Health - General (GHG) — Title 10. Mental Health Law

“Admission” means the process by which an individual is accepted as a resident in:

“Admission” includes the physical act of the individual entering the facility or Veterans’ Administration hospital.

Except as otherwise provided in this title, “facility” means any public or private clinic, hospital, or other institution that provides or purports to provide treatment or other services for individuals who have mental disorders.

“Facility” does not include a Veterans’ Administration hospital.

“Mental disorder” means a behavioral or emotional illness that results from a psychiatric disorder.

“Mental disorder” includes a mental illness that so substantially impairs the mental or emotional functioning of an individual as to make care or treatment necessary or advisable for the welfare of the individual or for the safety of the person or property of another.

“Mental disorder” does not include an intellectual disability.

To develop, extend, and improve services for finding these individuals; and

To provide facilities for diagnosis and treatment of nonresidential cases.

Prepare plans for the program;

Adopt necessary rules and regulations to carry out these plans;

In accordance with these plans, receive and spend any available funds;

Coordinate and supervise the provision of program services that the Administration does not provide directly; and

Cooperate with the federal government and with all other public or private agencies in:

Include an inventory of the mental health resources in this State;

Set out the needs of the various areas for services, including community-based services in accordance with the findings and recommendations of the plan described in § 10-207 of this subtitle;

Establish priorities of the different services needed; and

Include any other matter that the Secretary thinks should be covered.

Have a serious mental disorder as defined in the plan; and

Are not receiving the appropriate array of community–based services described in the “total need” section of the 3–year mental health plan that expired on June 30, 1991.

On or after October 1, 1993, within existing resources and in concert with local core service agencies or local behavioral health authorities, the Director shall prepare a comprehensive mental health plan which identifies the needs of all individuals who have a serious mental disorder and who are targeted for services in the “Comprehensive Mental Health Services Plan” submitted by the State to the federal government in accordance with § 1925 of the Public Health Service Act.

The comprehensive mental health plan shall:

There is a continuing, nonlapsing Mental Health Community–Based Services Fund.

The purpose of the Mental Health Community–Based Services Fund is to ensure that funds realized from the sale or lease of Behavioral Health Administration facilities as the result of downsizing, consolidation, or closure are used to provide community–based services.

If a facility operated by the Behavioral Health Administration is downsized, consolidated, or closed such that the net resident population declines or if a facility is closed or consolidated and bed capacity levels remained unchanged:

Funds in the Mental Health Community–Based Services Fund shall be spent in accordance with a plan developed by the Behavioral Health Administration in consultation with consumers, family members, providers, and mental health advocates.

The population of one of the counties is too small to warrant the establishment of a mental health advisory committee for that county; and

The Director consents.

The mental health advisory committee of each county shall consist of:

If more than one State inpatient facility serves a county, a representative from at least 1 of the facilities shall be appointed by the Director.

At least one–half of the voting members shall be appointed from among the individuals listed in paragraph (1)(ii)2A through C of this subsection.

Notwithstanding paragraphs (1) through (3) of this subsection, if the governing body of Baltimore City or Anne Arundel County designates a core service agency or local behavioral health authority as the mental health advisory committee, the mental health advisory committee shall consist of the governing body of the core service agency or local behavioral health authority.

The term of an appointed member is 3 years and begins on July 1.

The terms of one–third of the appointed members of each county advisory committee or intercounty advisory committee end each year.

At the end of a term, a member may continue to serve until a successor is appointed and qualifies.

A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.

A member who serves 2 consecutive full 3–year terms may not be reappointed for 2 years after completion of those terms.

Create subcommittees; and

Have additional individuals participate as needed.

Monitor, review and evaluate the allocation and adequacy of publicly funded mental health services within the county through means such as conducting or participating in site visits;

Determine the needs of the county mental health system, including quality of services, gaps in the system, and interagency coordination;

Participate in the development of the local mental health plan and local mental health budget;

Review and comment upon the annual core service agency or county mental health plan and preliminary budget, prior to submission of the budget to the State; and

Review and comment upon the annual fiscal report.

