If a loved one is struggling with mental illness and find they are in need of emergency medical services, it can be a daunting and possibly scary endeavor. That is why we want to ensure you have clarity into the process – including the legal and medical professionals that are involved when making these important decisions.
We’ve included some of the most common questions from patients and their families below. If you have additional questions about this process or other behavioral healthcare needs, please call the Behavioral Health Hotline at 1-833-TREATBH (873-2824).
How is someone involuntarily admitted to an acute psychiatric hospital?
The regulations for involuntarily admitting a patient vary by State and County, but generally, the proceedings are initiated by a third party outside the psychiatric hospital such as law enforcement, first responders or a licensed healthcare professional. In some states, a family member can initiate the process.
The reason a person would be brought to a psychiatric hospital and admitted involuntarily is generally consistent across state lines (although wording may vary) – the person who initiated the process believes the patient is at risk of harming themselves, harming others or is gravely disabled and unable to take care of themselves.
What happens after a person is brought to the psychiatric hospital?
The hospital (usually a hospital specializing in psychiatry) must safely admit the patient and quickly initiate a psychiatric evaluation and other clinical assessments. It is important for the patient to be assessed quickly – some states even require the timeframe in which these assessments must occur. In Florida, for example, the patient must be evaluated by two independent psychiatrists within 72 hours. These assessments are completed by a multi-disciplinary team comprised of a psychiatrist, nurse and therapist.
Once admitted to the hospital, treatment can start if the patient consents. The primary goal is to stabilize the individual to a place where they can safely re-enter their community. Medication interventions, with consent, and therapeutic programming are provided, including group therapy and individual therapy.
How long is a patient typically at the psychiatric hospital before they are once again able to function safely on their own?
This is an individualized decision based on the patient’s needs. There are many factors to consider but three important ones to keep in mind: 1) the severity of the patient’s illness, 2) management of patient’s symptoms, and 3) the patient’s responsiveness to treatment.
The average time spent in a hospital to stabilize and regain safe functioning for an adult is 5-10 days. For a variety of reasons (disease complexity, co-occurring disorders, challenges with comprehensive discharge planning and disposition), admissions for adolescents and seniors average slightly longer (~2+ weeks).
Regardless of how long the patient stays in the hospital, the psychiatrist(s) need to ensure the patient is safe when discharged and that their needs can be met effectively outside the hospital.
What happens if the clinical team believes the patient needs to stay in the hospital at an acute level of care, but the patient disagrees?
Involuntary psychiatric commitment is a serious decision that necessitates a system of checks and balances to protect individual liberties while ensuring an individual receives access to necessary safe care for themselves (and for the public’s safety if they are going to hurt others). These safeguards include but are not limited to:
- Legal protections: such as the right to a hearing, legal representation, limited initial holds and regular reviews of the admission status.
- Medical and ethical guidelines: strict criteria for involuntary admission, prioritizing the least restrictive treatment setting, informed consent whenever possible and patient advocacy programs.
- Insurance oversight: an additional layer of review to ensure medical necessity and appropriate use of resources for patients with insurance coverage.
In addition, if the psychiatrist, who is the attending physician for inpatient behavioral health, believes a patient who was admitted involuntarily is at risk of harming themselves, others or unable to take care of themselves due to being gravely disabled, the legal system can become involved as another check and balance to the situation.
For example, in Florida, through legislation commonly referred to as the Baker Act, a request to keep an involuntarily admitted patient beyond 72-hours requires approval from the court system. Many times, when a patient is brought to a hospital under the Baker Act and shows signs of acute mental illness, the clinicians will file paperwork as a precautionary measure in the event it takes the patient more then 72-hours to stabilize. A court hearing is then scheduled within five business days. However once the patient is stabilized, they will be discharged regardless of whether the court hearing has occurred or not.
Just like every person is different – every situation and circumstance is unique. It is important to note that the clinicians are using their best judgement based on their training and experience to determine the optimal clinical treatment for patients. One of the key outcomes a psychiatrist seeks to avoid is if a patient is discharged prematurely and causes harm to themselves or others.
As a family member, friend or advocate for a person who has been involuntarily admitted to a hospital – what can I do to help them?
It can be difficult to know how to best support a loved one when they are going through a crisis. If the patient has listed you as a contact in their paperwork, you will be made aware of any proceedings. Patients communicate with their families directly while undergoing treatment so you will be able to speak with them expressing your support.
Keep in mind, your family or friend is in the hospital to receive healthcare services. Reducing stigma, shame or embarrassment for seeking help is another way to show your family or friend you support them getting healthy.
Anything else that would be helpful to know?
There is a lot of complexity in the process of involuntarily admitting a patient. Hospitals strive to balance an individual’s freedom with ensuring crisis care is provided safely and effectively. Although we have tried to distill this down to a digestible level with a few examples, this is not representative of the intricacies of the broader process and delivery of high-quality behavioral healthcare.
Acadia and our psychiatric partners are truly humbled by the privilege of delivering this life-saving work and to care for patients across our communities who need services the most.