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Mental-health agency opposes restricting first-certification to psychiatrists, seeks Title 26 fix to include physician assistants
Summary
A Department of Mental Health representative told a legislative committee the department does not support a draft that would require board-certified psychiatrists for the first certification in the involuntary-admission process; DMH said APRNs are currently authorized under Title 26 but that physician assistants would need statutory changes and additional training to be included.
A Department of Mental Health representative told a legislative committee that the agency does not support proposed statutory language that would change who may complete the "first certification" used in involuntary mental-health admissions.
The representative said the draft appears to reference the statutory provision used for second certifications and therefore needs technical correction, and added that APRNs (advanced practice registered nurses) are already able to complete first certifications under current Title 26 authority. "The Department of Mental Health does not support the change that includes the other health professionals," the DMH representative said, while offering to work with legal staff to draft language tied to Title 26 that could allow physician assistants to sign when the statute is amended.
Why it matters: The bill concerns who may certify that a person meets the threshold for involuntary admission and who can determine whether inpatient care is required. That determination has implications for emergency-department workflows and for which clinicians must have admitting authority at a hospital.
What was said: A committee member asked DMH to clarify whether the bill's text was pointing to the correct statutory section. The DMH representative answered that the bill as drafted appears to cite the provision governing second certifications (referred to in the hearing as "7508") while the intended change targets the first-certification provision (referred to in the hearing as "7504"). The representative said the department follows the statute that permits a physician or a designee to complete a first certification, and that Title 26 currently enables APRNs to sign "anything that a physician can sign," which explains why APRNs can perform the first certification today.
Training and scope concerns: DMH emphasized training differences between APRNs and physician assistants (PAs). The agency said it would not oppose including PAs only if the statutory framework were broadened in Title 26 to give PAs the same authority as APRNs and if the department could provide or require enhanced education for any new certifiers. Committee members noted that APRNs working in emergency departments are often generalists and may not have psychiatric specialization, underscoring the department's concern about scope-of-practice and diagnostic capability.
Clinical standard described: DMH described the first certification as requiring a determination that a major mental illness is directly causing dangerousness; it said the first certification process asks whether a lower level of care (including voluntary admission) is appropriate and does not necessarily require having fully ruled out a medical cause at that stage. The department also noted that clinicians need admitting privileges within a hospital to conclude a patient requires admission rather than a lower level of care.
Next steps: The committee agreed to seek drafting clarification from legislative counsel. The DMH representative said the department would consult its legal team and could provide proposed statutory language that ties any change to Title 26 and addresses training requirements. No formal motion or vote was recorded during the discussion.
The committee proceeded to schedule witnesses and follow-up on the bill's language and statutory references.
