Malcolm Rivera
Being admitted to a mental institution, or psychiatric ward, can be a voluntary or involuntary process. A voluntary admission may be initiated by the patient themselves, or by a family member, friend, or medical professional. In the case of involuntary admission, a patient may be admitted against their will if they meet the criteria set forth by the state in which they live. This typically includes presenting an imminent danger to themselves or others, but the specific criteria vary from state to state. In both cases, a detailed assessment of the patient's mental health is necessary, and they will receive treatment and care until they are stable enough to be discharged.
| Characteristics | Values |
|---|---|
| Referral | A referral from a mental health professional, such as a psychologist, psychiatrist, or social worker, is often required for admission to a mental hospital. |
| Assessment | A detailed assessment of the person's mental health is necessary prior to admission. |
| Recommendation | Some facilities may require a recommendation for admission from a mental health professional or a loved one. |
| Danger to Self or Others | Involuntary admission is often considered when an individual poses an imminent danger to themselves or others due to their mental state. |
| Refusal of Treatment | In some states, involuntary hospitalization may be considered if an individual is refusing necessary treatment for their mental illness. |
| Inability to Care for Self | Psychiatric wards often admit patients involuntarily if they are unable to care for themselves or others due to their mental state. |
| Substance Abuse | Short-term commitment may be recommended for individuals struggling with severe substance abuse. |
| Mental Breakdown | A mental breakdown can be a reason for voluntary or involuntary admission, depending on the circumstances. |
| Suicidal Thoughts | Individuals experiencing suicidal thoughts or intentions can be admitted to a mental institution, either voluntarily or involuntarily. |
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What You'll Learn
Involuntary admission
In the United States, involuntary commitment procedures vary from state to state and typically involve three stages: emergency psychiatric evaluation, inpatient treatment, and assisted outpatient treatment. During the emergency psychiatric evaluation, an individual in a mental health crisis is placed in temporary emergency custody, which is usually capped at 72 hours. This evaluation often leads to inpatient treatment, which may include the involuntary administration of psychoactive drugs.
In addition to inpatient treatment, individuals may be subject to community treatment orders, which require them to adhere to specific conditions such as taking medication and attending psychotherapy sessions. Restrictive practices, such as seclusion, physical restraint, mechanical restraint, and chemical restraint, may be used as a last resort to ensure the safety of the patient and others.
The decision to involuntarily commit someone is not taken lightly, and there are procedures in place to protect the rights of the individual. In the United States, the Mental Health Act 1983 and its subsequent revisions regulate the process of involuntary commitment. Involuntary treatment should only be used as a last resort when no less restrictive treatment options are available. It is important to note that even during involuntary commitment, individuals retain certain rights, and there are legal protections in place to safeguard their well-being.
Involuntary commitment has been a subject of controversy and ethical debate, with concerns raised about protecting individual rights while ensuring safety and the effectiveness of compulsory treatment. Additionally, there is a history of racial disparities in the mental health system, with African Americans being diagnosed with more serious mental illnesses and experiencing higher rates of inpatient and outpatient commitment compared to their white counterparts. As a result, there is a growing movement to minimize coercion in the mental health system and increase the use of advance directives to enhance personal autonomy.
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Referral requirements
The referral requirements for admission to a mental health facility vary depending on the facility and the state. However, there are some general guidelines that can provide insight into the process. Firstly, it is important to note that anyone can seek help for themselves or a loved one by reaching out to a mental health professional or a healthcare provider. This could be a therapist, psychiatrist, primary care provider, or a community outreach team. These professionals can help assess the situation and determine the best course of action, which may include recommending inpatient treatment at a mental health facility.
In most cases, a referral from a mental health professional or a healthcare provider is required for admission to a mental health facility. This could be a psychologist, psychiatrist, social worker, or a member of the person's healthcare team. The referring professional will often need to provide a detailed assessment of the person's mental health and recommend admission to the facility. It is important to note that even with a referral, admission to a mental health facility is not guaranteed and will depend on the facility's intake process and available resources.
In some cases, involuntary admission to a mental health facility may be necessary. This typically occurs when an individual is deemed to pose an imminent danger to themselves or others due to their mental state. Involuntary admission can be initiated by a mental health professional, a healthcare provider, or in some cases, by family members, friends, or law enforcement officers who have witnessed the individual's behaviour. Each state has its own procedures and criteria for involuntary admission, which may include medical certification or judicial approval, and time limits on how long an individual can be held against their will.
It is important to note that even in cases of involuntary admission, individuals will not be forced to undergo specific treatments for their mental illness unless it is an emergency situation requiring immediate stabilisation. However, individuals who are admitted involuntarily may be subject to restrictions during their stay, such as being required to remain in a specific unit or wing and having limited outdoor time. Additionally, individuals who are involuntarily committed may be restrained with wrist or ankle cuffs or given physical or chemical restraints if they pose a threat to themselves or others.
