So I'm gonna shift gears a little bit, which is kind of somewhat related to a lot of what we're seeing on the ground and move on to involuntary hospitalizations.

And I know that this is a topic that people have very strong feelings about on both sides, but just so one part of the care community action program is the involuntary hospitalization and removal of individuals that are mentally ill and possess harm to themselves or others.

The individual would be taken into custody by police officers for a psychiatric evaluation.

So what is your role, DOHMH's role, in the involuntary hospitalizations?

Thank you for the question.

Certainly this is something that as you said has been a topic of a lot of conversation.

We have a couple of different roles and those roles are really you know essentially part of the triage and assessment for involuntary hospitalizations.

I will pass to Doctor.

Wright to share a little bit more of the specifics about how we engage in involuntary hospitalization in the health department.

Thank you commissioner.

So we are involved in terms of the involuntary commits for September, mental hygiene law nine thirty seven is one where community psychiatrists or level of personnel are able to help an individual get connected to emergency services or comprehensive psychiatric emergency programs.

The nine fifty eight is also one that the mental hygiene law where we have individuals, professionals, psychiatrists that work with our mobile crisis teams and that's generally the the mode of the involuntary commit.

We also have the 9.6 o which is specifically to AOT in terms of removal.

So what all of those have, those professionals that are able to make that decision, and it's very thoughtful decision that is not quickly, but it's thoughtful.

It's using professionals to understand their clinical expertise to make sure that we're taking into consideration all aspects of the clinical care, but also the needs of the individual.

Yeah.

And I know it's

And Jamie's going to elaborate

a little Oh, sorry, yeah.

I just want to add to that.

In addition to what Doctor.

Morrison, Doctor.

Wright just said, those descriptions were assessments in the community for involuntary transport to the hospital.

At the hospital then, the psychiatric emergency room or the Comprehensive Psychiatric Emergency Program, so Psych ER or CPAP in the local lingo.

Then you have two physicians who are assessing the person for admission.

So there's two levels here of assessment: in the community, where we have a really active role as we just described, and then in the hospital for the admission or commitment.

Okay.

So I I asked this question from the perspective of what you see on the ground as well as in the hospitals.

Where do you think I'm trying to see, like

where I

mean it's interesting because I know that there's these laws that are in place but where do you think the points of improvement could be when it comes to this and how has this impacted the workers at the hospital as well as in the outreach teams like what are they seeing because I'm sure that they have their own thoughts about how to improve the system and they would probably know best because they're on the ground right and so I'm just curious to hear what feedback you've been getting in terms of this and where there could be improvements because I know obviously the consent piece is a huge one, but I'm just curious to see what your thoughts are on this involuntary removal of people experiencing mental illness without their consent because I think that can be tricky.

I can go ahead and start just to share a little bit of our like perspective and philosophy behind this because ultimately our perspective is that people with severe mental illness should be in treatment and should have supportive housing or stable housing.

And that those two things are critical to make sure that instead of focusing on involuntary removals, we are doing the public health approach to mental health and behavioral health, which again is about making sure that people's needs are met and their access to care is met and that, you know, we're not dealing with involuntary removals as a first approach to the care of people with severe mental illness.

These other programs are the ones that are going to prevent us from having to, in rare and unfortunate circumstances, use this tool of involuntary removal that we think should be used extremely judiciously, and only again when all of these other programs have failed.

So philosophically, a public health approach to mental health is really about making sure that people are housed, that they have stable housing, whether that's supportive housing or another type of housing, that their basic needs are being met, that they have access to healthcare including behavioral healthcare.

And if we are able to continue to invest in those programs, the conversations about involuntary removals again are rare and not our first line of care for people with serious mental illness.

But I'll pass it to Doctor.

Wright to share a little bit more about any ideas on the program and process.

Process.

Thank you commissioner.

And I think that what I would add to what commissioner Morris said is that it's important to keep in mind that these individuals, the professionals making these decisions, they do it in a very thoughtful process.

This is not something that happens often and so they're using their clinical expertise to make sure that they're also balancing a person's rights and responsibilities in that way, but also generally leaning on the care of the person.

And so as an example individuals that as Jamie mentioned that do end up being hospitalized of that group, a very small percentage three percent that are removed of that group seventy five percent that are admitted is because the clinical work was done appropriately.

And so those individuals that indicates that the experts know what they're doing when they make those assessments to determine that a person one needs to be removed for their safety or health of themselves or others, but also that they can get the treatment that they need.

So that high level of admission tells us that the experts know what they're doing.