On March 28, 1988, Ohio Governor Richard F. Celeste signed into law Amended Substitute Senate Bill 156, now known as the Mental Health Act of 1988. As Ohio’s most significant piece of mental health legislation in 29 years, the law firmly established the state’s commitment to addressing the mental health needs of Ohioans through a unified system of community-based services. The law more fully defined the roles and responsibilities of the community mental health boards and the Ohio Department of Mental Health (ODMH) and updated and revised many areas of mental health law.
ODMH committed substantial amounts of time and resources to support effective implementation of the law beginning July 1, 1989. Training and technical assistance focused on commitment procedures, financing provisions, local system development and preparation for consumers and family members for mental health board membership.
The following gives an overview of some of the more prominent features of the legislation. It does not cover all features of the law and should not be taken as a legal interpretation of its provisions.
Responsibilities of ODMH
The law allows the department to be organized by the director, based on the various functions and responsibilities of its components, by removing requirements for various divisions and bureaus. It also requires the department to have a medical director.
Department functions and responsibilities identified in the law include:
Where ODMH is responsible for developing guidelines, standards and rules, it must consult with relevant constituencies, which must include primary and secondary consumers and may include public and private providers, labor and other organizations, when appropriate. ODMH is required to develop rules to specify how it will notify and consult with these groups.
The law set forth the policy that ODMH will provide a full range of services, not only by operating state hospitals, but also by operating other community-based services and may deploy its staff in community settings and locations. ODMH also has a clear role in providing funding for services through the community mental health boards.
ODMH is responsible for developing residency and training programs with hospitals, colleges and universities to meet the public mental health system’s need to professionals, including women, minorities and handicapped people.
Responsibilities of the community mental health boards
The law firmly establishes the boards as the single authority for the mental health system in each community, especially for children, adolescents and adults who are severely mentally disabled. Each board must submit a Community Mental Health Plan to ODMH for approval. This plan must include a list of the services the board intends to purchase, a projection of inpatient and community-based services the board proposes that ODMH operate, an assessment of the number and types of residential facilities needed, proposed use of funds and budgets and other information requested by ODMH.
Each board is to establish, to the extent resources are available, the essential elements of a community support system that would locate people in need and inform them about available mental health services; assist clients with meeting basic human needs; provide mental health services; provide emergency services and crisis intervention; assist clients with vocational services and opportunities; develop clients’ social, community and personal living skills; provide access to housing and residential treatment and support; assist families, friends and consumers; recognize and encourage natural support systems; provide grievance procedures and protect client rights and provide case management.
Pursuant to the law, as of July 1, 1989, people who are civilly committed to the public mental health system are committed to a board or its designated agency, rather than to a state hospital. (The only exceptions are people found incompetent to stand trial but likely to be restored, people found not guilty by reason of insanity and commitments from the adult correctional system or Department of Youth Services.) The board must provide services in the least restrictive and most appropriate setting, including both public and private hospital and non-hospital settings.
Additional responsibilities of the boards include establishing assessment methods for people who are involuntarily committed; ensuring that apartment residences for people who are mentally ill meet fire safety standards and that residents are receiving mental health services; establishing involvement of consumers and families; investigating cases of alleged abuse or neglect and taking appropriate action; assessing and evaluating services per ODMH standards and through the community mental health plan and reviewing residential facilities’ applications for licensure.
The law provides a means to integrate funding for the operation of state hospitals with the planning process of the community mental health boards. A proportionate amount of state hospital appropriations is made available to boards to plan for state hospital care, state-operated community-based services or board-contracted services. The board must include the proposed utilization of these funds in its community plan submitted to ODMH. ODMH establishes a formula for these allocations, and boards may elect, on an annual basis, whether or not to accept the funds. Boards that elect not to accept the funds must still include plans for utilization of state-operated community or hospital services through the community plan process. Funds will be distributed on a regular basis, rather than by reimbursement for services previously provided.
ODMH is authorized to license and prescribe minimum standards for private psychiatric hospitals and may inspect and seek an injunction against any hospital operating without a license. The law specifies types of residential facilities and permits ODMH to license, review the operation of, establish minimum standards for and inspect such facilities. ODMH may seek an injunction against any facility operating without a license and may revoke the license of a facility that does not comply with established standards. Applications for licensure are to be reviewed by the appropriate community mental health board. ODMH may also seek receivership of a facility if its residents are at risk, and there is no other means to ensure their safety.