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Individualized Mental Health Safety (State Form 56901)

Pursuant to updates to IC 12-21-5-6, the Division of Mental Health and Addiction has developed an Individualized Mental Health Safety Plan (State Form 56901) for use by psychiatric crisis centers, psychiatric inpatient units and psychiatric residential treatment providers. Mental health providers should develop the plan with individuals receiving treatment and/or their legal representative. With consent from the individual or their legal representative, other family members, friends and supports should be involved in the development of the plan and/or receive a copy of the plan. Pursuant to IC 16-39-2-6(b), this plan may be shared in certain circumstances, without the individual or their legal representative’s consent.

All psychiatric crisis centers, psychiatric inpatient units and psychiatric residential treatment providers are subject to the above requirements and should review the relevant codes, update internal policies and procedures and begin use of the Individualized Mental Health Safety Plan as soon as feasible. Relevant links are below.

Please submit questions or concerns via email to Erin Quiring, DMHA’s assistant deputy director for quality improvement, erin.quiring@fssa.in.gov.

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Frequently asked questions

Indiana Code 12-21

Indiana Code 16-39