Clifton T. Perkins Hospital Center;

Eastern Shore Hospital Center;

Regional Institutes for Children and Adolescents — Baltimore and Rockville;

Springfield Hospital Center;

Spring Grove Hospital Center; and

Thomas B. Finan Hospital Center.

By January 1, 1985, the Department shall adopt rules and regulations for admission to all Regional Institutes for Children and Adolescents in cooperation with representatives from the advisory committees of the Regional Institutes for Children and Adolescents, the mental health advisory committees in each region, the local education agencies, and the Mental Health Association of Maryland.

In determining these rules and regulations, the Department shall provide that no bona fide candidate for admission may be rejected solely because of residence outside the regular catchment area served by the institution.

In determining these rules and regulations, the Department shall provide that candidates for admission who reside in the regular catchment area served by the institution shall be granted priority in admissions to the institution.

Beginning in fiscal year 2007, the Department may not bill a local board of education for any services provided by the State at a regional institute for children and adolescents.

Notwithstanding paragraph (1) of this subsection:

Before a regional institute for children and adolescents may be closed, the Department shall submit a report to the Governor and, in accordance with § 2–1257 of the State Government Article, the Senate Finance Committee, the Senate Budget and Taxation Committee, the House Health and Government Operations Committee, and the House Appropriations Committee, justifying the closure.

The report shall address:

The committees shall have 60 days to review and comment on the report.

In programs by January 1, 1992; and

In facilities by July 1, 1994.

Supervise generally the State facility;

In accordance with the provisions of the State Personnel and Pensions Article, appoint a staff for the State facility as needed and as provided in the State budget; and

Report to the Director as the Director requires.

The Board for each State facility shall reflect adequately the composition of the community that the State facility serves.

Of the members of the Board for a State facility:

The Governor shall appoint the members from a list of qualified individuals submitted to the Governor by the Secretary.

The term of a member is 4 years.

At the end of a term, a member continues to serve until a successor is appointed and qualifies.

A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.

Each Board serves in an advisory capacity.

Each Board shall:

In this subsection, “facility” means:

In a fiscal year in which an upward adjustment to the pay scale is made for initial appointments to a “Registered Nurse” position in a facility, the “Registered Nurse Charge”, “Registered Nurse Supervisor”, and “Registered Nurse Manager” positions in the same facility shall receive an upward adjustment to their pay scales in an amount at least equal to the adjustment for the employees in a “Registered Nurse” position who report to employees in the “Registered Nurse Charge”, “Registered Nurse Supervisor”, and “Registered Nurse Manager” positions at the facility.

In a fiscal year in which an upward adjustment to the pay scale is made for initial appointments to a “Registered Nurse Perkins” position at the Clifton T. Perkins Hospital Center, the “Registered Nurse Charge Perkins”, “Registered Nurse Supervisor Perkins”, “Registered Nurse Manager Perkins”, “Assistant Director of Nursing Perkins”, and “Director of Nursing Perkins” positions at the Clifton T. Perkins Hospital Center shall receive an upward adjustment to their pay scales in an amount at least equal to the adjustment for the employees in a “Registered Nurse Perkins” position who report to employees in the “Registered Nurse Charge Perkins”, “Registered Nurse Supervisor Perkins”, “Registered Nurse Manager Perkins”, “Assistant Director of Nursing Perkins”, and “Director of Nursing Perkins” positions.

The Superintendent of the Center and each individual in a scientific position or technical position shall be in the management service or special appointments in the State Personnel Management System.

The remaining administrative employees and all clerical employees shall be in the skilled service in the State Personnel Management System.

The Executive Board shall determine the status of each position at the Center.

As ex officio members:

3 psychologists;

3 physicians who are licensed to practice medicine in this State and devote a substantial amount of professional time to the practice of psychiatry; and

3 citizens of this State chosen by the Executive Board of the Center from individuals who are interested in and concerned about the care of individuals who have a mental disorder and about research directed toward the prevention, discovery of causes, and treatment of mental disorders and allied conditions.

