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Commitment Process: When a Person Is a Danger to Self or Others

When to commit someone to a psychiatric facility

When to commit someone to a psychiatric facility

The Importance of Mental Health

In the United States, approximately one in four adults suffers from a mental disorder (National Institute of Mental Health, 2004). These numbers may be greatly out of date. According to John Grohol, Psy.D., as many as 75 million people, or one in three adults, suffer from mental disorders. This figure includes diseases such as alcoholism and drug addiction.

As the number of mentally ill people grows, it is evident that in our society, not everyone receives the necessary care. Treatment can range from outpatient clinic care, in which a patient meets a qualified therapist, or inpatient care in a psychiatric facility, state hospital, or special unit in a general hospital.

If a person seeks help in an outpatient clinic, a psychiatrist (a medical doctor specializing in mental disorders) will treat the patient with medication and evaluate its effectiveness. A therapist (psychologist, social worker, or nurse) will meet with the patient for a session in which cognitive therapy, group therapy, or other variations of therapy are used. The therapist will have expertise and advanced education in the specialty of psychological disorders and mental health.

These therapy modalities are used to support the client’s problem-solving ability and bring them to a higher level of functioning. A set number of sessions are usually initiated on the first meeting, often dictated by a client’s ability to pay or whether an insurance case manager has assigned a designated number of sessions.

However, what happens if a person cannot afford to see a clinician and their mental condition continues to deteriorate? When payment, through self-pay or insurance, disqualifies one for private sessions, how does one get the help or hospitalization they need?

Psychiatric Hospitalization

When therapy is not enough to help a person with a mental health disorder, hospitalization may be the best process to protect all parties.

What is the process of hospitalizing someone with a mental illness? The broad terms for inpatient involuntary commitment are that the person is deemed to be a "danger to himself, a danger to others, or is incapable of taking care of his needs." If a person meets any of these criteria, he or she can be detained in a psychiatric hospital or mental health unit for observation and examination.

When a person is committed, it is usually because they do not recognize their need for treatment or do not agree that they need it. Although they may protest being hospitalized, they must follow the decision of a magistrate who has signed the legal affidavit which claims the terms of the hold. On this form, the date, time, number of days for the hold, and explanation of the person in question’s behavior is detailed. The affidavit will also state the name and address of the person who has requested the involuntary commitment.

Once the form is signed by the magistrate, it is brought to the police department, which will send an officer to transport the person to the closest hospital emergency room for an initial medical exam. That documentation is considered to be the first mental health exam, and the physician’s findings, which include a psychiatric diagnosis, will be documented and accompany the person to the accepting psychiatric facility.

Upon admission, the psychiatrist has 24 hours to conduct a mental status exam on the patient to determine if this person indeed meets the criteria to continue the commitment. This is referred to as the second exam, and the findings are faxed to the judge at the county courthouse.

Other times a person may enter the hospital emergency department with a medical complaint, and emergency room staff will alert a physician that a psychiatric evaluation is warranted. Criteria for that request include psychotic behavior or patient threats of suicide or homicide. In these cases. the patient may be given the choice to be transported to the unit as a voluntary patient if the patient agrees to sign himself in for treatment, or to be transported as an involuntary patient. If the person refuses to sign him or herself in and meets the requirements for commitment, the medical personnel is required by law to process an involuntary commitment form, especially in cases of suicidal or homicidal threats.

Mental health laws are designed to protect people.

Mental health laws are designed to protect people.

Mental Illness and the Law

In the United States, mental health laws are designed to protect people from getting lost in the system, forgotten, or losing access to treatment. Nonetheless, these laws are still abused through loopholes, and the process can be manipulated to suit certain parties.

Laws that were erected to protect the mentally ill are sometimes misused to hospitalize people whose behavior is eccentric. In some cases, family members may abuse the law to commit a relative so that the relative will lose control of disputed family property.

The Florida Mental Health Act of 1971 (also referred to as the Baker Act, after state Representative Maxine Baker, who advocated for the mentally ill) was created in response to numerous cases in which family members committed elderly relatives and took over their estates. This form of commitment in state mental facilities is identified as a form of elder abuse.

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Any person, regardless of age, who has been detained through an involuntary commitment process has the right to a hearing before a judge within a set amount of time. Usually, the hearing window is the first ten days of admission. The patient has the right to be present and appeal the commitment individually or with counsel representation. If the person is unable to afford counsel, they have the right to court-appointed representation.

