When Involuntary Hospitalization Becomes Necessary
If your loved one is experiencing symptoms such as severe depression, suicidal urges, mania, or psychosis, it can have a devastating impact on them and the people around them. Possible consequences can include:
Destroyed relationshipsFinancial ruinInability to take care of basic daily needPhysical harm to othersSuicide
Unfortunately, mental illness often makes a person unable to think clearly about their situation. It may be up to the people around them—such as family members, police, emergency responders, or mental health providers—to take the initiative to get help in order to prevent a tragic outcome. For more mental health resources, see our National Helpline Database.
Who Can Be Involuntarily Committed?
The laws vary widely from state to state, but a person must be living with a mental illness in order to be involuntarily committed. Mental Illness Policy Org. provides criteria listed by state for both involuntary commitment for inpatient care and involuntary commitment for outpatient care. Criteria that states may consider include:
A “clear and present danger” to himself or herself (someone who has inflicted serious bodily injury on themselves, has attempted suicide or serious self-injury, or threatened to inflict serious bodily injury on themselves)Grave disability (someone who can’t take care of themselves)The need for involuntary treatment (essential for health and safety)
Less common criteria used by some states include:
Availability of appropriate treatment at the facility to which the person will be committedFuture danger to propertyLack of capacity to consentLeast restrictive alternativeRefusal of voluntary hospital admissionResponsiveness to treatment
While most states require that the person presents a clear and present danger to themselves or others in order to be committed, this is not true for all states. In some, involuntary hospitalization may occur if a person is refusing needed treatment whether or not they are considered to be dangerous.
Types of Involuntary Treatment
There are three types of involuntary treatment, including emergency detentions, observational institutionalization, and extended commitment.
Emergency Detentions
Emergency detentions, in which immediate psychiatric help is being sought, are usually initiated by family members or friends who have observed the person’s behavior. Sometimes it’s initiated by the police, although any adult could request emergency detention. The exact procedures vary by state, with many states requiring judicial approval or evaluation by a doctor confirming that the person meets the state’s criteria for hospitalization. Emergency detention is typically only for a short period, with the average being about three to five days. It can vary a bit by state, however, ranging from just 24 hours in a few states to up to 20 days in New Jersey.
Observational Institutionalization
Patients may also be admitted for what is known as observational institutionalization, in which hospital staff may observe the person to determine a diagnosis and administer limited treatment. Application for this type of hospitalization can usually be made by any adult who has a reason to do so, but some states require that the application is made by a doctor or hospital personnel. And most require that an observational institutionalization receives the approval of the courts.
Extended Commitment
The third type of hospitalization, extended commitment, is a bit more difficult to obtain. Generally, it requires one or more persons from a specific group of people—such as friends, relatives, guardians, public officials, and hospital personnel—to apply for one. Often a certificate or affidavit from one or more physicians or mental health professionals describing the patient’s diagnosis and treatment must accompany the application. A typical length for extended commitment is up to six months. At the end of the initial period, an application can be made for the time to be extended, generally for one to two times longer than the original commitment. Requests can be made for further commitment when each period expires, as long as the patient continues to meet the legal criteria.
How to Initiate the Process of Committing Someone
Because the actual process varies by state, it is a good idea to consult a local expert who can educate you about your state’s procedures. People best able to advise you include:
Your family doctor or a psychiatrist Your local hospital A lawyer specializing in mental health law Your local police department Your state protection and advocacy association
In most states, you will need a qualified civil official, crisis team member, or medical staff to deem a person a danger to themselves or others and enact a “psychiatric hold” or “pick up.”
Can a Patient Be Forced to Receive Treatment?
Patients cannot be forced to receive treatment unless there has been a hearing declaring them legally incompetent to make their own decisions. Even though the person has been hospitalized involuntarily, most states will treat them as being capable of making their own medical decisions unless it has been determined otherwise. Patients who are in immediate danger may be given medications on an emergency basis. However, these medications are directed at calming the person and stabilizing their medical condition rather than treating their mental illness. For example, a sedative might be administered to prevent the person from harming themselves, but they could not be forced to take an antidepressant, as this is considered to be treatment.