1 shall be chosen by the Executive Board of the Center from the University of Maryland School of Medicine;

2 shall be chosen by the Executive Board of the Center from the Johns Hopkins University School of Medicine; and

3 shall be chosen by the Executive Board of the Center from other affiliations, including private practitioners.

Except as provided in paragraph (2) of this subsection, the Department shall inspect each private, inpatient facility at least once every 6 months and at any other time that the Department considers necessary.

A facility that is accredited by the Joint Commission on Accreditation of Hospitals shall be inspected under § 19-308(b) of this article.

“Private group home” means a residence in which individuals who have been or are under treatment for a mental disorder may be provided care or treatment in a homelike environment.

“Private group home” does not include:

Is deemed conclusively a single–family dwelling; and

Is permitted to locate in all residential zones.

Be signed and verified by the applicant; and

Contain:

Cause serious bodily harm to the individual or another individual; or

Be unable, except for reasons of indigence, to provide for the individual’s basic needs, including food, clothing, shelter, medical care, self–protection, or safety, to such a degree as to create a substantial risk of serious bodily harm, serious illness, or death in the near future.

Licensed as a registered nurse and certified as a nurse practitioner under Title 8 of the Health Occupations Article; and

Practicing in the State as a certified registered nurse practitioner–psychiatric mental health.

Transferred from a facility of another state to a State facility under the Interstate Compact on Mental Health; or

Admitted after an emergency evaluation under Part IV of this subtitle.

Each geriatric evaluation shall be done by the geriatric evaluation team of a county health department.

Each geriatric evaluation team consists of the individuals whom the Secretary designates from multiple disciplines.

Be on the form that the Department requires; and

Contain the information that the Department requires.

Submit a formal, written application that contains the personal information and is on the form required by the Administration; or

Informally request admission.

The individual has a mental disorder;

The mental disorder is susceptible to care or treatment;

The individual understands the nature of the request for admission;

The individual is able to give continuous assent to retention by the facility; and

The individual is able to ask for release.

In addition to the limitations in subsection (c) of this section, a State facility may not admit an individual who is 65 years old or older unless a geriatric evaluation team determines that there is no available, less restrictive form of care or treatment that is adequate for the needs of the individual.

If admission is denied because of the determination of the geriatric evaluation team, the team shall:

Any facility that is not a State facility; or

The following State facilities:

The individual has a mental disorder;

The mental disorder is susceptible to care or treatment;

The applicant understands the nature of a request for admission; and

Assent to the admission has been given:

In this section the following words have the meanings indicated.

“Disabled person” has the meaning stated in § 13–101 of the Estates and Trusts Article.

“Guardian of the person” means a guardian of the person of a disabled person appointed under Title 13, Subtitle 7, Part II of the Estates and Trusts Article.

“Mental disorder” has the meaning stated in § 10–620 of this subtitle.

The disabled person submits a formal, written application that contains the disabled person’s personal information and is on the form required by the Administration; and

In accordance with subsections (c) through (e) of this section, either a physician and a psychologist, two physicians, a physician and a psychiatric nurse practitioner, or a physician and a physician assistant certify that:

A certificate for voluntary admission of a disabled person under subsection (b) of this section shall:

The rules and regulations shall require the form to include an opinion that:

Has a financial interest, through ownership or compensation, in a proprietary facility and admission to that proprietary facility is sought for the disabled person whose status is being certified; or

Is related, by blood or marriage, to the disabled person or the guardian of the person of the disabled person.

As certified in accordance with subsection (c) of this section, the disabled person satisfies the criteria under subsection (b)(2) of this section; and

The disabled person is able to ask for release.

In addition to the limitations in subsection (f) of this section, a State facility may not admit a disabled person who is 65 years old or older unless a geriatric evaluation team determines that there is no available less restrictive form of care or treatment that is adequate for the needs of the disabled person.

If admission is denied because of the determination of the geriatric evaluation team, the team shall:

That the disabled person has been admitted to the facility; and

If the disabled person requests to be discharged from a facility to which the disabled person was voluntarily admitted.