During the hearing, the judge will listen to testimony and review documentation presented by the psychiatrist, the first examiner, or other staff with evidence of the patient’s condition. The judge will then listen to the patient. Questions may be asked, and the circumstances leading to the lock-up will be reviewed. If there is insufficient evidence that the criteria for commitment are met, the judge will release the patient. The judge may also extend the treatment by a certain number of days—usually ten to fourteen. A follow-up court date will be set to ensure that the patient is not stuck endlessly in a locked facility.

Mental health laws vary from state to state, but each state has an obligation to follow the process through the legal system. In 1975, the U.S. Supreme Court ruled in O’Connor v. Donaldson that it is unlawful to hold a person against their will without a timely evaluation and that they must be released if there is no evidence to substantiate the need for continued hospitalization.

danger-to-self-or-others

As a psychiatric nurse, I’ve been present at commitment hearings on occasion. I have seen how hearings can protect patients from being held unfairly by people who do not have the best interest of the patient at heart. When I was a student nurse in 1983, I watched as several cases were presented in a Detroit courtroom. My instructor asked for our decisions on the cases prior to hearing which way the judges ruled.

One case stands out in my memory. An elderly African-American woman had been committed by her daughter. The older woman was skinny and animated. She looked disheveled in her crumpled clothes. A colorful knit hat on her head created a bizarre look that made one take a pause. Going by appearances alone, it was an easy call.

The daughter alleged that her mother was exhibiting paranoia and was delusional because she locked herself in her house, barricaded the door, and threatened anyone who approached the house with a baseball bat. After listening to the facts, most of the students were convinced that she was committable.

However, as the judge questioned her, she had a logical and reasonable explanation for everything the daughter had said. She countered the allegations and insisted that her daughter was attempting to take guardianship of her finances. Regarding the eccentric hat: It was cold at night in her house, and it kept her head warm. She locked and barricaded her doors because she lived in a bad neighborhood and was afraid at night. She explained that she kept the baseball bat as protection from “any fool who would come knocking on a door in the middle of the night."

The judge ruled her competent and dismissed the case.

It's Important to Discern When Intervention Is Necessary

It is important that we all protect and care for our own mental health. When it comes to loved ones, particularly the vulnerable, we must be vigilant about discerning when they may be struggling with real mental health issues or simply living in a manner we do not understand.

The law protects our independence and self-determination. Imagine how grateful you would be for these laws if you felt you were being unfairly committed to a psychiatric hospital!

I hope you have found this article helpful as you investigate the facts about the commitment process.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

Lynn Rogers on April 02, 2019:

Can my nineteen yr old daughter have me sectioned? I am an alcoholic.

Pamela Oglesby from Sunny Florida on December 02, 2018:

Very interesting article. As a retired RN I and FL resident I have heard of the Baker Act, but I never worked in a psychiatric facility. I didn't know much about the process. I am glad the judges will ask some questions because money does corrupt.

Steve Perzan on September 01, 2017:

Geart article. But one thing seems odd to me. If a person does not agree to voluntary commitment, after an intitial involuntary commitment, they can be involuntarily recommitted. Yet, if they voluntarily say they need help, the are committed willingly. If they, are given the choice and make the right choice, namely voluntary commitment, they are considered basically okay, yet still in need of treatment. If not, treatment is forced. It is like say you need help and you can get out. A little silly to me? If you give the person the choice then you must think they are capable of properly answering it. However, if they don't answer it in the way you want, namely voluntarily, you go on and commit them involuntarily. Sounds coerced and crazy to me.

Melody on August 08, 2017:

Scary person hears noises sees people running through the yard no one is there with a 22 in one hand and a shot gun in the other. I believe it is Bipolar 1 with paranoia/possibility of schizophrenia

I’m not a doctor but I have bipolar 2 and have been to county hospitals to get my meds and check up.

This person reminds me of all those people sitting there talking to themselves,pacing etc.....classic symptoms

This person is High all the time on opioid and coke pot. This person is not all there.

Believing his owns stories how does one get a 30 year old help ???? he cannot hold down a job No money no insurance cannot do anything for himself meaning responsibility of doing things other then searching for the next fix.

