H.F. 468 Section 1. Section 229.1, Code 2015, is amended by adding 1 the following new subsections: 2 NEW SUBSECTION . 1A. “Advocate” means a mental health 3 advocate. 4 NEW SUBSECTION . 14A. “Region” means a mental health and 5 disability services region formed in accordance with section 6 331.389. 7 Sec. 2. Section 229.9A, Code 2015, is amended to read as 8 follows: 9 229.9A Advocate informed. 10 The court shall direct the clerk to shall furnish the 11 advocate of the respondent’s county of residence with appointed 12 for the county in which an application is completed a copy of 13 the application and any order issued pursuant to section 229.8, 14 subsection 3 . The advocate may attend the hospitalization 15 hearing of any respondent for whom the advocate has received 16 notice of a hospitalization hearing. 17 Sec. 3. Section 229.12, subsection 2, Code 2015, is amended 18 to read as follows: 19 2. All persons not necessary for the conduct of the 20 proceeding shall be excluded, except that the court may 21 admit persons having a legitimate interest in the proceeding 22 and shall permit the advocate from the respondent’s county 23 of residence where the respondent is located to attend the 24 hearing. Upon motion of the county attorney, the judge may 25 exclude the respondent from the hearing during the testimony of 26 any particular witness if the judge determines that witness’s 27 testimony is likely to cause the respondent severe emotional 28 trauma. 29 Sec. 4. Section 229.19, Code 2015, is amended to read as 30 follows: 31 229.19 Advocates —— appointment —— duties —— employment and 32 compensation —— state and county liability . 33 1. a. In each county with a population of three hundred 34 thousand or more inhabitants the board of supervisors shall 35 -1- LSB 1600HV (5) 86 rh/rj 1/ 6

H.F. 468 appoint an individual who has demonstrated by prior activities 1 an informed concern for the welfare and rehabilitation of 2 persons with mental illness, and who is not an officer or 3 employee of the department of human services nor , an officer 4 or employee of a region, an officer or employee of a county 5 performing duties for a region, or an officer or employee of 6 any agency or facility providing care or treatment to persons 7 with mental illness, to act as an advocate representing the 8 interests of patients involuntarily hospitalized by the court, 9 in any matter relating to the patients’ hospitalization or 10 treatment under section 229.14 or 229.15 . In each county with 11 a population of under three hundred thousand inhabitants, the 12 chief judge of the judicial district encompassing the county 13 shall appoint the advocate. 14 b. The committing court or, if the advocate is appointed 15 by the county board of supervisors, the board shall assign 16 the advocate appointed from a patient’s county of residence 17 to represent the interests of the patient. If a patient has 18 no county of residence or the patient is a state case, the 19 court or, if the advocate is appointed by the county board of 20 supervisors, the board shall assign the advocate appointed 21 from the county where the hospital or facility is located 22 to represent the interests of the patient shall assign the 23 advocate for the county where the patient is located . A county 24 or region may seek reimbursement from the patient’s county of 25 residence or from the region in which the patient’s county of 26 residence is located. 27 c. The advocate’s responsibility with respect to any patient 28 shall begin at whatever time the attorney employed or appointed 29 to represent that patient as respondent in hospitalization 30 proceedings, conducted under sections 229.6 to 229.13 , reports 31 to the court that the attorney’s services are no longer 32 required and requests the court’s approval to withdraw as 33 counsel for that patient. However, if the patient is found to 34 be seriously mentally impaired at the hospitalization hearing, 35 -2- LSB 1600HV (5) 86 rh/rj 2/ 6

H.F. 468 the attorney representing the patient shall automatically be 1 relieved of responsibility in the case and an advocate shall 2 be assigned to the patient at the conclusion of the hearing 3 unless the attorney indicates an intent to continue the 4 attorney’s services and the court so directs. If the court 5 directs the attorney to remain on the case, the attorney shall 6 assume all the duties of an advocate. The clerk shall furnish 7 the advocate with a copy of the court’s order approving the 8 withdrawal and shall inform the patient of the name of the 9 patient’s advocate. 10 d. With regard to each patient whose interests the advocate 11 is required to represent pursuant to this section , the 12 advocate’s duties shall include all of the following: 13 (1) To review each report submitted pursuant to sections 14 229.14 and 229.15 . 15 (2) If the advocate is not an attorney, to advise the court 16 at any time it appears that the services of an attorney are 17 required to properly safeguard the patient’s interests. 18 (3) To be readily accessible to communications from the 19 patient and to originate communications with the patient within 20 five days of the patient’s commitment. 21 (4) To visit the patient within fifteen days of the 22 patient’s commitment and periodically thereafter. 23 (5) To communicate with medical personnel treating the 24 patient and to review the patient’s medical records pursuant 25 to section 229.25 . 26 (6) To file with the court quarterly reports, and additional 27 reports as the advocate feels necessary or as required by the 28 court, in a form prescribed by the court. The reports shall 29 state what actions the advocate has taken with respect to each 30 patient and the amount of time spent. 31 (7) To utilize the related best practices for the duties 32 identified in this paragraph “d” developed and promulgated by 33 the judicial council. 34 e. An advocate may also be appointed assigned pursuant to 35 -3- LSB 1600HV (5) 86 rh/rj 3/ 6

