General Admission Procedures

(1) For the purpose of involuntary commitment, mental illness is defined as a substantial disorder of thought, mood, perception, orientation, or memory which grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, but shall not include intellectual or developmental disabilities, autism spectrum disorder, traumatic brain injury or psychiatric or behavioral disorders or symptoms due to another medical condition as provided in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5 edition th published by the American Psychiatric Association, or except as provided in 104 CMR 27.18, alcohol and substance use disorders; provided however, that the presence of such conditions co-occurring with a mental illness shall not disqualify a person who otherwise meets the criteria for admission to a mental health facility. (2) For the purposes of voluntary or conditional voluntary admission to mental health facilities in the Commonwealth, any degree of severity of a mental disorder, including co-occurring substance use disorders, may qualify a person for admission to a mental health facility at the discretion of the facility director or designee when it is determined that the person is in need of care and treatment, and that the admitting facility is suitable for such care and treatment. (3) No facility licensed as Class III through VII shall have exclusion criteria for admission that would result in the rejection of any patient who has been determined by a designated physician or designated Psychiatric APRN of the facility to meet the clinical criteria for involuntary commitment pursuant to M.G.L. c. 123, § 12(b), or who has been committed pursuant to M.G.L. c. 123, § 12(e); provided however, that a facility that has been certified to treat specialty populations, such as for treating geriatric patients or patients with co-occurring intellectual or developmental disabilities, may preferentially admit such patients. Facilities may not deny admission to a patient for whom it has the clinical competency and staffing to appropriately treat, except as provided in 104 CMR 27.05(3) (b) through (d). (a) A facility licensed as Class III through VII shall have the capacity to care for patients otherwise meeting admission criteria who have co-occurring medical needs in accordance with clinical competencies and operational standards determined by the Department. (b) A facility may deny admission to a patient if such admission would result in a census exceeding the facility’s operational capacity; provided however, that the facility is able to demonstrate that, despite its best efforts, it is unable to accommodate the additional capacity. (c) A facility may deny admission to a patient if such admission would result in a census exceeding the facility’s licensed capacity. (d) A facility may deny admission to a patient whose needs have been determined by the facility medical director to exceed the facility's capability at the time admission is sought. The determination shall include the factors justifying denial of admission and why mitigating efforts, such as utilization of additional staff, would have been inadequate. This determination must be recorded in writing and shall be subject to review by the Department; provided however, that such written determination need not contain patient-identifiable information. (e) Facilities shall keep data on patients referred for admission in a form and format and containing data elements as determined by the Department; provided however, that facilities shall not be required to maintain patient-identifiable data on individuals not accepted for admission. Such data shall be available for inspection by the Department upon request. (4) Admission Examination. Upon admission, each patient shall receive a mental status examination and, within 24 hours of admission, a complete psychiatric and physical examination. In the case of admissions to an IRTP, such physical examination shall occur within seven calendar days of admission. As part of the admission examination, staff shall seek to determine from the patient, the patient’s record, the patient’s legally authorized representative or, if appropriate, from other sources, whether the patient has a history of trauma including, but not limited to, physical or sexual abuse or witnessing violence. At the completion of each admission examination, the admitting clinician shall make an admission diagnosis, and shall enter the findings of such admission examination in the patient’s medical record. (5) Admission Examination for Patients Younger than 22 Years Old. (a) In addition to the requirements of 104 CMR 27.05(4), the admission examination for patients younger than 22 years old shall include a determination as to whether the patient has special educational needs. (b) If the patient has special educational needs, the facility director shall seek written authorization to provide necessary clinical information to the patient’s Local Education Authority (LEA) in order that an educational program can be jointly developed for such patient by the LEA and the facility. (6) Notice to Family or Others. (a) Admission of Patients 16 Years of Age or Older. In accordance with M.G.L. c. 123, § 4, the facility director or designee shall, within 48 hours after admission of any patient, including a patient 16 or 17 years of age who has applied for admission himself or herself, notify the patient’s legally authorized representative or, if there is no such legally authorized representative and the patient does not knowingly object, his or her nearest relative. Notice may be given by telephone, letter or other appropriate means. (b) Emergency or Court Ordered Admissions of Minors. Except in the case of a mature or emancipated minor as defined in 104 CMR 25.03: Emancipated and Mature Minors, the legally authorized representative of a minor shall be notified immediately upon receipt of the minor who is admitted pursuant to court order or an application for admission pursuant to M.G.L. c. 123, § 12. (7) Denial of Admission. Applicants for voluntary or conditional voluntary admission to mental health facilities shall not be denied admission without an explanation of the basis for such refusal, and alternatives shall be offered or recommended by the admitting clinician where feasible. (8) Prohibition of Admission of Individuals Younger than 19 Years Old to Adult Inpatient Units; Exceptions. Except as provided in 104 CMR 27.05(8), no individual younger than 19 years old shall be admitted to an adult unit of a Department operated facility. (a) The Department may place an individual 17 or 18 years of age on such an adult inpatient unit where a judge of a court of competent jurisdiction has issued an order for the commitment of the individual to a mental health facility pursuant to the provisions of M.G.L. c. 123, §§ 15, 16, 17 or 18, or where the individual has been committed to the Department of Youth Services, and the Commissioner or designee has determined that one or both of the following factors exist: 1. placement of the individual on an adolescent inpatient unit would create a likelihood of serious harm to the individual or others; or 2. the individual is in need of stricter security than is available on an adolescent inpatient unit. (b) The factors to be considered in the above determinations include, but are not limited to, the following: 1. the nature, circumstances and seriousness of the offense with which the individual has been charged; 2. the individual’s court and delinquency record; 3. the individual’s maturity; 4. the individual’s history of mental illness; 5. the individual’s social history; 6. the risk of harm presented by the individual’s placement on an adolescent inpatient unit; 7. the individual’s history of victimizing others; and 8. the mental health treatment most suitable for the individual. (c) Specialty services or units designated by the Department may admit individuals younger than 19 years old, provided that they ensure appropriate separate physical space and programmatic services, as approved by the Commissioner. (9) Unless otherwise specified, computation of time for any action required to be taken under 104 CMR 27.00 shall be in accordance with 104 CMR 25.04: Computation of Time.