Standards of Judicial Practice: Civil Commitment and Authorization of Medical Treatment for Mental Illness: Standard 9

Standards 9:00 through 9:05 of the District Court's Standards of Judicial Practice: Civil Commitment and Authorization of Medical Treatment for Mental Illness - Civil Commitment for Mental Illness.

9:00 Location of § 8B hearings

The legal requirements and District Court standards that apply civil commitment proceedings in this area also apply to G.L. c. 123, § 8B proceedings. See Standard 4:00.

9:01 Public access to § 8B hearings

The legal requirements and District Court standards applicable to civil commitment proceedings in this area also apply to G.L. c. 123, § 8B proceedings. See Standard 4:01.

9:02 Electronic recording of § 8B hearings

The legal requirements and District Court standards that apply to civil commitment proceedings in this area also apply to G.L. c. 123, § 8B proceedings. See Standard 4:02.

9:03 Adversarial nature of § 8B hearings

The legal requirements and District Court standards that apply to civil commitment proceedings in this area also apply to G.L. c. 123, § 8B proceedings. See Standard 4:03.

9:04 Findings, decision and order in § 8B proceedings

The court should render its decision on the § 8B petition immediately upon the completion of the hearing, if possible, and no later than ten days after the completion of the hearing.

 “[T]he court shall not authorize medical treatment [with antipsychotic medication] unless it (i) specifically finds that the person is incapable of making informed decisions concerning the proposed medical treatment, (ii) upon application of the legal substituted judgment standard, specifically finds that the patient would accept such treatment if competent, and (iii) specifically approves and authorizes a written substituted judgment treatment plan.” G.L. c. 123, § 8B(d). 

The court’s decision must include specific, written findings of fact and conclusions of law.

The petitioner, the respondent and respondent’s counsel should be notified of the court’s decision immediately after it is rendered. 

While routine periodic judicial reviews of commitment decisions are disfavored (see Standard 4:06), judicial reviews in support of the court’s obligation to monitor the treatment plan (see Standard 11:04) are entirely appropriate.

Commentary

Since time is usually of the essence in § 8B proceedings, whenever possible the court should render an immediate decision regarding the authorization of treatment at the conclusion of the hearing, with specific, written findings to follow immediately afterward. In no event should the decision be rendered more than ten days after completion of the hearing, so that the treatment plan may be implemented forthwith in order to achieve the desired benefit. 

The statutory requirement in § 8B(d) of specific findings echoes the Supreme Judicial Court’s direction that the court enter “specific and detailed findings demonstrating that close attention has been given the evidence.” Guardianship of Roe, 383 Mass. 415 , 421 (1981). The court may rely on counsel to assist in this regard by requesting the preparation of proposed findings of fact and rulings of law. 

Findings must include a summary of the evidence necessary to support the court’s determinations of the four key issues: 

1. the respondent’s competency or lack thereof to make informed treatment decisions;
2. if the respondent is found incompetent, a substituted judgment determination on whether the respondent, if competent, would consent to the proposed medical treatment, including specific findings on the Rogers criteria (see Standard 7:03);
3. if there is a substituted judgment determination that the respondent, if competent, would not consent to the proposed treatment, a further determination as to whether there is a countervailing State interest; and
4. the authorization of a treatment plan, if applicable. 

If the court authorizes treatment for the respondent, it may, on its own motion or at the request of either party, set the case down for judicial review at any appropriate point during the period of authorization. At such a review hearing the court may consider the current status of the respondent, take further evidence, and modify or vacate its original authorization as it determines to be appropriate.

9:05 Appeal of § 8B orders

The legal requirements and District Court standards applicable to civil commitment proceedings in this area also apply to G.L. c. 123, § 8B proceedings. See Standard 4:07.