Mark Ponsolle, Director, Human Services Division
The Civil Commitment Unit handles those matters occurring under the Minnesota Commitment and Treatment Act that involve residents of Ramsey County. The Unit deals with issues covering the different types of commitment proceedings, the petition process, and the court process.
Types of Commitment Proceedings
The six types of commitment proceedings are:
- Mentally Ill persons (MI) Persons that are mentally ill (defined as an organic disorder of the brain or a substantial psychiatric disorder of thought, mood perception, orientation, or memory which grossly impairs judgment, behavior, capacity to recognize reality or to reason or understand, which is manifested by instances of grossly disturbed behavior or faulty perceptions) and, as a result, pose a danger to themselves or others;
- Developmentally Disabled persons (DD) Persons that are developmentally disabled (defined as having significantly sub-average intellectual functioning existing together with demonstrated deficits in adaptive behavior prior to age 22) and, as a result, pose a danger to themselves or others;
- Chemically Dependent persons (CD) Persons that habitually and excessively use alcohol, drugs or other mind-altering substances, who are incapable of self-management or management of personal affairs because of that use, and as a result of that use pose a substantial likelihood of physical harm to themselves or others;
- Persons Mentally Ill and Dangerous to the Public (MI&D) Persons that are mentally ill, who have engaged in a past overt act causing or attempting to cause serious physical harm to another, and who are likely to engage in future acts capable of inflicting serious physical harm because of their mental illness;
- Sexual Psychopathic Personalities (SPP) Persons who have an utter lack of power to control their sexual impulses as the result of emotional instability, impulsiveness of behavior, lack of customary standards of good judgment and/or failure to appreciate the consequences of personal acts, who have demonstrated a habitual course of harmful sexual misconduct and who are highly likely to reoffend sexually, posing a danger to the public; and
- Sexually Dangerous Persons (SDP) Persons who have a sexual, personality or other mental disorder or dysfunction who have engaged in a course of harmful sexual conduct and who are highly likely to engage in future acts of harmful sexual conduct.
For most “routine” commitment cases (mentally ill, chemically dependent, and developmentally disabled), the commitment process begins with a petition for commitment. Any “interested party”—which broadly includes any adult—may prepare and present a petition for commitment of an individual. Typically, a treating hospital or other health care facility serves as the petitioner. The petition for commitment must be accompanied by an “Examiner’s Statement” prepared by a duly qualified medical professional and stating that the examiner is qualified to render an opinion on the need for commitment, that it is necessary to commit the proposed patient, and that the examiner has seen the patient within 15 days of filing the petition for commitment. The petition also typically requests that the patient be placed under the care and supervision of the treating hospital involuntarily on a “court hold” pending the outcome of the commitment proceeding.
This petition and all of the attachments that describe the patient's recent behavior and reasons supporting commitment are forwarded to the Ramsey County Pre-Petition Screening Unit (PPSU). The PPSU, located in the Adult Mental Health Division of the Ramsey County Community Human Services Department, reviews the petition, investigates the allegations, interviews the patient and other interested persons, and reviews the patient's treatment records.
After collecting and reviewing all relevant information, the PPSU determines whether to support the commitment process. If the PPSU rejects the petition, its decision is communicated to the petitioner, who may then appeal the PPSU decision directly to the Ramsey County Attorney's Office. The County Attorney will then obtain all required paperwork from the PPSU and may also discuss the case with both the petitioner and the PPSU screener before deciding whether to file the petition. In cases where the PPSU recommends commitment, it drafts a report summarizing its investigation (the “pre-petition screening report”) and submits the report and the petition to the Commitment Unit of the Ramsey County Attorney's Office.
An Assistant County Attorney then reviews the petition, all the attachments, and the pre-petition screening report to insure that all of the requirements necessary for a valid commitment are met, that there is sufficient evidence to prove the underlying condition(s) and behaviors, and that based on the information provided commitment appears to be the most appropriate, least restrictive alternative available to the patient. If the County Attorney's Office approves the petition, the petition is filed with the Court and the matter is set for an initial hearing. Petitions for the commitment of persons who are mentally ill and dangerous (MI&D) are most often initiated by the Ramsey County Attorney’s Office. These petitions are frequently filed immediately after a criminal prosecution in circumstances where the criminal case involved a serious assault or other, similar dangerous behavior. These commitments often occur when the proposed patient/defendant has been determined incompetent to proceed to trial in criminal court, or has been found not guilty of the crime because of their mental illness at the time they committed the criminal act.
Petitions for the commitment of sexually dangerous persons (SDP) and sexually psychopathic personalities (SPP) are also initiated by the Ramsey County Attorney’s Office, most often after a referral from the Minnesota Department of Corrections approximately one year prior to a criminal sexual offender’s release from prison. The County Attorney’s Office conducts a thorough investigation and evaluation of the inmate’s offense history, prison and treatment records prior to determining whether a petition for commitment should be filed.
Once a petition is filed for the commitment of a patient, an attorney is selected from a pre-appointed panel to represent the patient throughout the commitment process. The patient also has the option of his or her own private attorney. This attorney is an advocate for the patient's legal interests who informs the patient about the commitment process and the law and also represents the patient in court throughout the commitment proceedings.
