Claire Dawson
Admitting a loved one to a psychiatric hospital can be a challenging experience. While the exact requirements and criteria for commitment vary from state to state, the process generally involves an emergency psychiatric evaluation, inpatient treatment, and assisted outpatient treatment. Most mental hospitals require a referral from a mental health professional, such as a psychologist, psychiatrist, or social worker, for admission. Additionally, a detailed assessment of the person's mental health and a recommendation for admission may be requested. If you are concerned about a loved one's safety and health, you can recommend a short-term commitment if they are at risk of harming themselves or others. In non-emergency situations, you can file a petition to initiate the involuntary commitment process.
| Characteristics | Values |
|---|---|
| Who can admit someone to a psychiatric hospital? | Family members, friends, police, emergency responders, mental health professionals, judges/magistrates, and physicians. |
| Who can be admitted to a psychiatric hospital? | Individuals with mental illness, those in danger of hurting themselves or others, and those refusing treatment for mental illness. |
| What is the process of admission? | Involuntary admission: filing a petition, emergency psychiatric evaluation, inpatient treatment, and assisted outpatient treatment. Voluntary admission: referral from a mental health professional, recommendation for admission, and physical and psychiatric evaluations. |
| What to prepare before admission? | Psychiatric Advance Directive, choosing the hospital or treatment facility, and necessary belongings (e.g., comfortable clothing, sports shoes). |
| What happens during admission? | Psychiatric and physical evaluations, nursing assessment, patient record creation, identification photograph, tuberculosis skin testing, laboratory tests, dental screening, and social history assessment. |
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What You'll Learn
Involuntary admission criteria
Involuntary admission to a psychiatric hospital can be a complex process and varies depending on the state. However, there are some general criteria and procedures that are commonly followed. Firstly, it's important to understand that involuntary admission means placing someone in an inpatient setting, such as a hospital psychiatric unit or a mental hospital, against their will. This is typically done with the goal of helping the person and ensuring their safety, rather than restricting their rights.
The criteria for involuntary admission often include presenting an imminent danger to oneself or others. This could be due to severe mental illness, such as depression, suicidal thoughts, mania, or psychosis. Some states may also consider involuntary hospitalization if an individual is refusing necessary treatment for their mental illness, even if they do not pose a direct danger. In most cases, involuntary admission requires the involvement of a medical professional or judicial approval to ensure the protection of the individual's rights.
The process for involuntary admission usually begins with an emergency psychiatric evaluation, which can be requested by concerned family members, friends, police, or emergency responders. It's important to note that almost anyone can initiate the process, but most states require either medical evaluation or court approval to proceed. This evaluation will determine if the individual meets the state's criteria for hospitalization, which may include a detailed assessment of their mental health and functioning.
Following the evaluation, the next step is typically inpatient treatment, where the individual will be admitted to a psychiatric facility for a short-term emergency detention. The duration of this detention varies by state, ranging from 24 hours in some states to 20 days in others, with an average of about three to five days. During this time, the individual will receive treatment and support to stabilize their condition. It's important to note that patients cannot be forced to receive treatment unless there has been a hearing declaring them legally incompetent to make their own decisions.
In some cases, involuntary admission may also include observational institutionalization, where hospital staff observe and diagnose the individual while administering limited treatment. This type of hospitalization can usually be requested by any adult with a reasonable concern, but some states require the application to be made by a doctor or mental health professional. Overall, the involuntary admission process aims to prioritize the individual's safety and well-being while ensuring their rights are respected.
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Voluntary admission preparation
Voluntary admission to a psychiatric hospital is a personal decision that often comes at a time of significant distress or crisis. It is a courageous step towards healing and stability. Here is some detailed information to help you prepare for voluntary admission:
Recognizing the Need for Inpatient Care:
The decision to seek inpatient care is often influenced by specific signs and symptoms. These may include:
- Experiencing psychosis, mania, substance misuse, or suicidal thoughts/behaviors.
- Sudden changes in mental status, such as suicidal ideation or paranoia.
- Hearing voices, especially those commanding violence.
- Need for detoxification from drugs or alcohol.
- Development of psychotic thinking that detaches you from reality.
- Inability to perform basic Activities of Daily Living (ADLs), such as eating, grooming, or sleeping.
- Physical or verbal abuse, psychomotor agitation, violent tendencies, or substance abuse.
Consulting a Healthcare Professional:
Before voluntarily admitting yourself, it is essential to consult a healthcare professional, such as your therapist, psychiatrist, or primary care provider. They can help determine if inpatient care is the best treatment option for you and provide referrals or admissions guidance.
Understanding the Admission Process:
When you arrive at the psychiatric hospital, you will undergo an evaluation process:
- A psychiatrist will assess your mental and physical health, take your history, and make an initial diagnosis.
- The treatment team will work to stabilize your condition and develop a treatment plan, which may include psychotherapy and medications.
