Connecticut State Department of Mental Health and Addiction Services

Police Request for Emergency Examination

Pursuant to Connecticut General Statutes Section 17a-503:

"Any police officer who has reasonable cause to believe that a person has psychiatric disabilities and is dangerous to himself or herself or others or gravely disabled, and in need of immediate care and treatment, may take such person into custody and take or cause such person to be taken to a general hospital for emergency examination under this section. The officer shall execute a written request for emergency examination detailing the circumstances under which the person was taken into custody, and such request shall be left with the facility. The person shall be examined within twenty-four hours and shall not be held for more than seventy-two hours unless committed under section 17a-502."

In the event an officer finds reasonable cause to request an emergency examination, form MHCC-1 must be completed. The form is not available online and must be requested by contacting the Department of Mental Health and Addiction Services (DMHAS).

Police departments may request the forms by calling DMHAS at (860) 418-7000 and requesting the "Police Request for Emergency Examination" forms be mailed to the police department.