The admission status of the disabled person has been changed to an involuntary admission in accordance with Part III of this subtitle; and

An involuntary commitment proceeding is held.

Diminish the rights, duties, or responsibilities conferred on the guardian of the person under § 13–708 of the Estates and Trusts Article; or

Confer any additional power or authority on the guardian of the person, including the power or authority to commit the disabled person to a mental facility, that a court has not otherwise conferred on the guardian of the person under § 13–708 of the Estates and Trusts Article.

The Administration, in the case of a facility; or

The Veterans’ Administration hospital, in the case of a Veterans’ Administration hospital;

1 physician and 1 psychologist;

2 physicians;

1 physician and 1 psychiatric nurse practitioner;

1 physician and 1 licensed certified social worker–clinical; or

1 physician and 1 licensed clinical professional counselor; and

A certificate for involuntary admission of an individual under this part shall:

The rules and regulations shall require the form to include:

More than 1 week before the certificate is signed; or

More than 30 days before the facility or the Veterans’ Administration hospital receives the application for admission.

Has a financial interest, through ownership or compensation, in a proprietary facility and admission to that proprietary facility is sought for the individual whose status is being certified; or

Is related, by blood or marriage, to the individual or to the applicant.

The individual has a mental disorder;

The individual needs inpatient care or treatment;

The individual presents a danger to the life or safety of the individual or of others;

The individual is unable or unwilling to be admitted voluntarily; and

There is no available, less restrictive form of intervention that is consistent with the welfare and safety of the individual.

In addition to the limitations in subsection (a) of this section, a State facility may not admit an individual who is 65 years old or older unless a geriatric evaluation team determines that there is no available, less restrictive form of care or treatment that is adequate for the needs of the individual.

If admission is denied because of the determination of the geriatric evaluation team, the team shall:

“Emergency facility” means a facility that the Department designates, in writing, as an emergency facility.

“Emergency facility” includes a licensed general hospital that has an emergency room, unless the Department, after consultation with the health officer, exempts the hospital.

“Mental disorder” means the behavioral or other symptoms that indicate:

“Mental disorder” does not include intellectual disability.

Publish a list of emergency facilities and their addresses; and

Give the list to each health department, judge of a court, sheriff’s office, police station, local behavioral health authority, and Secret Service office in this State.

Comprehensive crisis response centers;

Crisis stabilization centers;

Crisis treatment centers established under § 7.5–207 of this article; and

Outpatient mental health clinics.

Is adequately staffed to provide 24–hour emergency petition services;

Provides the necessary services required for an emergency petition;

Has written procedures in place that provide for involuntary admissions, through an emergency petition, including to a licensed hospital, as necessary;

Provides additional support to respect the due process rights of patients received through the emergency petition process; and

Complies with additional procedures as otherwise determined by the Department.

The number of facilities that have sought to be designated an emergency facility;

The number of the facilities reported under item (1) of this subsection that have attempted to meet the model facility standards developed under subsection (c) of this section;

The progress of the facilities reported under item (2) of this subsection toward meeting the model facility standards;

The development of collaborative models between State, local, and private entities; and

Whether the Department, in consultation with stakeholders, has determined that any changes to the model facility standards are necessary.

Has a mental disorder; and

Presents a danger to the life or safety of the individual or of others.

The petition for emergency evaluation of an individual may be made by:

An individual who makes a petition for emergency evaluation under paragraph (1)(i) or (ii) of this subsection may base the petition on:

A petition under this section shall:

The petition form shall contain a notice that the petitioner:

A petitioner who is a physician, psychologist, physician assistant, clinical social worker, licensed clinical professional counselor, clinical nurse specialist in psychiatric and mental health nursing, psychiatric nurse practitioner, licensed clinical marriage and family therapist, health officer, or designee of a health officer shall give the petition to a peace officer.

The peace officer shall explain to the petitioner:

A peace officer shall take an emergency evaluee to the nearest emergency facility if the peace officer has a petition under Part IV of this subtitle that:

The petition required under paragraph (1) of this subsection may be:

To the extent practicable, a peace officer shall notify the emergency facility in advance that the peace officer is bringing an emergency evaluee to the emergency facility.

