Options When Your Loved One Refuses Voluntary Substance Abuse Treatment

By Amanda Meneses, Psy.D

Navigating the world of substance abuse treatment can be an overwhelming experience. As the Admission Director at a local behavioral health hospital, I am familiar with the difficulties families face and the questions that arise as they seek help. Due to denial and a number of other factors, patients themselves can be one of the biggest barriers to receiving life-saving treatment. Florida Law offers involuntary substance abuse treatment options through the Marchman Act to address treatment needs when patients are unable to determine for themselves when treatment is necessary. The purpose of this article is to share information in order to help guide families, and reduce stress, time, and obstacles associated with the pursuit of involuntary treatment.

The Marchman Act is the Florida Substance Abuse Impairment Act (Florida Statues Chapter 397). The criteria for someone to qualify for involuntary admission under the Marchman Act are: (1) When there is a “good faith reason” to believe that a person is substance abuse impaired, and as a result of which has lost the power of self-control. (2) There also must be inflicted or the threat to inflict physical harm on himself/herself or another; or (3) due to the effects of substance abuse his/her judgment has been so impaired that the person is incapable of appreciating the need for such services and of making a rational decision related to treatment.

There are several ways involuntary admission can be initiated:

1. Law enforcement officials through “Protective Custody.”
2. Physician through completion of an “Emergency Admission” certificate.
3. Alternative Involuntary Assessment for Minors where a parent or guardian files an application at an Addictions Receiving Facility. The minor may be admitted short-term for assessment and stabilization.
4. Filing a Marchman Act petition through the county court system. In practice, this is the most commonly seen method of seeking involuntary admission and treatment. This is also the area in which family members have the greatest impact.

The process for filing a Marchman Act petition may sound a little daunting at first, but you can take comfort in knowing that many families have helped a loved one through this method. It also unfolds fairly quickly given that Marchman Act Court is held weekly. In general, the procedure is as follows:

• A parent, relative, three adults with first-hand knowledge of the patient’s condition, or a licensed service provider can file a petition with the Clerk of Court for “Involuntary Assessment and Stabilization.”
• A hearing will then be set within 10 days. A law enforcement officer or court official will serve the patient in person with a notice of the hearing, and the petitioner(s) will receive a notice by mail.
• During the hearing, the General Magistrate will review all testimony and may enter an order for Involuntary Assessment/Stabilization.
• Following the assessment, adults will only be admitted if they meet criteria for needing detox stabilization. If they do not meet detox criteria, the assessment that was completed in the Admission Department will be submitted to the court and they will be discharged from admissions. Adolescents may be admitted without meeting criteria for detox if
substance abuse is having a significant and detrimental impact on their life.
• If admitted, the patient can be held at the hospital, treatment, or detox facility for up to 5 days while the assessment is completed and sent to the court.
• If the assessment recommends involuntary treatment, then the petitioner is responsible for filing the petition for “Involuntary Treatment.” A second hearing will then be set, during which time treatment may be ordered for up to 60 days, with the possibility for extension. Often the patient will participate in the hearing from the treatment facility by phone.
• If the patient is ordered to assessment or treatment and they are unwilling to go on their own, a pick up order may be issued whereby law enforcement will take them to treatment. It generally takes 2-3 days to process.
• If the patient refuses an assessment or stabilization, then a “Show of Cause” can be filed by the petitioner or the facility. Once filed, a hearing will be set. The court must offer a “purge” (another opportunity to go into treatment). If the patient still refuses treatment, then another Show of Cause must be filed to be followed by another hearing. At that point the General Magistrate may choose to give an order for a specified period of incarceration in the county jail or at the department of juvenile justice.

Seeking legal consultation can make the process simpler and in some cases more effective, but it’s not required. It is important to note that the patient will be assigned a public defender to represent them. The public defender is responsible for seeing that the patient’s preferences are expressed (which may be to avoid treatment).

A frequent concern I hear from loved ones stems from the fear that pursuing the March-man Act may reflect negatively on the patient’s permanent record. Since the Marchman Act is a civil proceeding, it will not affect their record. However, if the patient leaves treatment, police may be contacted to return them to treatment. The patient can also be held in Contempt of Court for leaving the facility or failing to stay abstinent from substances. In this case, the “Motion of Show Cause” must be filed by the petitioner for the court to take action (as described above).

There are many different program options available. It is critical to research which type of program will best fit the patient’s needs, such as a public vs. a private facility, dual diagnosis (i.e., focus on mental health and substance abuse) vs. substance abuse specific, 12-step, religious based, gender specific, etc.

Financial constraints are another important element to consider in selecting a program. Private facilities are not an option for everyone due to financial obligations. Individuals and families are encouraged to contact their insurance company ahead of time to determine what levels of treatment are included under the patient’s benefit package. For example, if you’re seeking Residential Treatment, but the benefit isn’t covered under their insurance plan, then either county funded treatment or other levels of care should be considered instead. The General Magistrate will appreciate your proactive approach to help inform their decision on where to order treatment.

If state or county funded treatment is the best option, it’s important to contact
designated facilities in advance of the court hearing to learn about any requirements necessary to apply for a bed. You will also want to inquire as to whether there is a wait list so the court can consider accommodations for treatment prior to an inpatient bed becoming available.

It is important to have a basic understanding of how insurance companies work with regard to covering substance abuse treatment. Once it has been determined that the patient has the benefit for the specific level of care, the next step is for them to be assessed at the treatment facility. This clinical information is then shared with the insurance company to determine if the patient meets their criteria for treatment. If so, they generally authorize a few days at a time. If the insurance company does not authorize treatment, then they are likely to authorize treatment at a lower level of care. For instance, at our Adolescent Residential Substance Abuse Program, an insurance company may choose to authorize treatment in a Partial Hospitalization Program (PHP), or Intensive Outpatient Program (IOP), which is less intensive than inpatient or residential treatment. It is critical to be aware of the fact that insurance companies are not compelled to authorize treatment simply because of a court order. If this occurs and discharge is imminent, then the petitioner would be advised to contact the court to inform of the financial conflict and need for a revised plan.

Lastly, one specific piece of criteria that carries the most weight with insurance companies is the patient’s prior participation in lower levels of care such as an Intensive Outpatient Program, Partial Hospitalization, outpatient therapist, or psychiatrist. Typically, failure at a lower level of care is a requirement before the insurance company will authorize a more intensive (and often more expensive) residential level of care. Notably, if the individual is using certain substances daily or in extreme excess, detox may be required before entering into a treatment program. This can often be accommodated either within the facility of choice or nearby.

Substance abuse treatment options are far more numerous for adults, and there are many outstanding programs in our area. Fewer options exist for adolescents, if you are seeking voluntary or involuntary residential treatment for your son or daughter; I encourage you to consider Atlantic Shores Hospital. Our Admission Coordinators are available 24/7 at 954-771-2711.

Additional useful information and forms can be found at:
Florida State Statue 397
http://www.flsenate.gov/Laws/Statutes/2012/Chapter397
The DCF Website
http://www.dcf.state.fl.us/programs/samh/SubstanceAbuse/marchman/index.shtml
Baker Act & Marchman Act Q&A
http://www.bakeracttraining.org/files/faq/ba-marchman_act.pdf
Amanda Meneses, Psy.D., Director of Admissions
Atlantic Shores Hospital
954-229-1235
www.atlanticshoreshospital.com