How Involuntary Hospitalization for Depression Works

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Are you considering for someone involuntary hospitalization for depression? You may be wondering what you can do. You may not even be sure if hospitalization is really necessary. The following is meant to answer some of the questions that you may be having when making the difficult decision to commit someone to a mental hospital against his or her will.

When Does Involuntary Hospitalization Become Necessary?

If your loved one is experiencing symptoms such as severe depression, suicidal urges, mania, or psychosis, this can have a devastating impact on the loved one and the people around him or her. Possible consequences can include suicide, physical harm to others, financial ruin, destroyed relationships, and the inability to take care of basic daily needs.

Unfortunately, mental illness often makes the person unable to think clearly about his situation. It may be up to the people around him—such as family members, police, or mental health providers—to take the initiative to get help in order to prevent a tragic outcome.

Terms to Understand

The term "mentally ill" is not as clearly defined for legal purposes as it is in the treatment of mental illness. With the exception of Utah, none of the states uses a list of recognized mental disorders to define mental illness. Instead, the definition varies from state to state and is usually defined in rather vague terms describing how mental illness affects thinking and behavior.

The definition of "grave disability" also varies from state to state. In general, it refers to a person's inability to take care of himself.

Who Can Be Involuntarily Committed?

The laws vary widely from state to state, but the person must be suffering from a mental illness to be committed.

Mental Illness Policy Org. has the 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 himself or herself, has attempted suicide or serious self-injury, or threatened to inflict serious bodily injury on himself or herself)
  • Grave disability
  • The need for involuntary treatment (essential for health and safety)

Less common criteria used by some states include:

  • Responsiveness to treatment
  • Availability of appropriate treatment at the facility to which the person will be committed
  • Refusal of voluntary hospital admission
  • Lack of capacity to consent
  • Future danger to property
  • Least restrictive alternative

While most states require that the person presents a clear and present danger to himself or others in order to be committed, this is not true for all states. In some, involuntary hospitalization may occur if individuals are refusing needed treatment even though they are not considered to be dangerous.

Who Can Get Someone Involuntarily Hospitalized?

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.

Patients may also be admitted for what is known as observational institutionalization, in which hospital staff may observe the patient 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.

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.

In virtually all states a hearing must be held, with a judge or jury making the final decision about whether the person can be held.

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
  • Your local police department
  • A lawyer specializing in mental health law
  • Your state protection and advocacy association

If you believe that your loved one is in danger of hurting himself or others or is experiencing a life-threatening emergency, call a crisis center or 9-1-1, or take the person to the nearest emergency room.

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."

Commonly Asked Questions

How long does involuntary hospitalization last?
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 24 hours in a few states to 20 days in New Jersey.

In the states that allow for observational commitment, the length of hospitalization can vary considerably, ranging from 48 hours in Alaska to six months in West Virginia.

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.

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 patient has been hospitalized involuntarily, most states will treat the patient as being capable of making his 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 patient and stabilizing his medical condition rather than treating his mental illness.

For example, a sedative might be administered to prevent the patient from harming himself, but he could not be forced to take an antidepressant, as this is considered to be treatment.

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