What Criteria Must Be Met for an Involuntary Psychiatric Hold?

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In the battle against addiction and mental illness, sometimes things get so bad that you may feel you need to use a psychiatric hold on a loved one who you feel is in danger. You have tried interventions, you have tried rehabilitation, and you’re at the end of your rope and want to get them into safety. You’ve made a hard decision and if you’re doing it for a loved one, they may have a lot of anger towards you and swear they’re never going to speak to you again. If an involuntary psychiatric hold is necessary, here’s how you do it.

What Are the Criteria?

Regulations for psychiatric holds vary from state to state, so be sure to check with your state for variations. However, if someone is a threat for harming themselves or others, they are unable to care for themselves, or have a “grave disability,” you may need to take drastic measures. When someone needs mental health intervention and there is a danger to their mental health if they don’t receive it, you may be able to seek involuntary hospitalization.

Some states also take into consideration symptoms like severe depression, mania, or psychosis. Criteria may also include factors, like financial ruin. Suicidal tendencies are often the most compelling reason for involuntary hospitalization. To see specific state laws, you can search mental illness policy on various sites.

Special State-Specific Laws

Some states, such as New York, have a specific law to address severe mental illness called Kendra’s Law. If someone suffers from severe mental illness and has a pattern of noncompliance with treatment and re-hospitalization because of that, the state can order enforced outpatient treatment as an alternative to involuntary hospitalization. The law came about in 1999 when a person with untreated schizophrenia pushed Kendra Wendale into the path of an oncoming subway train, killing her. At the time, he had gone off his medication.

Since New York enacted this new law, there have been studies on its effectiveness. Among the subjects that are treated under Kendra’s Law, there has been decreased homelessness of 74%. Hospitalization has been reduced 77% and arrest and incarceration statistics have gone down 83% and 87% respectively. There’s been a 47% reduction in physical harm to others, a 48% reduction in substance abuse, and a whopping 55% reduction in suicide rates.

Kendra’s Law has allowed New York to enforce treatment for serious illness without hospitalization and preserving the civil liberties of those who suffer from mental illness. It’s also saving money since people can remain in the community instead of inpatient treatment and the criteria requires a much easier threshold than most states.

However, some states have lower standards for allowing involuntary hospitalization. In some states, a person can be committed if it’s determined that they cannot consent or are refusing admission to a hospital.

Other Types of Involuntary Treatment

There are three other kinds of intervention available besides involuntary hospitalization. Emergency detention is very similar except it may be used while someone is trying to initiate the process for involuntary hospitalization. It’s designed to keep the person safe from harm during the filing process. Depending on the state, this can range from 24 hours up to 20 days.

You can also file for observational institutionalization. This is a limited hospitalization designed to determine a diagnosis and what kind of treatment should be administered. Some states require the application from a doctor but some allow anyone to make the application. The amount of time for observation can be anywhere from 48 hours to six months in the state of West Virginia.

Extended commitment is a little more difficult to acquire and has a higher threshold of criteria you need to meet. This often has a range of people who can apply, from family and friends to public officials and hospital personnel. You will likely need an affidavit from a doctor or mental health professional. This also usually requires a hearing with a judge or even a jury present. When you are talking about extended commitment, someone’s basic civil rights are taken away, so it’s appropriate that the criteria are higher in these cases.

Hopefully, you will try several alternatives before this step, including rehabilitation in a treatment center for mental illness or substance abuse and counseling. If options have been attempted several times without success, you may have to take more extreme measures.

If You Have to File

This isn’t–and shouldn’t be–an easy decision, but if you are considering some kind of forced hospitalization, things have likely gotten to a breaking point and the subject’s life may be in danger. If you’re ready to take that step, consult your state’s laws and gather together help from the following resources. You want to get help from a family doctor or psychiatrist. You’ll also want to make sure your local hospital gets involved and can provide the right kind of treatment. Find a lawyer who specializes in mental health issues and is familiar with mental health laws. You also want to get your local police department involved and check with your state’s advocacy association. Your word alone probably isn’t enough to get someone mandatory treatment, so you’ll need medical staff to vouch for the fact that the patient needs immediate medical intervention whether they agree to it or not.

Note that, except for cases of extended commitment with a court hearing, patients may be given emergency medications while stabilizing them and getting them into treatment, but they maintain the right to refuse medications such as antidepressants or other medications for treating mental illness. It’s important to maintain a realistic perspective of what this process may achieve.

Choosing any kind of mandatory treatment or involuntary hospitalization is never an easy decision for a friend or family member struggling to get help for a loved one. If all other avenues have been exhausted, you may have to take this drastic step. The general criteria in every state maintain that if a patient is a danger to themselves or others, there is some kind of process to get them committed involuntarily to a hospital. After that, laws do vary from state to state and the time committed varies. This decision should never be made lightly as it means temporarily taking away someone’s freedom to get them the help they need. Here at Everlast Recovery Center, we can help before things get so serious you have to consider involuntary hospitalization. For substance abuse, we start with detoxification. In rehabilitation, we address your substance abuse, mental illness, or combination of both, and move into therapy to treat your illness. We also offer holistic healing such as yoga or equine therapy in conjunction with traditional counseling. Call us today and learn how we can help at 866-DETOX-25, (866-338-6925).

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