P.R. Laws tit. 24, § 6152b
Except otherwise provided in this chapter, the following terms shall have the following definitions:
(a) Abuse. — Means any action or omission by a mental health professional, private or public institution, or by any other person toward the adult or minor who receives mental health services, during his/her process of treatment, recovery and rehabilitation. The abuse may be manifested as:
(1) Physical abuse. — Any act or omission resulting in physical harm to the person, or other forms of harm such as sexual abuse, including any form that may cause death.
(2) Emotional abuse. — Any omission of a necessary action, excessive unjust or improper action in which the adult or the minor, is humiliated, insulted, intimidated, threatened, or persecuted, among others, or his/her autonomy to receive clinical services or while receiving them has been ignored.
(b) Access to services. — Means the guarantee that all persons receiving mental healthcare services shall receive such services in accordance with their clinical condition and the level of service which best suits their condition at the time they request such services.
(c) Administration. — Means the Mental Health and Addiction Services Administration.
(d) Administrator. — Means the Administrator of the Mental Health and Addiction Services Administration.
(e) Health facility administrator. — Means the professional licensed by the Board of Examiners of Health Service Administrators of the Commonwealth of Puerto Rico, who has the mission of administering, directing, planning, organizing, coordinating, controlling, evaluating, and making proper use of the human, material and financial resources of the health program or facility.
(f) Adult. — Means any person of eighteen (18) years of age or more. For the purposes of this chapter, any minor who has been legally emancipated shall receive services for minors.
(g) Security agent. — Means any state or municipal police officer, or any custody officer duly identified as such.
(h) Isolation. — Means the therapeutic measure consisting of the involuntary confinement of an adult or minor with mental disorders, in a room, isolated from others, in which he/she is physically restricted from leaving for a certain period, and requires specific care and proceedings.
(i) Release. — Means the suspension order, final or temporary, of the services offered by a providing institution to any person, be it through voluntary or involuntary admission.
(j) Express authorization. — Means the process by which a person, freely, without any threat, intimidation or coercion, issues a written authorization to a third party to receive or obtain his/her confidential information, pursuant to the procedure provided in this chapter.
(k) Capacity to give consent. — Means the physical and mental condition that allows a person to make any decision at a specific time.
(l) Certificate. — Means the document issued by a psychiatrist, a clinical doctor, clinical psychologist or person authorized therefor, which describes aspects of the mental health treatment of the person subject to treatment with a specific purpose, such as a court order, petition by an attorney or request from an insurance company.
(m) Certificate for involuntary placement or mandatory treatment. — Means the document issued to the court by the psychiatrist, in consultation with the inter- or multidisciplinary team, when the involuntary placement of a person in a mental healthcare service is requested, be it hospitalization or another level of care that accords greater autonomy, which shall contain the recommendation based on the warranted clinical need.
(n) Acute condition. — Means a clinical manifestation characterized by beginning very quickly and having an intense biological, psychological, social and behavioral conduct, which makes it necessary that the person receive treatment, recovery and rehabilitation mental health services. The person may or may not show evident or known triggering factors, which frequently cause that a person is put at risk of causing damage, injury or death to the self, others or property.
(ñ) Confidentiality. — Means the right that a person who receives mental health services has to communicate orally or in writing without it being disclosed to third parties when there is no express authorization from him/her, except when otherwise provided in this chapter.
(o) Professional counselor. — Means the professional licensed by the Professional Counselors Examining Board of the Commonwealth of Puerto Rico pursuant to §§ 3241 et seq. of Title 20, known as “An Act to Regulate the Practice of Professional Counselors in the Commonwealth of Puerto Rico”, who is knowledgeable in the application of mental health, psychological or human-developmental principles through the employment of cognitive, affective, behavioral, or systemic intervention strategies to tend to the welfare, personal growth, or career development, as well as pathologies.
(p) Informed consent. — Means a determination made by an adult or his/her guardian, or by the father, mother or a legal guardian of a minor, to receive or reject a mental health service or any other procedure resulting from a dialogue in which the provider of mental health services informed the person subject to receive such services, or the parent with patria potestas, or legal guardian, the nature, need and scope of these mental health services.