After a peace officer brings the emergency evaluee to an emergency facility, the peace officer need not stay unless, because the emergency evaluee is violent, emergency facility personnel ask the supervisor of the peace officer to have the peace officer stay.

A peace officer shall stay until the supervisor responds to the request for assistance. If the emergency evaluee is violent, the supervisor shall allow the peace officer to stay.

If emergency facility personnel ask that a peace officer stay, a physician shall examine the emergency evaluee as promptly as possible.

If the petition is executed properly, the emergency facility shall accept the emergency evaluee.

The petition required under paragraph (1) of this subsection may be:

Within 6 hours after an emergency evaluee is brought to an emergency facility, a physician shall examine the emergency evaluee, to determine whether the emergency evaluee meets the requirements for involuntary admission.

Promptly after the examination, the emergency evaluee shall be released unless the emergency evaluee:

An emergency evaluee may not be kept at an emergency facility for more than 30 hours.

If the examining physician is unable to have the emergency evaluee admitted to a facility, the physician shall notify the Department.

Within 6 hours after notification, the Department shall provide for admission of the emergency evaluee to an appropriate facility.

Within 30 hours after the emergency facility completes an application for the involuntary admission of an emergency evaluee, the emergency facility shall notify the Mental Health Division in the Office of the Public Defender, by e–mail or facsimile, of the completion of the application.

The notice required under paragraph (1) of this subsection shall include any legal documents relating to the acceptance of the emergency evaluee into the emergency facility, including the emergency petition, application for involuntary admission, and certification for involuntary admission.

The notice required under paragraph (1) of this subsection does not apply to a patient who agrees to voluntary admission.

The examining physician shall send a brief report of the evaluation to the court; and

The peace officer shall:

The charges against the individual are dismissed, nol prossed, or stetted; or

The individual appears in court.

If an emergency evaluee cannot pay or does not have insurance that covers the charges for emergency services, an initial consultant examination by a physician, physician assistant, or nurse practitioner, and transportation to an emergency facility and, for an involuntary admission of the emergency evaluee, to the admitting facility, the Department shall pay the appropriate party the actual cost or a reasonable rate for this service, whichever is lower, except that hospitals shall be paid at rates approved by the Health Services Cost Review Commission.

The reasonable rate for the services provided under an emergency petition shall be calculated by using a methodology established by regulation and reasonably related to the actual cost.

Personnel of the court;

The petitioner;

The emergency evaluee or counsel for the emergency evaluee;

Authorized personnel of the Department;

Authorized personnel of the local core service agency or local behavioral health authority;

A law enforcement agency; or

A person authorized by a court order on good cause shown.

Shall be considered a mental health record under Title 4 of this article; and

May be released by a health care provider, as defined in § 4–301 of this article, only as permitted by law.

An emergency evaluee who was a minor when a petition for emergency evaluation was made or sought concerning the emergency evaluee under this part may file a motion with the court at any time requesting that any court records relating to the petition be sealed.

The court shall have a copy of the motion filed under this subsection served on the petitioner at the address stated for the petitioner in the petition for emergency evaluation.

The court may order court records relating to the petition for emergency evaluation that is the subject of the motion sealed for good cause shown.

If sealed, the court records relating to the petition for emergency evaluation that is the subject of the motion may not be opened, for any purpose, except by order of the court for good cause shown.

Notice of the admission of the individual;

The right of the individual to consult with a lawyer that the individual chooses;

The availability of the services of the legal aid bureaus, lawyer referral services, and other agencies that exist for the referral of individuals who need legal counsel;

The right of the individual to call or write a lawyer or a referral agency or to have someone do so on behalf of the individual; and

In substance:

Within 12 hours after initial confinement of an individual to any facility or a Veterans’ Administration hospital, the form provided for in this section shall be read and given to the individual.

If the individual does not understand the notice required by this section and its legal effect, the notice also shall be given to:

In any event, if possible, notice of the admission shall be given to the parent, guardian, or next of kin of the individual.