H.F. 468 this section for an individual who has been diagnosed with a 1 co-occurring mental illness and substance-related disorder. 2 2. The hospital or facility to which a patient is committed 3 shall grant all reasonable requests of the advocate to visit 4 the patient, to communicate with medical personnel treating 5 the patient, and to review the patient’s medical records 6 pursuant to section 229.25 . An advocate shall not disseminate 7 information from a patient’s medical records to any other 8 person unless done for official purposes in connection with the 9 advocate’s duties pursuant to this chapter or when required by 10 law. 11 3. The court or, if the advocate is appointed by the 12 county board of supervisors , the board shall prescribe 13 reasonable compensation for the services of the advocate. The 14 compensation shall be based upon the reports filed by the 15 advocate with the court the duties performed by the advocate 16 and in accordance with the personnel policies set forth by 17 the board for county employees . The advocate’s compensation 18 shall be paid by the county in which the court is located, 19 either on order of the court or, if the advocate is appointed 20 by the county board of supervisors, on the direction of the 21 board. If the advocate is appointed by the court, the advocate 22 is an employee of the state for purposes of chapter 669 . If 23 the advocate is appointed by the county board of supervisors, 24 the The advocate is an employee of the county for purposes 25 of chapter 670 . If the patient or the person who is legally 26 liable for the patient’s support is not indigent, the board 27 shall recover the costs of compensating the advocate from that 28 person. If that person has an income level as determined 29 pursuant to section 815.9 greater than one hundred percent 30 but not more than one hundred fifty percent of the poverty 31 guidelines, at least one hundred dollars of the advocate’s 32 compensation shall be recovered in the manner prescribed by 33 the county board of supervisors. If that person has an income 34 level as determined pursuant to section 815.9 greater than 35 -4- LSB 1600HV (5) 86 rh/rj 4/ 6

H.F. 468 one hundred fifty percent of the poverty guidelines, at least 1 two hundred dollars of the advocate’s compensation shall be 2 recovered in substantially the same manner prescribed by the 3 county board of supervisors as provided in section 815.9 . 4 4. The state mental health and disability services 5 commission created in section 225C.5, in consultation with 6 advocates and county and judicial branch representatives, shall 7 adopt rules pursuant to chapter 17A relating to advocates that 8 include but are not limited to all of the following topics: 9 a. Quarterly and annual reports. 10 b. Data collection requirements. 11 c. Juvenile patient representation. 12 d. Grievance procedures. 13 e. Conflict of interest provisions. 14 f. Workforce coverage. 15 g. Confidentiality. 16 h. Minimum educational requirements. 17 i. Caseload criteria. 18 j. Caseload audits. 19 k. Quality assurance measures. 20 l. Territory assignments. 21 5. An advocate appointed by the chief judge of a judicial 22 district or by the county board of supervisors prior to July 23 1, 2015, shall be considered to be appointed by the county 24 board of supervisors on July 1, 2015, as required in subsection 25 1. Such an advocate shall be compensated at a minimum at the 26 advocate’s wage and benefit level in place immediately prior to 27 July 1, 2015. 28 EXPLANATION 29 The inclusion of this explanation does not constitute agreement with 30 the explanation’s substance by the members of the general assembly. 31 This bill relates to the appointment of mental health 32 advocates. 33 Under current law, the appointment of a mental health 34 advocate to represent the interests of a person involuntarily 35 -5- LSB 1600HV (5) 86 rh/rj 5/ 6

H.F. 468 hospitalized under Code chapter 229 is made by either the 1 county board of supervisors in a patient’s county of residence 2 if the county has a population of 300,000 or more, or by the 3 chief judge of the judicial district if the patient’s county 4 of residence has a population under 300,000. A mental health 5 advocate is paid by the appropriate county. 6 The bill amends this current law to eliminate the court 7 appointment of mental health advocates and specifies that all 8 mental health advocate appointments shall be made by the county 9 board of supervisors. The bill specifies that certain officers 10 or employees shall not be assigned to be an advocate. The 11 court that involuntarily commits a person under Code chapter 12 229 is required to assign to the person the advocate for the 13 county where the patient is located. 14 A county or region may seek reimbursement from the patient’s 15 county of residence or from the region in which the patient’s 16 county of residence is located. Reasonable compensation 17 for the advocate’s services shall be based upon the duties 18 performed by the advocate and in accordance with county 19 personnel policies. All advocates are considered to be county 20 employees. 21 The bill directs the state mental health and disability 22 services commission, in consultation with advocates and county 23 and judicial branch representatives, to adopt rules relating 24 to advocates and specifies topics to be included in rulemaking 25 including conflict of interest provisions. 26 The bill provides that an advocate appointed by the court 27 or by a county board of supervisors prior to July 1, 2015, 28 shall be considered to be appointed by the county board 29 of supervisors on July 1, 2015. Such advocates shall be 30 compensated, at a minimum, at the advocate’s wage and benefit 31 level in place immediately prior to July 1, 2015. The bill 32 makes conforming changes to Code sections 229.1 (definitions), 33 229.9A (certain information furnished to an advocate), and 34 229.12 (advocate attendance at hospitalization hearing). 35 -6- LSB 1600HV (5) 86 rh/rj 6/ 6