(q) Custody. — Means the care and vigilance given to a person, and includes the following types of custody:
(1) Legal custody. — The one granted by a court, in addition to the one parents have over a minor.
(2) Provisional custody. — The one granted to a person temporarily by a government agency empowered to do so.
(3) Emergency custody. — The one carried out in cases when if not carried out immediately, the person represents a risk to his/her safety and welfare, that of other persons and to property.
(4) Custody in fact. — Is the custody delegated during his/her absence by the person with patria potestas or the legal guardian of the minor to a person over twenty-one (21) years of age.
(r) Medical director. — Means the mental healthcare professional responsible for directing, coordinating and implementing the best practices for mental healthcare treatment in the services offered by the institutional provider.
(s) Medical emergency. — Means the sudden and unexpected start of a mental or physical health condition that requires immediate medical attention and that if not provided, would result in the injury of an organ, part of the body or could put the person, another person or property at risk of damage or death.
(t) Psychiatric emergency. — Means the clinical symptoms characterized by an alteration of the thoughts, of the perception of reality, of the affects or feelings, or of the person’s actions or conduct that needs immediate or emergency therapeutic intervention in which of the intensity of the symptoms and signs, and representing an immediate risk to the person, another person or property at risk of damage or death.
(u) Severe mental disease. — Means severe mental disorders in adults as specified in Federal Public Law 102-321, as amended, known as the “Alcohol, Drug Abuse and Mental Health Services Administration Reorganization Act”.
(v) Nurse. — Means the person authorized by the Board of Female and Male Nurse Examiners to practice the nursing profession, as provided by §§ 203 et seq. of Title 20, known as the “Act to Regulate the Practice of Nursing in the Commonwealth of Puerto Rico”.
(w) Interdisciplinary team. — Means the team composed of three (3) or more mental healthcare professionals of different disciplines, among which there shall be one (1) psychiatrist or one (1) psychologist, who provide mental healthcare services with the professional and legal capability and authority to diagnose and prescribe treatment in the different areas of human functionality and capabilities, and by those other professionals germane to the person’s condition, all working in the same scenario. The interdisciplinary team is distinguished by its cooperative and consensual work, which is characterized by the interaction of all the professionals with the patient under treatment, a discussion of the case, full knowledge of the contributions of each profession or discipline, and the application of the best practices of the field, geared toward the recovery of the person. The team’s composition and leadership shall vary in accordance with the scenario or the service to be rendered and the clinical needs of the person.
(x) Multidisciplinary team. — Means a work group composed of three (3) or more mental health professionals of different disciplines, who provide mental health services with the capacity, and the professional and legal faculty to diagnose and prescribe treatment in the different areas of human performance and capacities, and by other professionals related to the person’s condition, all working in the same scenario. They serve the same population, within the same category in order to develop the treatment, recovery and rehabilitation for the person’s best performance, according to his/her situation and diagnosis. This team works on consultation and may communicate through the clinical record and discussions of the case. A providing institution may use this team when, for any reason, is not able to gather an interdisciplinary team to diagnose and prescribe the corresponding treatment.
(y) Therapeutic team. — Means the group of health professionals that includes specialists in different behavioral areas that integrate into a single clinical task to implement the treatment, recovery and rehabilitation plan developed by the team of inter- or multidisciplinary professionals.
(z) Evaluation. — Means the procedure conducted by a psychiatrist, physician, psychologist or other professional within the professions related to mental healthcare, who is authorized to diagnose and prescribe treatment within his/her profession or specialty, certified and licensed to practice his/her profession in Puerto Rico. Said evaluation shall be the product of a direct clinical examination with instruments according to the corresponding level of care and setting when conducting the same, which shall contain the findings of the patient’s medical history, his/her emotional, mental and physical condition at the time it is conducted, diagnostic impressions applicable to each situation in particular, and specific recommendations as to the immediate management and prognosis of the patient.
(aa) Clinical record. — Means the organized and detailed compilation of data and information related to the medical treatment and health care that a person receives from a mental health professional or provider.