Notice of the admission of a minor shall be given as promptly as possible.

Within 24 hours after the admission of the individual, notice of the admission shall be given to the Mental Health Division in the Office of the Public Defender.

A new application is made under this subtitle for a voluntary admission; and

New certificates are made under this subtitle for an involuntary admission.

The hearing may be postponed for good cause for no more than 7 days, and the reasons for the postponement shall be on the record.

A decision shall be made within the time period provided in paragraph (1) of this subsection.

Adopt rules and regulations on hearing procedures; and

Designate an impartial hearing officer to conduct the hearings.

Consider all the evidence and testimony of record; and

Order the release of the individual from the facility unless the record demonstrates by clear and convincing evidence that at the time of the hearing each of the following elements exist as to the individual whose involuntary admission is sought:

Shall be given notice of the hearing on the admission; and

May testify at the hearing.

Surrender to law enforcement authorities any firearms in the individual’s possession; and

Refrain from possessing a firearm unless the individual is granted relief from firearms disqualification in accordance with § 5–133.3 of the Public Safety Article.

Incorporates all outpatient treatment services that are determined to be essential and available for the maintenance of an individual’s health and safety; and

Includes, at a minimum:

The basis for the involuntary admission of the respondent to a facility under this title; or

Used as evidence of incompetency of the respondent.

Any civil service ranking or appointment;

The right to apply for voluntary admission to a facility under § 10–609 of this title; and

Any right relating to a license, permit, certification, privilege, or benefit under any law.

On or before July 1, 2026, a county may establish an assisted outpatient treatment program in accordance with this subtitle.

A county may partner with another county to establish an assisted outpatient treatment program.

On or before July 1, 2026, the Department shall establish an assisted outpatient treatment program in any county that does not opt to establish an assisted outpatient treatment program.

A county in which the Department is required to establish an assisted outpatient treatment program shall reimburse the Department:

A care coordination team operating under an assisted outpatient treatment program shall consist of, at a minimum:

The Department shall establish clinical and operational standards for assisted outpatient treatment programs and care coordination teams established under this section.

The petitioner’s name, address, and relationship, if any, to the respondent;

The name and any known address of the respondent;

That the petitioner has reason to believe the respondent meets the criteria for assisted outpatient treatment in § 10–6A–05 of this subtitle; and

For each criterion for assisted outpatient treatment in § 10–6A–05 of this subtitle, the specific allegations of fact that support the petitioner’s belief that the respondent meets the criterion.

Examined the respondent within 30 days before the date of the petition; and

Concluded that the respondent meets the criteria for assisted outpatient treatment in § 10–6A–05 of this subtitle.

A petition for assisted outpatient treatment shall be filed in the circuit court for the county in which the respondent resides or in the county of the last known residence of the respondent.

On the filing of a petition under paragraph (1) of this subsection, the circuit court shall notify the following of the filing of the petition:

The respondent is at least 18 years old;

The respondent has a serious and persistent mental illness;

The respondent has demonstrated a lack of adherence with treatment for the serious and persistent mental illness that has:

In view of the respondent’s treatment history and behavior at the time the petition is filed, the respondent is in need of assisted outpatient treatment in order to prevent a relapse or deterioration that would create a substantial risk of serious harm to the individual or harm to others;

The respondent is unlikely to adequately adhere to outpatient treatment on a voluntary basis, as demonstrated by the respondent’s history of treatment nonadherence in the 36–month period immediately preceding the filing of the petition that is not due to financial, transportation, or language issues in the immediately preceding 36–month period; and

In consideration of items (1) through (5) of this subsection, assisted outpatient treatment is the least restrictive alternative appropriate to maintain the health and safety of the respondent.

After the filing of the petition with the court under § 10–6A–04 of this subtitle, but not later than the date of the psychiatrist’s testimony required under § 10–6A–07 of this subtitle, the care coordination team shall develop a treatment plan and provide a copy in writing to:

A treatment plan developed by the care coordination team shall be:

For each service listed in the treatment plan, a community–based provider that has agreed to provide the service to the respondent shall be identified to provide the service.