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Short-term vs long-term commitment
The criteria for admission to a mental hospital vary depending on the facility and the state. Generally, most mental hospitals require a referral from a mental health professional, such as a psychologist, psychiatrist, or social worker, for a person to be admitted. A detailed assessment of the person’s mental health is necessary, and a recommendation for admission to the hospital may be required.
Short-term commitment is recommended for individuals who are in danger of harming themselves or others. This can include those with suicidal thoughts or intentions. Short-term care helps to stabilize the patient and get them through the crisis. Short-term commitments are also known as emergency detentions and are associated with a lower mortality rate and an improved quality of life.
Long-term commitments are generally reserved for more serious cases and have more stringent requirements. The maximum length of a long-term commitment is six to 12 months, depending on the state, after which a reassessment must be made before the commitment can be extended. In the United States, long-term commitments are also used as an alternative to jail time for people with mental disorders convicted of some sexual offences or repeat offences.
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Patient rights
Being admitted to a mental health facility can be a daunting experience, and it is important to know your rights as a patient. While the criteria for admission vary depending on the facility and the state, there are certain rights that patients can expect to have protected. Here are some of the key rights that patients in mental health facilities are entitled to:
Right to Information and Consent: Patients have the right to be fully informed about their treatment options, including the potential side effects of any offered treatment. This information should be provided in a language they understand, and they have the right to ask questions and seek clarification. Patients also have the right to give or withhold consent for any treatment, including the right to refuse sterilization, electroshock treatment, insulin shock, lobotomy, and certain types of drug treatments.
Right to Dignity and Respect: All patients have the right to be treated with dignity and respect as human beings, regardless of their race, colour, sex, language, religion, political opinion, or social origin. This includes the right to be free from any cruel, inhuman, or degrading treatment and the right to official complaint if these rights are violated.
Right to Legal Representation and Due Process: Patients have the right to legal counsel and to take legal action if they feel their rights have been violated. This includes the right to a fair trial and proper legal representation if their personal liberty is at stake due to their mental health status. Patients also have the right to initiate criminal proceedings against any staff member for abuse, false imprisonment, assault, sexual abuse, or any other violation of their rights.
Right to Safe and Comfortable Environment: Mental health facilities should provide a safe, secure, and comfortable environment for patients. This includes the right to be free from physical restraints and chemical restraints unless they pose an immediate danger to themselves or others. Patients also have the right to personal clothing and effects, daily physical exercise, proper diet and nutrition, hygienic conditions, and sufficient leisure and rest.
Right to Self-Determination: Patients have the right to make decisions about their own treatment and care. This includes the right to refuse treatment, particularly if they believe it may be harmful, and the right to discharge themselves if they feel ready to leave. While emergency detention may be necessary in some cases, patients cannot be forced to undergo long-term treatment for their mental illness without their consent.
These rights are outlined in the Mental Health Declaration of Human Rights, and they serve to protect the well-being and dignity of individuals seeking mental health treatment. It is important for patients and their loved ones to be aware of these rights to ensure they receive ethical and respectful care during their time in a mental health facility.
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Leaving the facility
The process for leaving a mental health facility will depend on whether the patient was admitted on a voluntary or involuntary basis. If a patient was admitted voluntarily, they can request an early discharge and leave within a "reasonable time frame". However, the exact time frame for leaving will depend on the situation and will be decided by the patient and their treatment team.
In the case of involuntary commitment, the patient may be restrained with wrist or ankle cuffs or given physical or chemical restraints if they pose a threat to themselves or others. Involuntary patients can be held for a set period, typically ranging from 15 to 60 days, after which their status may be reassessed. Patients can request a court hearing regarding their commitment, which must be held within 5 days of the request. If the court denies the application for release, the patient may be held for the remainder of the commitment period or for up to 30 days after the application for release is denied, whichever is later.
It is important to note that even if a person has been involuntarily committed, they will not be forced to undergo treatment for their mental illness unless it is an emergency treatment to calm or stabilize them. To force a person to take medication or undergo therapy, they would need to be declared incompetent to make their own decisions, which is a separate process from commitment.
In some cases, a patient may be transitioned from inpatient care to outpatient therapy once they have been stabilized. Outpatient facilities provide a less intensive level of care and do not typically require involuntary admission.
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Frequently asked questions
The criteria for admission vary depending on the institution and the state. Generally, a person must be deemed a danger to themselves or others or be unable to care for themselves. A detailed assessment of the person's mental health is necessary, and most institutions require a referral from a mental health professional, such as a psychologist, psychiatrist, or social worker.
Yes, you can admit yourself voluntarily to a mental health hospital, with or without insurance coverage. However, even if admitted voluntarily, patients are required to stay in their wing or unit unless given permission to leave, and there are strict times for going outside.
Yes, involuntary commitment can occur if the person is deemed to be a danger to themselves or others, or if they are refusing needed treatment. This usually requires medical certification or judicial approval, and there are time limits on how long someone can be held against their will.