(bb) Family member. — Means the spouse or relatives up to the fourth degree of consanguinity or affinity of a person who receives mental health services, such as his/her parents, children, grandparents, siblings, uncles and aunts, grandchildren, and nephews and nieces.
(cc) Medical faculty. — Means the group of mental healthcare professionals of the highest order in each of their specialties, who are duly certified by their respective examining boards and licensed to practice in the jurisdiction of Puerto Rico, hold the highest rank in the mental healthcare institutional providers, and supervise and support other health professionals who are legally authorized to practice their professions.
(dd) Open source. — Means the software that may be obtained, used, copied, studied, modified, and redistributed due to having access to the source code, which does not abridge the capability of receiving services from a single source or electronic/computerized information system provider.
(ee) Hospitalization. — Means the highest level of psychiatric care, which is characterized by the continuous and frequent intervention of professional and technological resources twenty-four (24) hours a day, in order to achieve a prompt stabilization of the symptoms and signs that, due to their severity, make it necessary, so that the person may continue his/her recovery and treatment in another level of less intensive care and greater autonomy within the mental health care system.
(ff) Involuntary placement. — Means placement into a mental healthcare service ordered by the court after an evaluation by a psychiatrist in consultation with the inter- or multidisciplinary team certifying the need for this service, when there is no consent for such from the adult or the parent with legal or physical custody of the minor, or the person’s legal guardian, insofar as he/she meets dangerousness standards as to the likelihood of inflicting harm upon him/herself or others or damaging property, or has engaged in acts that put his/her life in jeopardy, or has engaged in acts which indicate that he/she cannot manage everyday life without the supervision or assistance of other persons for being unable to feed, protect, or care for him/herself, thus increasing his/her chances of dying or experiencing physical weakening to the point of putting his/her life in jeopardy.
(gg) Voluntary admission. — Means the determination made by an adult capable of consent to go to or be admitted into a providing institution and receive a mental health service after an evaluating process so determines, or the determination made by the parent with patria potestas, or a minor’s legal guardian, to be admitted into the providing institution, provided that the severity of the symptoms and signs so does justify. In both cases, this determination shall be made after having been duly informed of the conditions, rights and duties of the decision made.
(hh) Institutionalization. — Means the state that a patient reaches due to an excessive and improper use of the psychiatric hospitalization, as the only option of treatment or deficiency of the release plan without appropriate follow-up. It can also arise due to lack of services that are crucial for the person’s recovery. This entails mental deterioration and habits of variable intensity due to disuse, dependence, and impeding the person from acquiring the autonomy needed to cope [outside] of the hospital’s restrictive environment. The institutionalization usually happens in psychiatric hospitals, but it can also happen in any environment or level of therapeutic care that fosters and promotes dependence, and that does not stimulate the patient’s autonomy.
(ii) Institutional provider. — Means any juridical person, public or private facility, or facility fully or partially engaged in planning, administering and providing mental healthcare treatment, recovery and rehabilitation services and that operates with professionals authorized to practice as such, pursuant to the laws of Puerto Rico. This definition also includes professionals in mental healthcare sciences and their private offices, insofar as they operate with the purpose of providing treatment, recovery, and rehabilitation services to address mental health issues, including drug and alcohol-related disorders and comorbid conditions. Likewise, the term “institutional provider” is deemed to include for-profit or non-profit community-based organizations devoted to offering therapeutic interventions to patients with disorders arising from drug or alcohol abuse or dependency or comorbid conditions.
(jj) Case manager. — Means a person holding a Bachelor’s or higher degree in mental healthcare sciences, who, under the supervision of a mental healthcare professional duly licensed to practice his/her profession, discharges tasks, such as accessing all the comprehensive services needed for the recovery and rehabilitation of a person with a mental disorder. In addition, he/she follows up on the implementation of the person’s individual treatment, recovery and rehabilitation plan. Provided, That case managers presently working for nonprofit or for-profit organizations shall be certified by the Mental Health and Addiction Services Administration as such when credited proof is furnished to attest that they have rendered services for two (2) or more years prior to the approval of this act.
