Involuntary psychiatric holds have a bad reputation in popular media. Heroines like Linda Hamilton from "Terminator 2" or vampire slayer Buffy Summers were unfairly imprisoned by sadistic orderlies. In practice, medical providers must jump many hurdles before forcing a patient into medical custody. There are only two reasons why patients can be involuntarily committed. Here's a more detailed explanation of both.
History of Involuntary Medical Confinement
Forcing patients into care has a long history in the United States. In the 1800s and early 1900s, psychiatric hospitals were used as holding grounds for deviants. However, deviance was often defined by societal, not medical, standards. In the middle of the twentieth century, activists began to push back against unnecessary psychiatric hospitalization. This movement led to a strict legal standard for involuntary medical holds. It also reduced the number of psychiatric hospitals available and moved patients into a community-oriented setting.
The most common reason for an involuntary psychiatric commitment is for the protection of general society. When police or medical officials feel that an individual is likely to hurt other people, that individual can be forced into psychiatric care. In many cases, violent or erratic behavior can stem from an undiagnosed or poorly managed mental health condition. Imprisoning the individual will not be helpful in the long term because mentally ill people do not choose to act against societal norms. They need treatment, not punishment. Police hope that coercing the person to receive mental health care will protect society.
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According to the Mental Illness Policy Organization, a person may be involuntarily committed to protect that person. When someone makes threats of self-harm or suicide, police are legally allowed to force that person into medical care. The legal principle of parens patriea is most often used with children ormentallyl disabled people. Police and attorneys hesitate to use this reasoning to commit adults who may raise civil rights concerns over their involuntary confinement.
The 72 Hour Rule
In most states, an involuntary psychiatric commitment cannot extend beyond 72 hours without a formal hearing. This 3-day period allows patients to receive basic medical treatment, recover from psychotic episodes and hopefully understand the need for further help. The patient can choose to voluntarily remain in care or commit to ongoing out-patient care. However, after 72 hours, the patient can refuse to cooperate with further medical treatment. The medical providers must decide between releasing the patient or requesting a mental health hearing to persuade a judge that the patient needs further help to prevent self-harm or harm to others. This is a general overview. Laws regarding involuntary commit vary by state, so it's important to research state-specific rules. For example, the California Lanterman-Petris-Short (LPS) Act includes a Section 5250 hold that allows patients to be committed for an additional 14 days by a qualified psychiatric provider and a Section 5270 that adds an extra 30-day commitment period.
For people with mental illnesses or their loved ones, it's important to understand two things. One, police and medical providers only commit patients against their will during extreme cases. Two, involuntary psychiatric holds are performed with the patient's best interests in mind; they're not an arbitrary punishment.