PART I: The Emergency Petition

Many practitioners will find in the course of their career that they have a client in need of emergency psychiatric hospitalization or evaluation. However, if you were to explain the process by which this happens to a layperson, say the parent of a client, could you do it? 

Einstein famously stated, “If you can’t explain it simply, you don’t understand it well enough.” 

So, do you?  Most practitioners, if they are being honest, do not. In fact, most attorneys and the general public, especially, have no inkling of how this process works. Hopefully, after reading this blog, and going forward you will have an understanding of the process and you will feel confident explaining it to others.

In this first part, we will tackle the emergency petition process.

Stay tuned for Parts II and III, where we will cover the next steps: emergency psychiatric evaluation and psychiatric hospital commitment.


 So, picture this.  One day in your office a client either comes in or suddenly begins acting erratically; perhaps they are psychotic or talking about harming themselves or others.  The client is there alone or maybe a parent or friend brought them to the office. What do you do? There are a few options.

Many clinicians will allow a client who is at risk who is agreeable to evaluation in an emergency room and has someone with them in the office to go on their own to the emergency room. This is a judgment call by the clinician but could be a serious liability. What if the client changes their mind, refuses to go, or even harms themselves or others on the way to the emergency room?

I suggest you err on the side of caution and call 911 so that a peace officer (i.e. likely police or sheriff depending on the county) can assist. For the sake of this blog, since most counties use police officers rather than sheriffs, I will refer to peace officers as police. As a licensed clinician, you should complete a Petition for Emergency Evaluation (“EP”). Maryland Annotated Code HG §10–622 (b)(1)(i) details who is authorized to complete an EP.  Per the Code, authorized practitioners are physicians, psychologists, clinical social workers, licensed clinical professional counselors, psychiatric nurse practitioners, and a few others.  

An EP can be completed if two criteria are met (Maryland Annotated Code HG §10–622(a)):

1) That there is reason to believe the individual has a mental disorder and

2) That they present a danger to themselves or others.  

If you, a licensed clinician, believe the above two criteria are met, you may complete the EP and call 911. The 911 operators will direct the police to your location.  Once on site, the police will review the EP that has been completed and they will then take the client to the local emergency room. As a side note, this is a perfect example of why all practices should have protocols in place detailing how to handle situations like this.

In addition to licensed mental health practitioners, the police are also authorized to complete an EP themselves when necessary; however, they will need to personally observe the person in question before they can complete the EP and the police have to determine if the client poses a danger to self or others based on their observations and information that they gather on the scene.  This may be useful in situations where there isn’t a licensed practitioner available, a client presents as a danger in the office, and so 911 is called.  The police upon completing an EP themselves could transport the person to the local ER for further evaluation.  

What happens, though, if someone is having a psychiatric emergency and they are not in a licensed clinician’s office?  Suppose the person at risk is at a family member or friend’s house, and the family member or friend wants to get the person psychiatric help, but the person is refusing. Well, like the non-licensed practitioner who calls 911, a family member or friend can also call 911 and have the police come and evaluate and determine if an EP is warranted. Alternatively, the mobile crisis team, if there is one in that county, can be called and a mental health clinician will evaluate at the scene and can fill out the EP and assist the police often in a more therapeutic way in getting the person to the emergency room for evaluation.

However, in many cases the person at risk is not at the family member or friend’s house or police have come but do not recognize the severity of the situation based on their brief interaction with the police. Another route for family, friends, or any interested person is to have an emergency petition granted by the courts. “Interested person” is a legal term of art, and in this situation, it means anyone who has some interest in the individual in need of emergency psychiatric treatment, such as a friend, relative, neighbor, police officer, or health professional. 

To get the process started, an interested person would need to go to their local district court in Maryland (select circuit courts as well) and file a Petition for Emergency Evaluation (the relevant Maryland law governing this form and the filing of an EP can be found under MD Health-Gen Code § 10-622). Interestingly, in some counties some police stations will also accept emergency petitions during non-court hours.

Once the petition is submitted to the Court, a judge will hold a hearing on it. The judge must find two things:

1). that the person who is the subject of the EP has symptoms of a mental disorder and

2). they are a danger to themselves or others. 

Both must be present for a judge to grant the order. The more information that is provided by the interested person to the court the more likely the judge will grant the EP. It should be noted that because someone’s rights are being taken away and by holding them against their will for an evaluation, judges are often reluctant to grant the emergency evaluation unless it’s absolutely clear and there is probable cause that both conditions mentioned above are met. 

If granted, the EP can be given to local law enforcement who will then track down the individual who is the subject of the EP and take them into custody to bring them to an emergency room for evaluation.  In some cases, a specific hospital can be requested. It is important to note, again, that this can be a very traumatic experience for the individual.  They will often be put into handcuffs or restraints before being brought to the hospital.  In addition, because this process can take a long time between local law enforcement getting the order, dispatching officers to seek out and find the person, taking them into custody and then transporting them finally to a hospital, in a dire situation, 911 should still be called if the person is truly acting in a way that imminently threatens their and/or someone else’s safety. 

Once the person is at the emergency room the emergency evaluation will begin. The details of what will occur from here will be covered next month in the second installment.

In closing, I offer a final thought.   As you know, when someone is facing a psychiatric emergency, it can be a very emotional, traumatic, and potentially scary situation for all involved. This is true especially for a person who is subject to forced psychiatric evaluation and possibly forced treatment.  This is why police and/or judicial intervention is recommended as a last resort.  If a person at risk can be safely brought to an emergency room for evaluation without the need for an EP, it may be a less traumatic experience for all. With that said, what is most important is protecting a person at risk from being a danger to themselves or others.   

Knowing what to do and what steps to take is critical in an emergency situation like this so that the client and those around them remain safe. Make sure you and those who work for you know what to do if a crisis of this sort should arise and best practice would encourage a written procedure detailing such.

For more information, or for other legal considerations regarding clients or to set up a free consultation, contact Mayer Law, LLC today at (443) 595-M-Law! 

 


DISCLAIMER:

This article is legal information and is not provided as a source for legal advice. It is made available by Mayer Law, LLC firm for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By reading this blog, you understand that there is no attorney-client relationship established between you and Mayer Law, LLC. This blog should not be used as a substitute for competent legal advice and you should consult with an attorney before you rely on this information.