(kk) Minor. — Means any person less than eighteen (18) years of age. An emancipated minor shall be empowered to make decisions, provided he/she has the capacity to consent. For the purposes of this chapter, an emancipated minor shall be considered an adolescent, with respect to the treatment services to be rendered.
(ll) Justified clinical need for treatment. — Means the clinical determination that arises from the evaluation [of] a person according to the standards accepted by the different mental health disciplines as clinical option for treatment, recovery and rehabilitation due to the severity of the symptoms and signs in order to stop the progress of the disease, improve the person’s condition and keep him/her at a socially accepted performance level, according to the severity of the symptoms and signs. The purpose of this determination, which is included in the person’s clinical record, is to inform and support the need for initiating or continuing to render mental health services.
(mm) Levels of care. — Means the different degrees of intensity and frequency in the medical, psychiatric, psychological, social and rehabilitation treatments that lead a person to perform at the most independent level possible.
(nn) Psychotherapy notes. — Means notes recorded in any medium by a mental healthcare professional in order to document or analyze the contents of a conversation during a psychotherapeutic intervention session or an individual or group therapy session, which are separate from all other contents in the clinical record. The definition of this term does not include the prescription, medication monitoring, the sheet to record when the session begins or ends, treatment modality and frequency, clinical test results, the diagnostic summary, functionality status, the treatment plan, symptoms, prognosis, and progress notes.
(ññ) For-profit or nonprofit community-based organizations. — Means any for-profit or nonprofit community-based organization duly organized and certified by the Department of State of Puerto Rico that develops programs and services consistent with its statement of mission, vision, and objectives, which may include guidance, counseling, assistance, support, and treatment, recovery and rehabilitation services for persons who need services to address mental health issues, including disorders relative to drug and/or alcohol abuse or dependency and comorbid conditions.
(oo) Other level of care. — For the purposes of this chapter, it means all treatment, recovery and rehabilitation services or modalities that comprise the whole of ongoing mental healthcare services, excluding hospital and emergency services.
(pp) Pass. — Means the permit given to a person who receives mental health services to be absent from the providing institution for a determined period of time and based upon clinical reasons.
(qq) Dangerousness. — Means the state determined by the existence of an imminent risk of causing damage due to a mental disorder. For the purposes of this subsection, dangerousness shall be considered to be when:
(1) There exists a high probability of causing damage, or physical or psychological harm to another person as revealed by the patient’s actions, intentions or threats, based on the opinion of a psychiatrist, clinical psychologist, or social worker with clinical experience;
(2) Within twenty-four (24) hours prior to the evaluation, the patient has made threats, attempted suicide or caused severe bodily injuries to the self; or has carried out actions putting his/her life at risk; or has carried out actions that indicate that he/she cannot handle his/her everyday life without supervision or help from other persons for not having the capacity to feed, protect or care for the self, thus increasing the probabilities of death, substantial bodily injury or physical weakness to a level that would put his/her life at risk.
(3) The person carries out, attempts or threatens to damage or destroy his/her property or that of another person due to a mental health disorder.
(rr) Person who requires and receives mental healthcare services. — Means any adult or minor who receives mental healthcare services, also commonly denominated as patient.
(ss) Mental health support personnel. — Means all the professionals in different disciplines and levels of academic preparation who are trained to give support to the performance and necessary operations of the mental health services system. It also includes any other person or group whose participation is necessary and pertinent for treating and handling the condition of the person who receives mental health services. All support personnel shall comply with the requisites of law to practice his/her profession in Puerto Rico.
(tt) Discharge plan. — Means the document produced by the inter- or multidisciplinary team which summarizes and records in writing the clinical picture, the results of the treatment, the level of recovery achieved by the person, and the recommendations and arrangements at the time of changing his/her level of care to another to suit his/her needs. The discharge plan shall be available for immediate use, not less than 24 hours before transferring or discharging the person into the corresponding level of care.
(uu) Individualized treatment, recovery and rehabilitation plan. — Means the design and implementation of a series of strategies directed to support strengths and to deter, counteract, limit or eliminate problems and difficulties identified by mental health professionals on the person evaluated, at the time and level of care he/she is at.