A treatment plan may include medication.

The care coordination team shall give the respondent, the respondent’s guardian, the respondent’s health care agent, and any individual designated by the respondent a reasonable opportunity to participate in the development of the treatment plan.

If the respondent has executed a mental health advance directive, the care coordination team shall honor any directions included in the advance directive in the development of the treatment plan in accordance with §§ 5–602(a)(2) and 5–611(a) and (b) of this article.

The care coordination team shall provide to the respondent, the county attorney, and the Office of the Public Defender the treatment plan and the providers that are included in the treatment plan.

If the care coordination team changes the treatment plan or the providers included in the treatment plan before the hearing conducted under § 10–6A–07 of this subtitle, the care coordination team shall promptly notify the following of the change and the justification of the change:

The care coordination team shall assist in connecting the respondent to services that would help the respondent be successful in adhering to a treatment plan, including, if needed, transportation, housing, accessibility services, and other services that would address the health–related social needs of the respondent.

On receipt of a petition for assisted outpatient treatment that meets the requirements of § 10–6A–04 of this subtitle, the court shall schedule the date for a hearing.

The court may grant a continuance or postponement only for good cause shown.

A hearing shall be scheduled only if the respondent has not agreed to enter voluntary treatment.

The respondent shall be entitled to be represented by counsel of the respondent’s choice at the hearing and at all stages of the proceedings.

If the respondent is unable to afford an attorney, or is unable to obtain an attorney due to the respondent’s mental illness, representation shall be provided in accordance with §§ 16–204 and 16–208 of the Criminal Procedure Article.

All rules of civil procedure shall apply to cases filed under this subtitle.

Respondents may not be required to give testimony at hearings under this subtitle.

Participation in assisted outpatient treatment may not be used against a respondent in a subsequent legal matter that carries negative collateral consequences.

The petitioner’s presentation of evidence shall include the testimony of a psychiatrist whose most recent examination of the respondent occurred within 30 days before the date of the petition.

The psychiatrist shall state the facts and clinical determinations providing the basis for the psychiatrist’s opinion that the respondent meets each of the criteria for assisted outpatient treatment in § 10–6A–05 of this subtitle.

The petitioner’s presentation of evidence shall include the testimony of a psychiatrist to explain the treatment plan, who:

For each category of proposed treatment, the psychiatrist shall state the clinical basis for the determination that the treatment is essential to the maintenance of the respondent’s health or safety.

The psychiatrist shall testify as to the participation, if any, of the respondent in the development of the treatment plan.

If, after hearing all relevant evidence, the court finds by clear and convincing evidence that the respondent meets the criteria for assisted outpatient treatment, the court shall order the respondent to comply with assisted outpatient treatment for a period not to exceed 1 year.

The order of the court shall incorporate a treatment plan that:

Subject to paragraph (2) of this subsection, not later than 30 days after receiving a motion, and any timely responses to the motion, for a material change to the incorporated treatment plan, the court shall issue a ruling on the motion and any timely responses to the motion.

If the respondent informs the court that the respondent agrees to the proposed material change, the court may incorporate the material change into the treatment plan.

This section may not be construed to require a treating psychiatrist to delay changes to the respondent’s treatment plan as circumstances may immediately require.

If a treating psychiatrist makes a change to a treatment plan due to immediate necessity, a care coordination team member shall notify the following:

The number of individuals who were ordered to receive assisted outpatient treatment during the immediately preceding 12–month period;

For each individual ordered to receive an assisted outpatient treatment during the immediately preceding 12–month period, the de–identified data on the following for the 12–month period immediately preceding the assisted outpatient treatment order and the most recent 12–month period following the assisted outpatient treatment order:

Program statistics for the immediately preceding 12–month period, including:

Any information the Department has about system–wide impacts of assisted outpatient treatment ordered under this subtitle, including any information from hospitals, local detention centers, and counties; and

Information about the costs incurred by the Department, the Administration, and any county that establishes an assisted treatment program under this subtitle, including costs for:

In this subtitle the following words have the meanings indicated.