104 Mass. Reg. 27.09 : DEPARTMENT OF MENTAL HEALTH — LICENSING AND OPERATIONAL STANDARDS FOR MENTAL HEALTH FACILITIES — OPERATIONAL STANDARDS FOR MENTAL HEALTH FACILITIES — Discharge

(1) Discharge Procedures.

(a) A facility shall arrange for necessary post-discharge support and clinical services. Such measures shall be documented in the medical record.

(b) A facility shall make every effort to avoid discharge to a shelter or the street. The facility shall take steps to identify and offer alternative options to a patient and shall document such measures, including the competent refusal of alternative options by a patient, in the medical record. In the case of such discharge, the facility shall nonetheless arrange for or, in the case of a competent refusal, identify post-discharge support and clinical services. The facility shall keep a record of all discharges to a shelter or the street, in a form approved by the Department, and submit such information to the Department on a quarterly basis.

(c) When a patient in a facility operated by or under contract to the Department is a client of the Department pursuant to 104 CMR 29.00: Application for DMH Services, Referral, Service Planning and Appeals, the service planning process outlined in 104 CMR 29.00 shall be undertaken prior to discharge.

(d) A facility shall keep a record of all patients discharged therefrom, and shall provide such information to the Department upon request.

(2) Voluntary Admission Status. A patient voluntarily admitted to a facility under 104 CMR 27.06 shall be discharged upon his or her request, or upon the request of the patient's legally authorized representative who applied for the admission of such patient, without a requirement of a three-day notice.

(3) Discharge Initiated by Facility Director. The facility director may discharge any patient admitted as a voluntary or conditional voluntary patient at any time he or she deems such discharge in the best interest of such patient; provided however, that if a legally authorized representative made the application for admission, 14 days notice shall be given to such legally authorized representative prior to such discharge, in accordance with M.G.L. c. 123, § 10(a). With the consent of such legally authorized representative, the facility director may discharge the patient at any time.

(4) Conditional Voluntary Admission Status. A patient admitted to a facility on conditional voluntary status under 104 CMR 27.06 shall be discharged by the facility upon his or her request; provided however, he or she shall give three days written notice of his or her intent to leave the facility to the facility director, and may be retained at the facility for such three-day notice period, during which time the facility director may require an examination of such patient to determine his or her suitability for discharge. Such patients may be retained at the facility beyond the expiration of the three-day notice period if, prior to the expiration of the said three-day notice period, the facility director files with a court of competent jurisdiction, a petition for the commitment of such patient at the s facility.

(5) Discharge at Request of Legally Authorized Representative. A patient admitted by his or her legally authorized representative may be discharged at the request of such legally authorized representative consistent with procedures for discharge of a patient admitted upon his or her own authority.

(6) Patients 16 or 17 Years of Age. A patient who is 16 or 17 years of age, or who turns 16 years old during the course of hospitalization, and who has been admitted to a facility as a voluntary or conditional voluntary patient by application of a legally authorized representative, shall have the same rights pertaining to release, withdrawal and discharge as those patients 16 years of age or older who have applied for and been admitted on a voluntary or conditional voluntary status to the facility on their own behalf.

(7) Involuntary Commitment Status.

(a) Three-day Commitment. A patient admitted to a facility under M.G.L. c. 123, § 12, may be discharged by the facility director at any time during such period of hospitalization if the facility director determines that such patient is not in need of care and treatment in the facility. The three-day hospitalization period authorized under M.G.L. c. 123, § 12 shall not be extended and, at the end of such period, a patient so hospitalized shall be discharged by the facility unless, prior to expiration, such patient has applied for, and has been admitted on voluntary or conditional voluntary status to the facility, or the facility director has filed a petition for an order of commitment.

(b) Prolonged Commitment. A patient committed to a facility by order of a court of competent jurisdiction shall be discharged by the facility upon the expiration of the order, unless the commitment order is renewed under the procedures established in M.G.L. c. 123, §§ 7 and 8.

(c) Except as provided in 104 CMR 27.09(8), at any time during the period of hospitalization, the facility director may discharge such patient if he or she determines that such patient is no longer in need of care and treatment.

(8) Forensic Commitment Status.

(a) A patient committed to facility under M.G.L. c. 123, § 15 shall not be discharged, except to the committing court, or upon other court order.

(b) A patient committed to a facility under M.G.L. c. 123, § 16 shall not be discharged, unless appropriate notice has been given by the facility director to the court and district attorney which has or had jurisdiction of the relevant criminal case. If within 30 days of the receipt of such communication the district attorney has not filed a petition for further commitment of such patient, the patient may be discharged. The patient shall be held at the facility for such 30-day period, unless the district attorney provides written notice that he does not intend to petition for further commitment.

(c) In the event the facility director intends to remove or modify any court ordered restrictions on such a patient's movements, he or she shall communicate the intention to remove or modify such restriction in writing to the court which ordered the commitment and the district attorney who has or had jurisdiction of the relevant criminal case. If within 14 days neither the court nor district attorney makes written objection thereto, such restrictions may be removed or modified.

(d) The requirements of 104 CMR 27.09(8)(b) and (c) shall not apply to patients originally committed after a finding of incompetence to stand trial whose criminal charges have been dismissed.

(e) A patient on commitment status under M.G.L. c. 123, § 16 who was found incompetent to stand trial and whose charges are dismissed may be discharged at any time if the facility director determines that such patient is no longer in need of care and treatment. The dismissal of criminal charges shall not, however, terminate the underlying commitment order. Any subsequent commitment proceedings for such a patient shall be under M.G.L. c. 123, §§ 7 and 8.

(f) A patient hospitalized at a facility pursuant to M.G.L. c. 123, § 18 shall not be discharged, except to the custody of the place of detention from which the patient was hospitalized, unless such patient's sentence, or other authority under which the patient is being held in custody, has expired.