(vv) Mental health professionals. — Means those professionals in different disciplines and levels of mental health-related academic preparation who provide services and comply with the laws of Puerto Rico to practice their profession.
(ww) Indirect health service provider. — Means any public or private health service organization or insurer duly authorized in Puerto Rico to offer or bound to provide health services pursuant to the provisions of §§ 101 et seq. of Title 26, known as the “Puerto Rico Insurance Code”; health maintenance organizations as defined in subsection (x) of Section 1 of Act No. 101 of June 26, 1965, as amended; and any plan organized and authorized by any special law, as well as all Managed Behavioral Healthcare Organizations (MBHOs).
(xx) Proprietary provider of information systems. — Means a person or entity that offers the services of an electronic/computerized information system for sale, to rent, etc.
(yy) Psychologist. — Means the professional licensed by the Psychologists’ Examining Board of the Commonwealth of Puerto Rico, as defined in §§ 3201 et seq. of Title 20, known as “An Act to Regulate the Practice of the Profession of Psychology”, who has the training, knowledge, skills, and experience to offer services which include, but are not limited to: prevention, behavioral description or diagnosis, psychological evaluation, therapeutic intervention to address psychological issues in the several levels of severity, and counseling in connection with the intellectual, emotional, behavioral, interpersonal, familial, social, and occupational functionality of individuals and groups.
(zz) Psychiatrist. — Means the medical doctor specialized in general psychiatry, of children or adolescents, or in other sub-specialties known and duly certified, who is authorized to practice as medical doctor in Puerto Rico and with authority to practice the specialty or sub-specialty, as certified by the Board of Medical Examiners of Puerto Rico.
(aaa) Claim. — Means the statement made verbally, behaviorally or by any other means of expression, by which a person states his/her dissatisfaction or displeasure with the treatment or service received or lack thereof, in his/her inter-relationship with an institution engaged in rendering mental health services that provides direct or indirect services.
(bbb) Complaint. — Means the written statement expressing dissatisfaction with the treatment or services received or lack thereof, by the person, in his/her inter-relationship with an institution engaged in rendering mental health services that provides direct or indirect services.
(ccc) Recovery. — Means the ability to improve and maintain functionality in one (1) or more of the following dimensions of life, such as work, living accommodations, community or family roles, so as to be able to lead a full and fulfilling life, even if there are limitations brought on by the disease. Furthermore, recovery means the remission of symptoms and signs, and the resolution of situations for each level of care corresponding to the severity and level of functionality the patient acquires as he/she improves his/her state, and acquires knowledge and autonomy to manage his/her condition, to prevent relapses and to manage them effectively. Among the most imminent resolution of situations, there is the acceptance of the condition and its treatment, as well as its limitations, alternatives, triggering factors and resistance factors, among others.
(ddd) Referral. — Means the document issued by any health professional authorized to practice his/her profession pursuant to the laws of the Government of Puerto Rico, which states the need for a person to be evaluated in order to determine if he/she needs or not mental health services.
(eee) Rehabilitation. — Means the acquisition, restoration or compensation of skills and capacities to a satisfactory level of functionality of a person, according to his/her condition, diagnosis and prognosis on the basic skills to achieve an autonomous life and an affective, intellectual, working, academic satisfaction that would allow him/her to perform in all the aspects mentioned above.
(fff) Restriction. — Means the therapeutic measure that makes use of physical and mechanical means to involuntarily limit movement of all or part of the body, in order to control physical activity and protect the person subject to the restriction, thus avoiding injury to the self or others, or damage to property. The use of means to protect the person, such as rails, helmets and/or mechanisms such as orthopedic equipment, braces, wheel chairs and other equipment or artifacts to support the person’s posture or aid him/her in obtaining or maintaining the functions of the body, shall not be considered as a restriction.
(ggg) Mental health. — Means the whole of the state of wellness in the physical, mental and social orders, which enables persons to employ their intellectual, emotional, ethical and spiritual capabilities and their social resources in order to make rational and creative decisions, foresee the consequences of their actions, acknowledge their mistakes, feel comfortable with themselves, relate satisfactorily with other people and contribute to their welfare, strive to fulfill their own potential and to reach their own goals, adapt to changes constructively, deal with daily demands or stress which are commonplace in life, work productively, and contribute to the welfare of their community and society in general.
