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Involuntary Hospitalization for Depression

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Updated November 28, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

If someone you love is suffering from severe depression but refuses to get help, you may be wondering what you can do. You may have considered having him or her involuntarily hospitalized, but are unsure how to go about it. 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 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 sufferer 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.

Who Can Be Involuntarily Hospitalized?

The laws vary widely from state to state, but the person must be suffering from a mental illness in order to be committed. Other factors that states may consider are dangerous behavior toward self or others, grave disability and the need for treatment. While most states require that the person present 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.

Less common criteria used by some states include: responsiveness to treatment and the 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; and involuntary hospitalization as the less restrictive alternative.

What Does the Term Mentally Ill Mean?

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.

What Is Grave Disability?

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 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 an 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 having a reason to do so, but some states require that the application be made by a doctor or hospital personnel. And most require that an observational institutionalization receive the approval of the courts.

A 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, pubic 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 held, with a judge or jury making the final decision about whether the person can be held.

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.

How Do I Initiate the Process?

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

Source:

Jacobson, James L. and Alan M. Jacobson, eds. Psychiatric Secrets, 2nd ed. Philadelphia: Hanley & Belfus. 2001.

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