imposed under Section 12 of the Suicide Prevention, Response and Treatment Act. Money in the fund shall not revert to any other fund at the end of a fiscal year. The collaborative shall administer the fund, and money in the fund is appropriated to the human services department to implement the provisions of the Suicide Prevention, Response and Treatment Act.
B. Money in the fund shall be disbursed on warrants signed by the secretary of finance and administration pursuant to vouchers signed by the secretary of human services or the secretary's authorized representative.
SECTION 14. [NEW MATERIAL] HEARING.--
A. An outpatient treatment facility or an inpatient behavioral health care facility that the collaborative imposes an administrative penalty against shall be entitled to a hearing:
(1) upon request from the outpatient treatment facility or inpatient behavioral health care facility; and
(2) within ten days after receiving the notice of a penalty imposed by the collaborative pursuant to Section 12 of the Suicide Prevention, Response and Treatment Act.
B. A hearing under this section shall be held in accordance with rules that the collaborative shall adopt pursuant to the Suicide Prevention, Response and Treatment Act regarding adjudication procedures.
SECTION 15. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2021.
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