(hhh) Mental healthcare services. — Means, among others, the preventive, diagnostic and therapeutic interventions and activities that help to manage, reduce, or eliminate symptoms, suffering and distress in persons showing to have a mental disorder or mental health issue, and to effectively manage the impairment that usually ensues from these conditions, so that the person may recover from his/her condition, attain an age-appropriate level of self-sufficiency, and lead a stable life together with their families or within their communities. This term includes preventive interventions and activities geared toward reducing the risk or delaying the onset of mental disorders. Mental healthcare services may be offered in a wide array of places or settings covered under this chapter. These include the following kinds of services, among others:
(1) Treatment services. — Which include, but are not limited to: psychotherapy, counseling, pharmacotherapy, and support therapy geared toward curbing or lessening the symptoms or the suffering caused by severe mental disorders.
(2) Rehabilitation services. — Which are geared toward curbing or lessening the impairment associated with mental disorders or mental health issues. These services may include, but are not limited to: individual strength and personal goal evaluation, readiness or disposition, training in a specific skill, and assistance in designing settings which enable the person to enhance his/her ability to function and participate in the community.
(3) Support services. — Which include services geared toward assisting persons to lead their lives successfully within the settings of their choice. Such services may include financial income support, social support, housing support, vocational support, or accommodations to suit the symptoms or impairment associated with the mental disorder or mental health issue.
(4) Case management services. — Geared toward assisting persons in gaining access to formal and informal resources that they might need in order to successfully cope with the repercussions of their condition. These resources may include interventions for treatment, rehabilitation, or support, ministered by formal or informal service providers. Case management may include an evaluation of the needs of the patient or client; intervention planning together with the person, his/her family, and the providers; establishing the connection between the patient or client and the services; monitoring or following up on the services offered; evaluating the effect of the services and support provided; and advocate on behalf of the patient or client.
(iii) Interdisciplinary treatment services within the community. — Means those treatment, rehabilitation and recovery services rendered by a direct or indirect provider, to reach out to the person within his/her own community, in order for the person to remain integrated therein and to be able to remain functional with the support of his family and community groups, [especially] in cases at high risk.
(jjj) Severity. — Means the intensity of the symptoms and signs that result in a significant impediment as to the person’s social, working and occupational functionality at the time it is diagnosed.
(kkk) Collaborative system. — Means the interagency and community system of joint and collaborative work. Said system is characterized by the identification of a common problem in a common population, which through the arrangement of integrated services receives comprehensive services, thus involving an allocation of economic, professional and technological resources that correspond to the needs of said population. These agencies have the legal responsibility of handling different manifestations of the problem and its triggering factors.
(lll) Quality assurance system. — Means the systematic compilation of data and efficiency factors for executing and implementing mental health treatment services and procedures in each level of care according to the protocol by disorder, age, gender and severity. This system forms part of the normal standards and procedures of the institution providing mental health services as a mechanism that allows the faculty to assure their quality.
(mmm) Petition for mental health services. — Means the action to request mental health services for treatment, recovery and rehabilitation in a providing institution.
(nnn) Social worker. — Means the social work professional with a degree from an accredited institution, who has evidence of College of Social Workers membership, with license issued by the Board of Examiners of Social Workers, pursuant to §§ 821 et seq. of Title 20.
(ñññ) Transportation. — Means the action of moving a person from one place to another in a vehicle appropriate for his/her condition, which in the case of a medical-psychiatric emergency, shall include an ambulance certified by the Public Service Commission and the Department of Health. In the event that the person has the financial resources, including coverage under a health plan, to defray transportation expenses, these shall be defrayed under the coverage of his/her plan. In the case of persons receiving mental healthcare services under the Health Reform, the entity contracted to manage and coordinate the health services shall be responsible for defraying transportation expenses. If necessary, and in the absence of other alternatives, transportation shall be provided by ambulances serving under the 911 Emergency Hotline. Transportation shall cover from the point where the person who needs emergency services is located to any institutional provider of the medical services needed, or transportation between institutional health service providers. Transportation by ambulance shall meet the requirements set forth in the Emergency Medical Treatment and Active Labor Act, (42 USC § 1395; 42 CFR § 489.24) and §§ 3111 et seq. of this title.