Anthony Paul Fradella on August 03, 2017:

I have a friend who's suicidal and deeply depressed has been hospitalized two times within 6 months for a nervous breakdown and life is crashing down around her the hospitals and facilities in the state of New Jersey have refused to give her her medication because she doesn't have the money she was laid off from her job which makes things worse and about to be homeless staying on a friend's couch right now in the state of New Jersey and the mental health system has failed her

Whataboutmyrights on July 05, 2017:

WHY are the supposed rights of a person who sees and hears things more important than the rights of unwitting unwilling people who live near them? No one thinks that little old eccentric ppl should be locked up so their relatives can take their estates. Or that commitment should happen to sane people and they should be stuck in an institution without review.

But tell me why it is legal for group homes to place these delusional people out in the general public just bc on meds they can cook for themselves? That is not important. I know the system is being cheap. What if the deranged young man who has been known to go outside naked comes to my door? Is that fine with you? What if he thinks the children or pets outside are demons who say scary crap to him? What if he sees something while cooking and starts a fire? Would you let small children be at home alone while you went on vacation? BC sane children would be better able to function alone for themselves since they live in REALITY.

Its just fine for psychotics to roam into my world? The world that I and you and everyone we care about lives in? THAT is delusional. The world is an acid trip for them. The meds could talk to them for F's sake.

Thinking that they can be reasoned with, and trusted to act sanely and not endanger someone is what is DELUSIONAL. You must be seeing sanity where there is none.

My rights to peace are obviously less important to the system than an adult who should not have full adult rights. PPL like him are supposed to be locked up. Not tortured like its the 30s, but NOT FREE to stalk me, watch me, make me extremely uncomfortable so that I cant relax in a place that I pay rent for. He is a male not in touch with reality and no matter what meds he takes, he is never going to be safe for a young woman to be around.

So my question that I do not think you will like nor answer is this. How can I make the group home, or whomever necessary force him to get out? I would ask this of any creepy person who violates my rights. The fact that he is blatantly mentally disturbed and a group home pays his bills should NOT MEAN THEY CAN VIOLATE MY RIGHT TO PEACE.

The Mentalist on June 30, 2017:

Upon reading Endrun response and the story he is conveying I believe him. I worked in the system and seen everything he is saying to be true. Many mental health workers always try to change wording to make a greater impact of there side and there evaluations. As lawyers in a court hearing will also use that approach to justify and coerce the jurors in a court room to believe there side. I don't find him angry or upset at such circumstances that happen in his life like you are describing him out to be....but I do see you adding your thoughts as a result of his comments making him look like he is angry changing the scenario and your choice of words to convey to the people reading these comments he had a bad experience and is angry but that is what you people specialize in changing the picture to fit your evaluations etc..,now thats the Truth.

Lisa Mulligan on June 11, 2017:

If charged with DUI and mentally ill danger to yourself and others, is that a felony or misdemeanor in Kentucky?

victoria on May 21, 2017:

i have a couple questions

Theresa Watson on February 24, 2017:

My nephew has been diagnosed as schizophrenic for years but, since we live in San Diego, CA there is no room in any locked facility for him. He now lives in a board and care which takes most of his disability monies. He doesn't eat, doesn't bathe and is causing nothing but trouble. In spite of my sending his entire disability check to the board and care, he is out of control, doesn't eat, bathe as I indicated earlier. This particular board and care is supposed to be for the mentally ill but that doesn't seem to be the case. They can't handle him or see to it that he takes his meds. He is always in trouble. He is 6'3" and weighs less than 140 lbs. He obviously doesn't eat. All the locked facilities have six month waiting lists. Any ideas?

Jessica Purvis from Durham, England on April 13, 2016:

I've been to a psychiatric hospital but I went there voluntarily, I've never been sure of the process for involuntary patients. After reading your hub I know a little more about the process. Great information, thank you.

Jen p on February 22, 2016:

My husband admitted his self to a mental health ward he was there for 5 days an signed a paper for release he flipped out the night before he got out an was put in the padded room an they still released him six days later he killed himself is there anything I can do

helplesscry on October 22, 2015:

I'm sorry, either I over looked it by accident, or it wasn't stated clearly. Every state has different law. Does a person with no documented previous mental issues, and no current insurance, have the right in north Carolina to walk into an emergency room and put themselves under a 72 hr phsych evaluation and be guaranteed that 72 hrs? If not, can their spouse do something?

Laurie S on September 29, 2015:

My father is bi polar and a hoarder. He has recently lost is drivers lisence and is still driving. Even tho there has been several opportunities provided to him for transportation he refuses. I can NOT get any one, from medical to juditial to help. He says He will sell his house in OH and move to NC when he gets the house "fixed up". His idea of fixed up is much different than mine. He does NOT care that he is not to be driving or that there are so many tings wrong with the house including electrical and mold issues. I don't know what else to do!

