Mental health
Law No. 408 of 2000, known as the Mental Health Code,” as amended, establishes a system of prevention, treatment, recovery, and rehabilitation for people who suffer from any mental health condition.
Remedies under Law No. 408 of 2000
To whom do the remedies provided under the Mental Health Code apply?
They apply to any person who needs, requests, receives, or has received mental health services, including services for all disorders related to abuse, dependence, and substance-induced disorders (drug and/or alcohol).
This includes adults who are 18 years of age or older and minors who are 17 years of age or younger.
What are the most common remedies adults can requested from the court under the Mental Health Code?
- Request for Twenty-Four (24)-Hour Temporary Detention (OAT 1248)
- Request for Involuntary Admission for a Maximum of Fifteen (15) Days (OAT 1251)
- Request for Change from Voluntary Admission Status to Involuntary Status for a Maximum of Fifteen (15) Days (OAT 1749)
- Request for Compulsory Treatment (OAT 1747)
- Request to submit an adult person to electroconvulsive therapy (OAT 1751)
These forms are available at the offices of the clerks of court, at the Pro Se Centers and on the Forms page on this website.
How and where can the legal remedies of the Mental Health Code be requested?
- By electronic means through the Virtual Municipal Court, completing the corresponding forms and sending them to the email address presentaciones@poderjudicial.pr.
- In person at the nearest municipal court to the person for whom the order or legal remedy is requested.
- After court business hours, at a Police headquarters where communication is established with a judge on duty.
What else should you know about the Mental Health Code?
The person subject to the remedies of this law is presumed to be mentally fit and that recovery is possible.
The decisions of the court should be focused on the best interest of the person suffering from a mental health disorder and not on the best interest of their relatives or the mental-health service provider.
The relatives of the person receiving mental health services will have the opportunity to provide information to the professionals in charge of the treatment. They will also receive educational information about the nature of the disorders, medications and their side effects, available support services and groups, as well as assistance in crisis management strategies. This information will be provided by all provider institutions.
Any person entitled to mental health services and the parents or legal guardian of a person who receives mental health services have the right to express their needs, satisfaction, and recommendations about the services they receive or that are offered to them. They have the right to contribute, recommend, and be participants by themselves or through representation, in the development and planning of the strategies and services they need.
Any adult who, by reason of consanguinity or moral obligation—whether because they have benefited financially or otherwise from the person who suffers from mental disorders, or who needs or receives mental health services—has a duty to provide the necessary support and will ensure that the person with the mental disorder can participate in the services that lead to their recovery, according to their capacity. As required by the Mental Health Code, all providers of mental health services will maintain orientation offices to inform of their services. In addition, any provider institution will develop and implement a procedure for reconsidering and reviewing all clinical decisions. Therefore, you may request information on your rights and/or those of your family member when you wish to challenge a medical determination or you wish to file a complaint or grievance.
Temporary Detention
What is a petition for temporary detention and what does it involve?
It is a request made under oath and filed with the court when there are reasonable grounds to believe that a person who has reached the age of 18 or older requires immediate mental health treatment to protect them from physically harming themselves or others or to property and the person does not wish to receive medical care voluntarily.
If the request is granted, the adult will be temporarily detained for a maximum period of 24 hours and will be taken to a hospital facility and evaluated by a psychiatrist, in conjunction with a team of mental health professionals, to stabilize the person and determine the level of care and treatment necessary.
Who can file a petition for temporary detention?
Any person over the age of 18 years who observes that another person over the age of 18 is a risk to themselves or others or to property and refuses to receive treatment or psychiatric evaluation voluntarily. This includes, but is not limited to: family members, friends, neighbors, law enforcement officers, and agency officials, among others.
Where and when can a petition for a temporary detention order be filed?
It may be filed with the court closest to the place of residence of the person who is understood to need mental health services or at the court closest to the person.
The request should be filed as soon as possible after the person’s psychiatric emergency occurs, but never later than 24 hours after an episode has occurred.
If the psychiatric emergency occurs during nighttime hours or on a weekend or holiday, you can go to the nearest Police headquarters so that the judge on duty may be called. By activating the “judge on duty” system, the matter can be heard from police headquarters, not necessarily from the courthouse.
How is the temporary detention order requested?
The request is completed using the form Request for Twenty-Four (24)-Hour Temporary Detention (OAT 1248).
The court will hold an ex parte hearing, which means that only the petitioner will be present, that is, the person who requests the order. The judge will evaluate the content of the request and will interview the petitioner and, if the temporary detention of an adult is deemed appropriate, the court will issue a temporary detention order for the person to be evaluated by a psychiatrist.