(ooo) Transfer. — Means the action by which an institution makes a change in the responsibility of treating a person within the same institution, from one unit to another, from one service to another, or from one therapist to another. The change in treatment responsibility is also considered as a transfer when the transfer is made from one health institution to another. The transfer shall be made in a coordinated manner in order to continue rendering the service and treatment, according to the level of care person requires.
(ppp) Mental disorder. — Means a psychological syndrome or behavior pattern of clinical significance, which is associated with discomfort (i.e., pain), an impairment (deterioration in one (1) or more areas of functionality), or the significantly increased risk of dying or experiencing pain, an impairment or the loss of freedom. This syndrome or pattern should not be merely a culturally acceptable response to a particular event (i.e., the death of a loved one). Whichever its cause, this syndrome or pattern should be regarded as the individual manifestation of a behavioral, psychological or biological dysfunction. Controlled substance or alcohol abuse or dependency is included in this definition for being regarded as a mental disorder, as established in the Manual of International Classification of Mental Diseases (DSM-IV-TR) in effect, in its fourth and subsequent editions. It is hereby provided, that any subsequent version of this definition shall be applied by reference of this chapter, insofar as the same is contained in the Diagnostic and Statistical Manual in effect.
(qqq) Substance-related disorders. — Means the abuse of and/or dependency on alcohol, prescription drugs, solvents, illegal drugs, etc., as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), in its fourth and subsequently revised editions.
(rrr) Acute treatment. — Means the prompt and intense intervention by mental health professionals to attend a person with an acute clinical condition in order to avoid, stop or decrease the symptoms and signs of the condition and its consequences. Among others, it may include intervention during crisis, use of psychoactive drugs, hospitalization, restriction and isolation.
(sss) Compulsory treatment. — Means the treatment ordered by the court, under penalty of contempt, upon recommendation from the inter- or multidisciplinary team to be given to a person with a mental disorder who, although he/she does not meet the severity requisites, represents danger to the self to others, or to property, and meets the requirements for another level of care, such as ambulatory care, partial hospitalization or maintenance with medication.
(ttt) Complementary treatment. — Means the therapeutic services not included in the basic services of the mental health services system, which may help in the recovery process of a person with a mental disorder, as recommended by mental health professionals, such as art, sports and others.
(uuu) Community or Community-based treatment. — Means the strategies and efforts established by for-profit or nonprofit community-based organizations that develop service programs, which may include guidance, education, counseling, assistance, support, and treatment, recovery and rehabilitation services for persons who need services to address mental health issues, including disorders relative to drug and/or alcohol abuse or dependency.
(vvv) Legal guardian. — Means the person designated by the court to be in charge of the care and custody of a person and his/her property, upon the corresponding declaration of disability issued by the court.
(www) Visit. — Means any intervention conducted by a healthcare professional, as defined in this chapter, on a person receiving services, with the purpose of evaluating, diagnosing, and providing treatment and counseling to manage a mental disorder. Visits include the whole range of visits established in the codes, diagnoses duly accepted by the medical community. This includes introductory visits, follow-up visits, and any collateral visit needed to effectively treat the person who receives mental healthcare services, as defined below:
(1) Introductory visit. — Refers to the first intervention of a mental healthcare practitioner, after the placement of a patient, whereby the plan of action to be followed is set forth.
(2) Follow-up visit. — Refers to subsequent visits made to ascertain compliance with the plan of action and the present condition of the patient.
(3) Collateral visit. — Refers to the visit made to a mental healthcare practitioner that requires the presence of a close relative, in the case of adults, or of a parent, legal guardian or custodian, in the case of minors. Said visit provides for information to be furnished and for guidance to be received as to the management of the person who receives mental healthcare services.
History —Oct. 2, 2000, No. 408, § 1.06; Aug. 6, 2008, No. 183, § 3.