Lmbradley on August 17, 2015:

At 13, my daughter was diagnosed with major depressive disorder with psychosis and later, delusional was added by her therapist. She has been in 7 inpatient facilities from 2008 until 2010. All stays were involuntary as she was always a threat to self or others. She would go from 0 to 60 effortlessly with no specifc triggers. She got into trouble in school often and we have to go to court numerous times. She was doing school on medical homebound and then we tried online schools but she eventually gave up on school. She had weekly therapy sessions as well as visits to the psychiatrits for medication management. She was apart of continuum of care for a while. She went through many psych evaluations and medical tests. Of course her inpatient stays were short. The longest she stayed in one was one month. The doctors had her on so many medications at once. It was unbelievable. She gained so much weight. We started the process of bariatric surgery but she decided she didnt want to do it. At about 16, she told the psychiatrists that she was tired taking medication and she didn't want to any more so she told her it was her choice and from that day on, she has not taken any more medications. She stopped therapy and as the years rolled by, she completely stopped going anywhere. She won't wash or put clothes on. She won't do anything and over the last year or two, she has started talking about strange things and she truly believes what she is saying. She is now 20 and I still caannot get her back into therapy. All these years, we have been trying to be careful of what we say, how we say things, not pushing her because we dont want the violent behavior to come back but we are always fearful of what she will say or do. I was told that I can have her committed but in reading your posts and others, it doesn' t seem to be that easy. And even if I can, it would only be for 72 hours and then what? If they keep her longer, which seems to be only if there is current documentation, if prescribed medicine, she won't take it and she comes home the same way she left. And more angry because of what we did to her. I am at a lost and I have no idea of what to do or how to begin to do it. And she's been committed so many times before, will another time make a difference?

Denise Handlon (author) from Michigan on February 22, 2015:

I'm curious about what you find meaningless about it. What do you think, or rather, do you have any first hand experience of this?

endrun on February 19, 2015:

"The law protects our independence and self-determination. Imagine how grateful you would be for these laws if you felt you were being unfairly committed to a psychiatric hospital!"

I find this statement meaningless, but I am curious as to what the other thinks it means....

Denise Handlon (author) from Michigan on November 15, 2014:

I'm sorry to hear of your difficulties. I hope you are able to find a way. How interesting that different countries treat Mental Illness so differently. Thank you for sharing your experience. Take care of yourself as best you can.

Hendrika from Pretoria, South Africa on October 15, 2014:

In South Africa Mental Health facilities are very stretched and they keep a person in a normal medical ward before referring them to a psychiatric hospital. Government finances are also a problem so very limited medication is available. If the person needs just a little medication with a difference they cannot help. I suffer from bipolar, but I can not get government out patient treatment because they cannot give me the right combination of medicine. Now, the private sector is bleeding me with payments not covered by my medical aid!

Denise Handlon (author) from Michigan on May 19, 2014:

Hi Donna Williams, thank you for writing. Your son does not sound bipolar, by the behavior you describe. He sounds schizophrenic, or at least, bipolar with psychosis. If he is hallucinating, and is a danger to others, such as the man he sat on, you have the right to commit him when he gets out of jail. It sounds like he needs to be evaluated by a psychiatrist, especially if he has never been seen by one or has been on any medications to stabilize his mood. Please help him seek help.

Donna Williams on May 17, 2014:

I have a son who is bipolar he has been in and out of mental hospital for years. Unfortunately he hit an innocent middle age man in the mouth and set on him until police came. He thought the man was attacking his girlfriend. He has not seen her in two years. He run out at night doing thing like holding a hammer in his hand hitting at the air. He thinks people are trying to kill him. He went to jail a few days ago . I told the police that he needs to be in a locked faculty put no one cares. He will end up killing someone or shot dead bye police. Please help me fight the system .

Denise Handlon (author) from Michigan on March 31, 2014:

Kelley-I'm sorry you are having such a difficult time with your 18 yr old. Bad, disrespectful behavior isn't necessarily a reason to hospitalize someone. Once he has left your home to live on his own he does not need to seek therapy, if that is his choice. If he breaks things in your home, call the police. If you don't want to call the police, don't invite him in your home-it's called tough love. If he becomes a danger to himself or psychotic, or threatens harm to someone else, you can commit him. Otherwise, it sounds like a job for law enforcement. Best wishes to you.

