How Involuntary Hospitalization for Depression Works

Are you considering involuntary hospitalization for depression for someone you care about? 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 have when making the difficult decision to commit someone to a mental hospital against their will.

When Involuntary Hospitalization Becomes Necessary

If your loved one is experiencing symptoms such as severe depression, suicidal urges, mania, or psychosis, it can have a devastating impact on them and the people around them.

Possible consequences can include:

• Destroyed relationships
• Financial ruin
• Inability to take care of basic daily needs
• Physical harm to others
• Suicide

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

Who Can Be Involuntarily Committed?

The laws vary widely from state to state, but a person must be living with a mental illness to be involuntarily committed.

The Treatment Advocacy Center provides 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 themselves or others (someone who has inflicted serious bodily injury on themselves, has attempted suicide or serious self-injury, or threatened to inflict serious bodily injury on themselves or others)
• Grave disability (someone who can't take care of themselves)
• The need for involuntary treatment (essential for health and safety)

Less common criteria used by some states include:

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

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

Types of Involuntary Commitment

You may be familiar with terms such as "pink slipping," "5150," or "72-hour hold." These are all terms for involuntary commitment that vary by state.

Three main types of involuntary commitment exist: emergency detention, observational institutionalization, and extended commitment.

Emergency Detentions

Emergency detentions, in which immediate psychiatric help is sought, are usually initiated by family members or friends who have observed the person's behavior. Sometimes, the police initiate them, although any adult could request emergency detention.

The exact procedures vary by state, with many requiring judicial approval or evaluation by a doctor confirming that the person meets the state's criteria for hospitalization.

Emergency detention is typically only for a short period. It can vary a bit by state, but it can range from just 24 hours in a few states to 20 days in New Jersey, with an average of about three to five days.

Observational Institutionalization

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

Extended Commitment

The third type of hospitalization, extended commitment, is a bit more difficult to obtain. Generally, it requires one or more people from a specific group—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.

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 one to two times longer than the original commitment. Requests for further commitment can be made when each period expires as long as the patient continues to meet the legal criteria.

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

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."

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 person has been hospitalized involuntarily, most states will treat them as capable of making their own medical decisions unless otherwise determined.

Patients in immediate danger may be given medications on an emergency basis. However, these medications are directed at calming the person and stabilizing their medical condition rather than treating their mental illness.

For example, a sedative might be administered to prevent the person from harming themselves. Still, they could not be forced to take an antidepressant, as this is considered to be treatment.