What is next once the temporary detention order is issued?
The order is valid for 72 hours (or three calendar days) since it was issued. This means that, once the term has elapsed, it will be automatically void if it were not served (delivered to the person against whom the order was issued). Therefore, upon receiving the temporary detention order, the petitioner will have to make the appropriate arrangements, as soon as possible, to transfer the person to the hospital to be evaluated by a team of mental health professionals.
How is the person transferred to the hospital?
The person who requested the order must coordinate ambulance services through the health insurance plan of the person to be temporarily detained. An ambulance is an appropriate vehicle, according to the Mental Health Code, when a person facing a psychiatric emergency must be transferred. Such person must also coordinate with the nearest Police headquarters so that a peace officer, together with the first responder, to assists them in serving the court order. In coordination with the ambulance service and the Police, the person will be transferred to a hospital to be evaluated and to comply with what the court has ordered.
If it is a psychiatric emergency or the person does not have a health insurance, arrangements can be made through the 9-1-1 Emergency System or medical emergencies.
The petitioner must immediately deliver the temporary detention order to the corresponding hospital so the person may be evaluated and it is determined whether involuntary admission will be recommended.
This process involves the Puerto Rico Police. Does it mean that the temporary detention order is an arrest or that it affects the person’s record?
No. Procedures under the Mental Health Code are civil, noncriminal proceedings. For this reason, they do not affect the person’s record. In fact, they are also confidential proceedings, so the files are not accessible to anyone.
What happens to the person subject to the temporary detention order upon arrival at the hospital?
Within a period of no more than 24 hours after arriving at the hospital, the person must be evaluated by a team of mental health professionals composed of at least three professionals and a psychiatrist. This team will determine the appropriate level of care for that person. Levels of care can fluctuate between a hospitalization and outpatient treatment.
If, after evaluating the person, the psychiatrist, together with the team of professionals, understands that the person should not be hospitalized, the person will be discharged and the appropriate care plan will be established. This must be notified to the court within a period of no more than 72 hours after discharge.
If the psychiatrist—in consultation with the team of professionals—determines that the person requires involuntary hospitalization, a certification to such ends will be issued so that the family member, legal guardian or authorized representative from the institution, as applicable, may request an involuntary admission order from the court for a maximum of 15 days.
Involuntary Admission
What is involuntary admission?
Involuntary admission is the remedy for stabilizing a person in the middle of a psychiatric emergency. Admission is requested once the team of mental health professionals evaluates the person at a hospital and, by certification, recommends that the person be involuntarily admitted to receive mental health services. The initial involuntary admission is for a term of no more than 15 days. The term may be lesser or greater, depending on the progress of the person’s symptoms and the treatment recommendations made by the team of mental health professionals.
How and where is an involuntary admission order requested?
This request is submitted within 24 hours after the hospital issued the certification. The certification must be signed by the psychiatrist and contain the professional data of the members of the team of professionals who evaluated and recommended the person’s admission.
The petitioner may go to court nearest to the hospital where the person will be admitted, or the court closest to the person’s place of residence, whichever is closest. The request need not be filed in the same court that granted the temporary detention order.
To obtain an involuntary admission order for 15 days, the petition must be filed in the court through the form Request for Involuntary Admission for a maximum of 15 days (OAT 1251). The request must be accompanied by the certification of the psychiatrist who evaluated the person, in consultation with the team of mental health professionals, that justifies ordering the involuntary hospitalization.
Who can file a petition for involuntary admission?
The petition may be filed by the same person who requested the temporary detention, a representative authorized by the hospital, or any person over 18 years old who has the certification issued by the hospital recommending this level of care. This includes, but is not limited to: family members, neighbors, peace officers, authorized hospital representatives, and agency officials, among others.
What happens when the court authorizes the petition for involuntary admission?
When authorizing a person’s involuntary admission, the court will set a follow-up hearing within the next five business days in order to evaluate the need to continue with the admission or whether the person is to be discharged.
When the involuntary admission order is issued, the right of the person admitted involuntarily to be legally represented is triggered. If the person has no financial resources, they may be referred to an entity that offers these services to indigent persons or, if eligible, they may be appointed an attorney by the court. This may be requested by the petitioner for the benefit of the admitted person, or may be ordered by the court on its own motion.
The petitioner will be responsible for delivering a copy of the order to the hospital where the person will be admitted. The hospital has the duty to inform the person admitted involuntarily about their rights, including their right to legal representation.