Kelley on March 17, 2014:

have 18 yr old son who compulsively lies and blames other siblings, quit therapy, and dcf left when he turned 18, no one will help he spits on neighbor,leaves windows n screens wide open with fan in window even though heat on swears up down heat not going out window, busts up my stuff in house n his when mad, rent 3 bedrooms from his dad who gives him everything he wants even though he fc up, gives debit card to him, doesn't matter what i do his dad will always win, but afraid gonna end up in box or jail

Denise Handlon (author) from Michigan on February 14, 2014:

Somethingxpretty-I hope your condition stabilizes. It isn't easy trying to stay healthy without private insurance. Thanks for sharing your experience here. Take care, I wish you well.

Somethingxpretty on February 13, 2014:

I refuse to be hospitalized. I no longer have private insurance, and I have been to the psych ER several times for med adjustments, some of the people I met there scared the hell out of me. My condition would only worsen, the stress of being in this environment as well as my paranoia in general won't allow it.

Denise Handlon (author) from Michigan on February 11, 2014:

Hi Paula, thank you for your comments after reading this hub. I am truly amazed and humbled by the number of people who began to write seeking support and information. It has been interesting. Thanks again for your comments. :)

Suzie from Carson City on February 10, 2014:

I'm sure you are not surprised to know I am very impressed with this hub. The legal issues in terms of mental health is a powerful topic and you have done it great justice (no pun intended).

How I wish more people were aware of these facts. and speaking of.....it's almost appears as if you hung a shingle on your hub door, Denise! LOL

I'll bet you didn't expect the rush from the outside, laying their troubles and dilemmas at your feet. You are an amazingly patient woman!! Bless you. Once again, Great HUB!

Denise Handlon (author) from Michigan on February 10, 2014:

Thank you for sharing your experience, or rather, that you were hospitalized as a child. What a frightening experience that must have been for you. No wonder you are such an angry person at this adult stage. The anger is alive in your comments and capitalization of words. Are you yelling at me through this because of what happened to you?

Due to the mass closings of state facilities and mental health clinics people who are in need of mental health treatment have very few options to turn to for help. Whether you agree that this should be allowed or not...it is there for treatment, not some archaic, ancient torture to inflict on other people. I support anyone who is in need of help and who is willing to enter a hospital to receive that help.

My information here is to inform the public. Your experience isn't full of truth or facts in all hospitals. Whatever nightmarish experience has filled you with this rage against society, and apparently, against me personally-or rather the author of this article, I hope you will eventually come to terms with it. However, I doubt this will happen, because of the projection you are throwing out at me. Goodnight sir.

endrun on February 10, 2014:

WHY, I would ask IN THE WORLD would you DARE to assert that private facilities employ no security guards, and that these then do no injure and sometimes kill patients incarcerated on mental wards? You KNOW it happens....but it seems you are in COMPLETE DENIAL about what your profession represents in terms of the ABJECT EVIL IT SUPPORTS. I do not have a rationale(sp!) of lumping eveyone's experience into my own. It is for this precise reason I never disagree with any patient's opinions, but only insofar as to point out that procedurally the mental illness system is an abject danger to civil liberties, human rights, and has been proven so over and over and over again in state, federal , and international courts of law. There is simply no denying that fact and this is simply because there are NO procedural protections for ANYONE who gets scarfed up into the Involuntary Commitment regimen.

I would also be curious as to whether you support the idea of drugging and hospitalizing(imprisioning, which is a correct word, even though you don't like it) CHILDREN as was done to me in 1968 and is being done to more and more children as time proceeded from 1968 and is an ever-increasing phenomenon.

Denise Handlon (author) from Michigan on February 10, 2014:

I was hoping to hear back from you, Endrun. After reading your response to my response I can feel the anger...or, rage that explodes from your experience. I disagree with you on most of your accounts in regards to private psychiatric facilities. However, I have not worked in state facilities, so perhaps they do have security guards, (ours does not), and stricter restrictions than private facilities.

I support you in your experience and do not agree with your rational of lumping everyone's experience into what happened to you. Thank you for your response.

endrun on February 05, 2014:

1)Oh, so they are no longer "wards" but instead "units". They are also no longer "loony bins" but instead the euphemistic "behavioral health services." Bulldump and baloney on the euphemisms:"you cannot turn a sow's ear into a silk purse merely by changing its name".