In MI, CD and DD commitment cases, the court process consists of three statutorily required stages, beginning with the pretrial/preliminary hearing. This initial, dual-purpose hearing provides an opportunity settlement of the case that may eliminate the need for further hearings. If a settlement is not reached and the patient does not agree to remain in the treatment facility until the case is completed, the Court conducts an evidentiary proceeding to determine whether the patient should be ordered to remain in the treatment facility pending completion of the proceedings. If the Court determines by a preponderance of the evidence that there is an imminent risk of harm to the patient or others if the patient is released, the patient is ordered to be held in the treatment facility until the case is completed. The Court then appoints an examiner and the patient selects a second examiner to conduct a pre-hearing examination of the patient.
At the second stage of the proceedings the examiners, who are licensed professionals, conduct an interview of the patient, examine the patient’s treatment records and prepare written reports to the Court with their recommendations concerning the proposed commitment. These examinations are independent of those done by staff at the treating hospital.
At the third and final stage of the commitment process the case is heard by the Court in a full judicial hearing. The petitioner, through the County Attorney, calls witnesses and submits treatment records and other evidence to prove that the requirements for commitment have been met. The patient, through his or her court-appointed counsel, is allowed to cross examine the petitioner’s witnesses and submit his or her own witnesses and other evidence to show that he or she does not meet the conditions necessary for commitment or that a less restrictive alternative to commitment is available. The Court then makes a determination, based on all of the evidence, regarding the need for commitment and the appropriate level of treatment for the patient.
In MI&D and SDP/SPP commitment cases, the court process consists of at least five statutorily required stages including a pretrial/preliminary hearing, an examination by the court-appointed examiners, an initial hearing to determine whether the patient meets the required statutory criteria for commitment, a 60 day in-patient evaluation at a state hospital (if the court decides as the initial hearing that the patient does meet the statutory criteria for commitment), and then a final hearing after the 60 day treatment report is received from the state hospital to determine whether any of the patient’s conditions or circumstances have changed since the initial commitment and whether continuation of the commitment is necessary.
The Court may dismiss the petition completely or may structure a voluntary treatment plan with specific conditions that the patient agrees to comply with, called a stayed order of commitment. The stayed order of commitment avoids an actual commitment if the patient satisfies all of the required conditions within an initial six month period. By Court Rule, stayed orders of commitment cannot be put into place in SDP and SPP commitments unless all of the parties and the judge agree to that disposition. If necessary, the Court may commit the patient to a treating hospital under the care and supervision of the Court and the hospital. In MI, CD and DD cases, most patients are dually committed to either a public or private hospital or treatment facility with the State Commissioner of Human Services’ Hospital System (State Operated Services) serving as a back-up for treatment. In MI&D cases the patients are committed to the Minnesota Security Hospital (MSH) at St. Peter, and in SDP/SPP commitments the patients are committed to the Minnesota Sex offender Program (MSOP) with facilities at Moose Lake and St. Peter. Both MSH and MSOP are operated by the State of Minnesota under the authority of the Minnesota Commissioner of Human Services.
In cases where anti-psychotic medication is necessary to treat the patient, the patient is not competent to consent to the administration of medication and is refusing medication treatment, the Court may order the patient to receive anti-psychotic (neuroleptic) medication. This only occurs after a separate petition is filed and evidence is presented at a full judicial hearing to determine whether such action is necessary and appropriate. This hearing is known as a “Jarvis hearing”. Another form of treatment that can be ordered is electro-convulsive therapy (ECT), historically known as “shock treatment”. This form of treatment, which is now provided with strict medical monitoring, safeguards and the administration of anesthesia, is utilized most often in certain cases of medication/treatment resistant mental illness and will not be ordered by the Court unless the proposed treatment is both medically reasonable and necessary for the patient. This procedure also requires a separate petition and the evidence to support it at what is called the “Price-Sheppard hearing”. Each time an ECT petition is filed in Court, the patient is appointed a Guardian ad Litem to advocate in court for the patient’s best interests concerning the petition and the patient’s treatment.
In MI, CD and DD commitment cases, the initial commitment period cannot exceed six months. After six months, the Court is required, upon written request from the county mental health case manager or the treatment facility, to review the matter in a judicial hearing and decide whether to extend the commitment for a period of up to a maximum of twelve months. At the end of this up to 12 month period, the patient can be “recommitted” annually for periods of up to 12 months, but each recommitment requires a new petition for commitment supported by a new examiner’s statement. The burden of proof at extension and recommitment hearings is slightly lower than that required at an initial hearing on a new petition for commitment.
In cases involving Mentally Ill and Dangerous Persons, Sexual Psychopathic Personalities, or Sexually Dangerous Persons, the commitment is of an indefinite duration. Periodic reviews are conducted by the Special Review Board (SRB), an administrative panel of hearing officers operating under the authority of the State Department of Human Services, and the Supreme Court Appeal Panel (SCAP), a three judge panel of appointed District Court Judges operating under the authority of the Minnesota Supreme Court. The SRB and SCAP conduct hearings to determine whether the patient’s condition has been treated effectively to the point that it is safe to transfer the patient to a less restrictive treatment facility, or possibly provisionally discharge the patient from the treatment facility to the community under a prescribed plan for patient care and public safety.
Most hearings involving the Minnesota Commitment and Treatment Act are held in the Probate Courtroom on the basement level of Regions Hospital (formerly known as St. Paul-Ramsey Medical Center) East Building. The hospital is located at 640 Jackson Street in St. Paul.
For more information, please contact the Ramsey County Attorney's Office via email (rca@Co.Ramsey.MN.US) or telephone at (651) 266-3222 and ask for the Civil Commitment Unit.