Request for Change of Status from Voluntary to Involuntary Admission
What is a change in status from voluntary admission to involuntary admission?
This occurs when a person who came to the hospital voluntarily and was evaluated and admitted, then requests to be discharged, but the team of mental health professionals considers that the person poses a risk to themselves, to others, or to property, so they recommend that discharge be refused and that they be forced to remain hospitalized involuntarily.
Who can request a change of status from voluntary to involuntary admission with the court?
The request may be submitted by: a representative authorized by the hospital or any person over the age of 18 who has the certification issued by the hospital recommending involuntary admission. This includes, but is not limited to: family members, neighbors, peace officers, authorized hospital representatives, and agency officials, among others.
How and where is a change of status from voluntary admission to involuntary admission requested?
The petition must be filed with the court within 24 hours of the person having requested discharge from the hospital. It must also be accompanied by the psychiatrist’s certification that, in conjunction with the team of mental health professionals, the person has been evaluated and they recommend their involuntary admission.
The petition may be filed at the court closest to the hospital where the person has been admitted through the form Request for Change of Admission Status from Voluntary to Involuntary for a Maximum of Fifteen (15) Days (OAT 1749).
What happens after filing the petition for change of admission status from voluntary to involuntary?
The court will evaluate the request within the following 48 hours to determine whether or not the change of status should be granted. It will also verify whether the corresponding certification is included. While the court decides whether or not the request is appropriate, the person must remain admitted to the hospital.
For all intents and purposes, the same process for involuntary admission will be followed. This means that, if the change of status order is granted, the right of the person to be represented by an attorney is triggered and a follow-up hearing will be set within the next five business days to determine whether or not to continue with the person’s involuntarily admission.
Compulsory Treatment
What is compulsory treatment?
It is the mechanism a person may use when they want another to commit to their mental health treatment but the person does not wish to do so voluntarily. Compulsory treatment can be an alternative to psychiatric hospitalization so the person may commit to and comply with medical recommendations.
Why does the court intervene in compulsory treatment?
With a petition for involuntary and mandatory treatment, the court must evaluate the medical recommendations to determine if the person in question should be ordered to undergo compulsory treatment. If the court grants the request, the person will be required to comply with the mandatory treatment indicated and failure to do so may result in contempt of court. This may lead to economic sanctions or the person’s arrest.
Who can request that the court order compulsory treatment?
Any person over the age of 18 who has good reason to believe that a person needs treatment for their mental health disorder (including the use and abuse of controlled substances and/or alcohol), but does not want to commit to it voluntarily. This may include, but is not limited to: family members, friends, members of the team of healthcare professionals who care for the person, social workers, or other people who are interested in the person’s recovery.
How and where is the petition for compulsory treatment made?
It is requested through the form Request for a compulsory treatment order (OAT 1747) and should be filed with the court closest to the place of residence of the person who would be the subject of the compulsory treatment or with the nearest court.
Is it necessary to include others document with the petition?
Ideally, the petition should be accompanied by a written recommendation from a psychiatrist or mental health professional who, in conjunction with a team of mental health professionals, has evaluated and recommended this treatment for that particular person. The recommendation of such professional must detail the treatment that the person needs and establish the importance and need for the court to order it.
What happens if the petition is not accompanied by a medical recommendation for compulsory treatment?
If the petitioner does not have the medical recommendation in writing but considers that the person should be ordered to receive compulsory treatment, they may still file the petition. In that case, the judge will evaluate the situation, hold a hearing to hear the party who filed the request and, if convinced, will order a comprehensive evaluation so that an inter- or multi-disciplinary team may recommend this type of treatment or not. When the results of the assessment ordered are available, another hearing will be held to determine whether or not to order the treatment.
What will the court do once it receives the petition for compulsory treatment along with the medical recommendation?
If the petition for compulsory treatment is filed with the recommendation of the mental health professionals, the judge will schedule a subsequent hearing to hear the party who filed the request, the mental health professional who recommended that type of treatment, and the person for whom the treatment was requested.
What rights does the person subject to compulsory treatment have in this process?
The person has the right to be present at the hearing in which the results of the evaluation are explained. They also have the right to be represented by an attorney in the hearing, to challenge the medical recommendations and submit evidence in favor of rejecting compulsory treatment.
