Part III: The Psychiatric Facility Admission Process

Parts I and II covered the emergency petition process, how an individual is admitted to a hospital ER for psychiatric evaluation, and the process that ensues while in the ER.

In Part III, the third and final installment, what occurs once the individual reaches the psychiatric facility from the ER will be reviewed.

In this third part, the hypothetical individual who was previously admitted to a hospital ER and evaluated by medical and psychiatric staff, has now been sent to an inpatient psychiatric facility. They arrive by ambulance and are escorted to the unit where they will receive treatment. Within 12 hours of admission a form must be read and given to the individual that describes their admission status and rights. An involuntarily admitted individual has the right to be evaluated by a psychiatrist within 24-hours of admission. They also have a right to request a change in admission status at any time to become a voluntary patient if deemed able.

Individuals who present at a psychiatric facility involuntarily are often offered upon admission or soon thereafter to sign a voluntary admission order. An involuntary admission is only valid if the individual is unwilling or unable to sign an application for voluntary admission. If the individual requests to sign a voluntary and is able, then they have a right to do so at any time. This is very important for individuals and their advocates to understand.  I have seen countless times while representing clients being held in psychiatric facilities that they were denied the opportunity to sign an application for voluntary admission, despite being competent and willing to do so.

It is important to know that those who arrive at the psychiatric facility for voluntary admission have the option to sign a 72-hour notice requesting discharge. This gives the treatment providers 72-hours to determine if the individual meets civil commitment criteria. If not and discharge is still requested, at or before the 72-hour mark the individual must be released. If the individual is deemed to meet involuntary admission criteria, like in the ER, two certificates of involuntary admission and one report as to certification of commitment must be filled out in their entirety and signed by qualified individuals.

The question is, why wouldn’t an individual who is able and willing be allowed to sign themselves in voluntary as is their right? In my experience, treatment providers genuinely want to see people get help.  If signing a voluntary is delayed, then the requesting a 72-hour notice for release will also be delayed and there is more time to provide necessary treatment with the goal of improving the individual’s insight into the need for treatment and the benefits of continued inpatient care and continued services in the community.

Additionally, though, think of the game that is played and the added work there is when an involuntarily admitted individual agrees to sign a voluntary, immediately puts in a 72-hour notice for discharge which triggers the hospital to release or again decide to involuntarily commit.  When new certificates are completed, it is because the individual still meets civil commitment criteria.  When that happens, the process could begin again with the individual requesting to sign a voluntary and putting in their 72-hour notice for discharge. While perhaps annoying and time consuming for the treatment team, it is still the individual’s right to do so.  As time goes on and this back and forth continues, the argument for dangerousness weakens and there is less support for an involuntary commitment, therefore leading to their discharge.

In Maryland, an individual must meet all of the following criteria to be involuntarily detained for the purpose of inpatient psychiatric treatment:

  •  Have a mental disorder
  • Need inpatient care or treatment
  • Present a danger to the life or safety of themselves or others
  • Be unable or unwilling to be admitted voluntarily
  • There are no less-restrictive alternatives then inpatient psychiatric care available which is consistent with the individual’s wellbeing and safety
  • It is important to keep in mind that, as noted in Part II, this is often an extremely stressful and potentially upsetting experience for the individual.  Particularly when an individual is aware of their circumstances, but lacks insight into their symptoms or need for treatment. After all, if you were in their shoes, would you want to be told you were being held against your will for psychiatric treatment if you didn’t think there was anything wrong with you?

Under Maryland law, an individual who is involuntarily admitted is then required to have a hearing with an administrative law judge (also referred to as an ALJ) within 10 days of admission, but can be postponed for up to 7 additional days, to determine if the individual continues to meet the requirements for involuntary admission. Before the hearing, the individual has the right to be examined by a psychiatrist of their choosing, at their expense. The individual also has the right to hire private counsel to represent them at the hearing.  If no counsel is hired, a public defender will represent them at hearing. At the hearing, both the psychiatric facility’s representative—sometimes an attorney but often a social worker or psychologist—and the individual’s counsel will be allowed to present their arguments as to why involuntary commitment is or is not just.   

If the ALJ finds that the individual meets the requirements for involuntary admission, they will be committed for a period of 6 months. This does not mean that the individual will necessarily remain in the hospital for 6 months but rather the treatment team may hold the individual for that time frame unless they are deemed by treatment providers prior to that time to no longer meeting civil commitment criteria. This could be for example when the individual no longer presents a danger to self or others or a less restrictive means of care is found that provides for the welfare and safety of the individual. The individual will have the right to appeal the decision within 30 days to the local circuit court. If the individual should remain in the hospital for 6 months a subsequent ALJ hearing will be held at that time.

If the ALJ finds that the requirements for involuntary commitment have not been met, the individual will be immediately released.  It is important to note, though, that in some circumstances, if the treatment providers believe there is grounds to do so, they can emergency petition the individual again to a local ER and the process could start all over again.

Through this very complicated and stressful process having a knowledgable advocate for the individual, such as an attorney, ensures that laws are being followed and that civil rights are not being violated. There is a fine line between what might be in the best interest of an individual and an individual’s rights. It often takes a very knowledgeable attorney to fight for thoser ights and advocate on behalf of the client’s wishes. 

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

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.