- You will be informed of the hospital rules and safety measures, including locked wards and restricted items to ensure your safety and that of others.
What to Bring and Expect:
- Bring an advocate: This can be a spouse, parent, close friend, or relative who knows your situation and can support you during the process.
- Be prepared for paperwork: There will be paperwork to complete, and it is essential to provide honest and accurate information to the best of your ability.
- Know your rights: As a voluntary patient, you have the right to request your release from the hospital. However, the hospital staff may try to extend your stay if they believe it is necessary for your well-being.
- Expect a structured environment: Psychiatric hospitals follow schedules for meals, treatments, activities, and bedtime. This structure is designed to support your recovery.
Remember, the staff at the psychiatric hospital is there to help and support you. Be patient with the process, cooperate with the staff and other patients, and focus on your healing journey.
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Emergency psychiatric evaluation
An emergency psychiatric evaluation is a concise, focused assessment that aims to determine the appropriate level of care for a patient presenting with a psychiatric emergency. Psychiatric emergencies are acute disturbances in thought, behaviour, mood, or social relationships that require immediate intervention to protect the patient and/or others from imminent danger.
The first step of an emergency psychiatric evaluation is to establish safety and readiness for safety planning, including transport if necessary for a higher level of care. This involves identifying the level of danger and ensuring the safety of the patient, surrounding persons, and the medical team. The evaluation should also address any comorbid medical conditions to ensure appropriate and safe admission to a psychiatric facility.
The cornerstone of the initial psychiatric evaluation is a detailed history that focuses on the temporal development of symptoms, associated signs and symptoms, and possible precipitants and causes. This includes past history of medical and psychiatric illnesses, medication usage, allergies, adverse reactions to medications, patterns of substance use, family history of psychiatric illness, and psychosocial history. The interview should be a fact-gathering mission, with the elements of the history supporting the disposition chosen by the psychiatrist.
Collateral contact will likely be made with family members and friends, and other professionals like ED staff, outpatient therapists, or care coordinators will be consulted. The psychiatric evaluation is the primary part of a mental health ER visit and is often one of the most important components of the ED encounter, despite differing opinions among emergency medicine physicians and psychiatrists regarding the process.
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Inpatient treatment
During inpatient treatment, the individual will be admitted to a psychiatric hospital or unit within a medical hospital. The admitting procedures usually include a psychiatric evaluation, a physical assessment, nursing assessment, and the creation of a patient record. The patient's belongings will be searched and inventoried for safety, and they will be provided with information about their rights during hospitalization.
The inpatient treatment itself will vary depending on the specific needs of the individual and the resources available at the hospital. Treatment may include individual therapy, group therapy, medication, and other therapeutic interventions. The goal of inpatient treatment is to stabilize the individual's mental health and ensure their safety. It is also important to prepare them for the next step, which may involve discharge back into the community or further residential care.
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Assisted outpatient treatment
AOT is a general term describing all the types of services that an individual with mental illness may receive in the community, including case management services, medication, drug testing, educational and vocational training, group therapy, substance abuse treatment and counseling, and supervision of living arrangements. AOT can be recommended by family members, friends, police, and emergency responders, especially if the person in question is suicidal.
In communities where AOT has been implemented as a formal program, the mental health system itself — as represented by a government agency, community-based provider, or treating hospital — takes the initiative to identify an individual who meets the legal criteria for AOT and bring the matter to court. Most typically, individuals are referred to the program for AOT consideration upon their discharge from a hospital or jail, or after being determined not to meet the criteria for hospital commitment despite a clear need for better engagement with outpatient care. Many states allow family members (and sometimes other private parties) to petition the court for an AOT order.
If a physician determines that the person has not complied with an AOT order and may be in need of involuntary admission to a hospital, the physician may recommend that the patient be removed from the community for examination and transported to a county hospital, where they can be retained for up to 72 hours to determine if inpatient care and treatment are necessary. However, non-adherence to the court order should first trigger a re-evaluation of the person’s current clinical needs and a re-appearance before the judge to consider a change in legal status.
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Frequently asked questions
If you think someone is in danger of hurting themselves or others, call emergency services. If it's not an emergency, you can file a petition to get them committed. You can also recommend a short-term commitment if they are in danger of harming themselves or others.
Anyone can recommend a short-term emergency detention, including friends, family, police, and emergency responders.
The process for commitment varies depending on the state, but it often involves an emergency psychiatric evaluation, inpatient treatment, and assisted outpatient treatment. Most mental hospitals require a referral from a mental health professional, such as a psychologist, psychiatrist, or social worker.
If your loved one refuses to go to a psychiatric hospital, you can commit them involuntarily if a mental health professional and a judge/magistrate feel it is best.
Patients should bring comfortable items such as sports shoes and loose-fitting clothing. It is also recommended to fill out a Psychiatric Advance Directive beforehand, listing the types of medications you would and wouldn't like to take and any other preferences or instructions.
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