On the day of the evidentiary hearing, the person to undergo compulsory treatment must be represented by an attorney. Therefore, efforts to retain legal representation must be made from the time the petition for compulsory treatment was filed. If the person does not have means to pay for their own representation, they may request a referral to an organization that offers these services to indigent persons or, if eligible, they may be appointed an attorney. This may be requested by the petition in the interest of the person to undergo compulsory treatment or by the court on its own motion.
What may happen on the day of the hearing when the results of the evaluation and medical recommendations are discussed?
The petitioner, the party to undergo compulsory treatment, their attorney, and any representative authorized by the team of mental health professionals who evaluated and recommended or rejected this type of treatment must be present. In the absence of the latter, a detailed report may be filed with the court.
The court will evaluate the medical recommendations and hear the parties. If compulsory treatment is deemed appropriate, it shall issue a resolution and order compulsory treatment. Otherwise, the case may be closed.
What are the consequences of not complying with compulsory treatment after the court orders it?
A person who fails to comply with the compulsory treatment and the conditions ordered by the court may be held in contempt. Contempt is a penalty that the court imposes on a person who does not comply with an order. This could include economic sanctions or arrest, depending on the circumstances.
How long can a person be under compulsory treatment?
The time will depend on the person’s progress. The court shall order periodic follow-up hearings, at least every three months. In this period, the health professionals caring for the person under compulsory treatment must report the person’s progress to the and their adherence to treatment.
The court shall close the case when the person shows that they no longer represent a risk to themselves, to others, or to property, when it is recommended by the mental health professionals, or when it is shown that the person is in control of their recovery and is no longer at risk.
What can you do if, after the court supervision ends, the person discontinues their medical treatment?
Compulsory treatment may be requested again, as many times as necessary.
Electroconvulsive Therapy
What is electroconvulsive therapy?
It is a treatment technique that is performed by means of applying electricity to neurons to trigger the central nervous system. It must be repeated a certain number of times to treat certain psychiatric diseases.
When can a petition be made to the court to order a person to undergo electroconvulsive therapy?
This petition may be filed with the court when the person to undergo this type of therapy does not or is unable to consent to receive it or when their legal guardian—if assigned—does not consent to the therapy. If the person or their legal guardian consents to the therapy, the court’s intervention is not necessary.
Who can file this petition and how is it done?
It should be filed with the court closest to the institution that will administer the therapy. This is done through the form Request to subject an adult to electroconvulsive therapy (OAT 1751).
What does the court do upon receiving this request?
Who should appear for the hearing?
What happens if the court authorizes electroconvulsive therapy?
Mental Health Treatment for Children under the Age of 18
What happens if the person who needs the care or treatment is under the age of 18?
If the person in the middle of a psychiatric emergency is under the age of 18 and their parent with patria potestas (parental rights), the person with legal custody, or the child’s legal guardian understands that the minor requires urgent treatment, their consent is sufficient to take the minor to an institution to receive such services. With the consent of any of the above, the intervention of the court will not be necessary since it is considered voluntary treatment, even if the minor does not agree.
When the parent with patria potestas (parental rights), the person with legal custody, or a legal guardian is not available, any interested person over the age of 18 may arrange for the minor to receive a comprehensive evaluation to find out if they should receive emergency admission. These cases must be brought to the court for authorization.
If authorized by the court, the minor will be transferred to a hospital that offers services to minors and adolescents so that a child psychiatrist, together with the inter- or multi-disciplinary team of the provider institution, may establish the diagnosis and determine the level of care that corresponds to the severity of the symptoms and signs present at the time. The director of the provider institution must continue to make efforts to locate the parent with patria potestas (parental rights) or legal guardian. If the person is located and consents in writing to involuntary admission, it will be validated as if it were a voluntary admission and the minor may continue under hospital care.
If the parent with patria potestas (parental rights) or the legal guardian is not found within the next 24 hours, or if found but they do not consent to admit the minor, a petition and a report on the condition of the minor with the recommendations of the child psychiatrist will be filed with the court, in consultation with the inter- or multi-disciplinary team.
The court will determine whether to continue with treatment or to discharge of the minor, for which a hearing will be set within seven calendar days. The procedure will be similar to the involuntary admission of an adult person, triggering the child’s right to legal representation.
When does the court usually intervene in mental health cases involving minors?
The rule to decide whether a court should intervene is when the parent with patria potestas (parental rights), the person or agency with legal custody of the minor, or the child’s legal guardian is unable or not willing to consent, or in the event of an emergency and none of these persons can be found after reasonable efforts have been made to locate them.
If any of the above is available and consents to any of the services, a court order will not be necessary.