"Respondent's Report to the Court on Informed Consent for Voluntary Commitment" - Washington, D.C.

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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
FAMILY COURT
MENTAL HEALTH & HABILITATION BRANCH
In the Matter of
:
Case No.:
:
Magistrate Judge Diane S. Lepley
[PERSON’S NAME]
:
:
Annual Review Hearing:
Respondent
:
RESPONDENT’S REPORT TO THE COURT ON
INFORMED CONSENT FOR VOLUNTARY COMMITMENT
On ___________________________, 20___, Respondent’s interdisciplinary team
(“IDT”) or circle of support met with Respondent to obtain and provide information to the Court
for purposes of (1) assessing the Respondent’s capacity to provide informed consent for
voluntary commitment under D.C. Official Code § 7-1304.11(a)(1)(E); and, (2) to the extent
Respondent lacks capacity to provide informed consent, identifying individuals under D.C.
Official Code § 7-1304.11(a)(2) (see Question 3 below) who are reasonably available, mentally
capable, and willing to consent or refuse continued voluntary commitment on behalf of the
Respondent based on Respondent’s expressed wishes or, if Respondent’s wishes are unknown
and cannot be ascertained, on a good faith belief as to Respondent’s best interests. The names of
the persons present at the above-referenced IDT meeting and their relationship to the Respondent
are listed on the sign-in sheet filed herein. Based on the IDT meeting and in the consideration of
the views made known by persons in attendance and those persons whose views were otherwise
communicated, the undersigned respectfully submits this Respondent’s Report to the Court on
Informed Consent for Voluntary Commitment. The below descriptions do not include privileged
communications between the Respondent and his or her Counsel.
1
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
FAMILY COURT
MENTAL HEALTH & HABILITATION BRANCH
In the Matter of
:
Case No.:
:
Magistrate Judge Diane S. Lepley
[PERSON’S NAME]
:
:
Annual Review Hearing:
Respondent
:
RESPONDENT’S REPORT TO THE COURT ON
INFORMED CONSENT FOR VOLUNTARY COMMITMENT
On ___________________________, 20___, Respondent’s interdisciplinary team
(“IDT”) or circle of support met with Respondent to obtain and provide information to the Court
for purposes of (1) assessing the Respondent’s capacity to provide informed consent for
voluntary commitment under D.C. Official Code § 7-1304.11(a)(1)(E); and, (2) to the extent
Respondent lacks capacity to provide informed consent, identifying individuals under D.C.
Official Code § 7-1304.11(a)(2) (see Question 3 below) who are reasonably available, mentally
capable, and willing to consent or refuse continued voluntary commitment on behalf of the
Respondent based on Respondent’s expressed wishes or, if Respondent’s wishes are unknown
and cannot be ascertained, on a good faith belief as to Respondent’s best interests. The names of
the persons present at the above-referenced IDT meeting and their relationship to the Respondent
are listed on the sign-in sheet filed herein. Based on the IDT meeting and in the consideration of
the views made known by persons in attendance and those persons whose views were otherwise
communicated, the undersigned respectfully submits this Respondent’s Report to the Court on
Informed Consent for Voluntary Commitment. The below descriptions do not include privileged
communications between the Respondent and his or her Counsel.
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1.
Does the IDT believe that Respondent possesses capacity to provide informed
consent to voluntary commitment?
At the time of the meeting, or prior to submission of this Report, the IDT [ ] reached
consensus [ ] did not reach consensus that Respondent [ ] has [ ] does not have capacity to
provide informed consent for voluntary commitment in accordance with D.C. Official Code § 7-
1304.11(a)(1)(E). Under D.C. Official Code § 7-1304.11(a)(8), a prior court decision to commit
a person shall not be determinative of whether the person has capacity to give informed consent
to continue his or her commitment. The IDT was tasked with answering the following three (3)
questions to provide the Court with information relevant to whether Respondent has capacity to
provide informed consent to continued commitment:
 Is Respondent able to understand the information relevant to the decision of whether to
consent to continued commitment? [Does Respondent understand the nature of the
decision and the reason why the decision is needed? Efforts to explain the nature of the
decision in language understandable and accessible to the person must be made. People
who can only retain information for a short while must not be automatically assumed to
lack the capacity to decide – it depends on what is necessary for the decision in question.
Different methods may be needed to help Respondent retain or understand information
(e.g. written information).]
[
] Yes
[
] No
[ ] Disagreement
Please explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 Is Respondent able to identify the potential consequences of consenting to or refusing
continued commitment as part of the decision-making process? [Sometimes people can
understand information; however, they also should be able to understand the advantages
and disadvantages of the decision to be made.]
2
[
] Yes
[
] No
[ ] Disagreement
Please explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 Is Respondent able to unambiguously communicate the decision whether to provide
informed consent for continued commitment? [All steps need to be taken to aid
communication. Communication does not need to be verbal.]
[
] Yes
[
] No
[ ] Disagreement
Please explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Based on the above, does the IDT believe that Respondent possesses capacity to provide
informed consent to voluntary commitment?
[
] YES
[
] NO
[ ] DISAGREEMENT
2.
Irrespective of whether the IDT believes that Respondent has capacity to give
informed consent to continue his or her voluntary commitment, has the Respondent
expressed any wishes on the issue of continued commitment?
[
] YES
[
] NO
[
] NOT APPLICABLE
3
Please explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3.
To the extent the IDT agrees that Respondent lacks capacity to provide
informed consent, which individual(s) has/have been identified to provide consent or
refusal for continued voluntary commitment on behalf of the Respondent?
[
] APPLICABLE
[
] NOT APPLICABLE
In accordance with D.C. Official Code § 7-1304.11(a)(2), the following individual(s)
has/have been identified who is/are reasonably available, mentally capable, and willing to
consent to or refuse continued voluntary commitment on behalf of the Respondent:
[
] One or more
[
] None
[ ] Respondent’s General Guardian, ______________________________________.
[ ] Respondent’s Limited Guardian, ________________________________________,
who has obtained specific authority from the Court to provide informed consent.
[ ] Respondent’s Conservator, _____________________________________________,
who has obtained specific authority from the Court to provide informed consent.
[ ] Respondent’s spouse or domestic partner, _________________________________.
[ ] Respondent’s adult child, ______________________________________________.
[ ] Respondent’s parent, __________________________________________________.
[ ] Respondent’s adult sibling, _____________________________________________.
[ ] Respondent’s religious superior, _________________________________________.
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[ ] Respondent’s close friend, _____________________________________________.
[ ] Respondent’s nearest living, adult relative, ________________________________.
The known address of each person identified above is provided in the Certificate of Service.
[ ] Because no individual has been identified under D.C. Official Code § 7-
1304.11(a)(2)(A)-(I) who is reasonably available, mentally capable, and willing to consent to or
refuse continued voluntary commitment on behalf of the Respondent, it is recommended that the
Court appoint a guardian ad litem for that sole purpose.
4.
To the extent one or more individuals has been identified as being reasonably
available, mentally capable, and willing to consent to or refuse continued voluntary
commitment on behalf of the Respondent, has he or she made known the decision that he
or she intends to make?
[
] YES
[
] NO
[
] NOT APPLICABLE
If yes, for each individual, please list the decision he or she has made known.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5.
To the extent more than one individual has been identified as being
reasonably available, mentally capable, and willing to consent to or refuse continued
voluntary commitment on behalf of the Respondent, and their respective views have been
made known, has any individual with lower priority indicated that he or she intends to
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