If you go to the psychiatric hospital are you crazy? Involuntary holds


By David Joel Miller.

Why do people get hospitalized? Can I send my child or partner there?

English: Northern Michigan Asylum, Traverse Ci...

There are a lot of misconceptions about going to a psychiatric hospital, who goes and why. In this post, I want to talk with you about some general information about what it means to be in or be sent to a psychiatric hospital.

This may vary from hospital to hospital and from jurisdiction to jurisdiction so for legal information check with the laws or a lawyer in your area.

It is not the people with the most serious mental illnesses that end up in the hospital. Our policies around this have changed a lot over the last century.

There was a time when people were sent to psychiatric hospitals for long periods of time. Stays of a year or more used to be common in the days before medication. Today most hospital stays are as short as possible. The use of medications has shortened stays considerable and so have patient rights laws.

There was a time when a man could put his wife away in a hospital and then get to spend more time with his girlfriend. Families would try to put away people who had a lot of money or were eccentric, to get control of their assets. There were a lot of abuses as a result of having others in the family say you were crazy and then hospitalizing you. Once people got into the hospital it used to be hard to get out. Not anymore.

There are two ways that you might get hospitalized, voluntary and involuntary.

Voluntary psychiatric hospitalization.

If you go in voluntarily you need a lot of money. A single day could cost thousands of dollars. But just saying you want in will not get you a bed in most hospitals. A doctor needs to say that you have a psychiatric issue that would benefit from hospitalization.  Beds in psychiatric hospitals are at such a premium that you don’t get to stay just because you want to be in the hospital.

If you enter on a voluntary status you are entitled to leave anytime you want regardless of what the doctor says. There may be legal ways for the doctor to keep you by moving you to an involuntary hold but those laws get complicated.

Involuntary psychiatric hospitalization.

People are placed in the hospital involuntarily because they are in a crisis that cannot be resolved on an outpatient basis.

Involuntary holds vary from place to place. In most jurisdictions, there are three reasons you might be placed on an involuntary hold.

1. If you are suicidal.

If you are a danger to yourself, suicidal, you can be put on a hold and kept in the hospital in most places. You stay there until the thoughts of suicide are reduced enough that the treating psychiatrist no longer feels you are a serious threat to take your own life.

2. Are you Homicidal?

The second reason to involuntarily hospitalize you would be if you have a plan to kill a specific person and you will not back down on this. You will stay in the hospital as long as the staff thinks you still plan to kill someone.

This is sometimes referred to as a “danger to others.” This is easily misunderstood.

3. Are you gravely disabled?

If you have food, clothing, and shelter but can’t figure out how to use these things, we might need to hospitalize you to protect you. This person would be referred to as gravely disabled.

Someone may have a serious and persistent mental illness, they are very impaired, but if they can be maintained on an outpatient basis with meds or therapy. They may never end up in the hospital.

Someone who was just laid off or served with divorce papers may end up in the hospital because while upset or angry they think of hurting themselves or others. A few days in the hospital they change their mind and are sent home. They may never experience a recurrence of these feeling. We still recommend therapy for a while just to make sure they are OK.

The conclusions about involuntary commitments.

1. It is not always the most severely mentally ill that go to the hospital. It is the people who need to be protected from themselves and others that spend time on an involuntary hold.

2. Just because someone has a severe mental illness does not allow professionals to lock them away. They need to also be currently a danger to themselves or others or gravely disabled.

3. There are currently not many other options for monitoring someone who is mentally ill. They either meet criteria to be hospitalized or they don’t. If they do meet criteria they stay till they stop being a risk to themselves and others. If they don’t they can’t usually go to the hospital even if they want to.

4. Other options to make help more available to the mentally ill short of a return to full hospitalization are urgently needed.

There is so much more that needs to be said on this topic but I will close for now, but there will be more to follow.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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2 thoughts on “If you go to the psychiatric hospital are you crazy? Involuntary holds

  1. Hi David! I was put in for 1 month, because of attempting suicide. I had numerous ECT’S
    I hated being in hospital, but at the end of the day it was the best result! 🙂 it’s hard admitting you need help! Great post, David! …..Paula x

    Like

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