Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More
Multiple times during the year, I receive E. Mails from people who feel desperate about the health and well being of a loved one who is either mentally ill or addicted to drugs.
One of the questions they frequently ask is, "can we have her committed for a year or more so that she gets treatment and recovesr?" The answer is complicated, but is mostly "no." The reason for the negative response has to do with civil rights and patient rights. This is something everyone should be aware of regardless of whether they are concerned about their own situation or someone elses.
First, the days when people could be committed to mental institutions for many years are long gone and that is a good thing. In fact, during the 1960’s, when antipsychotic medications were developed that were able to reduce or control delusions and hallucinations, people were slowly discharged from the large state mental hospitals where they had languished for many years. They were referred to community programs where they received medication and treatment to help them understand and cope with their illness. Today, most patients with schizophrenia and other chronic mental illnesses are able to remain out of the hospital and live in the community as long as they do not pose a threat to themselves or to anyone else.
Simply put, it is not possible to hospitalize anyone, whether they are abusing drugs, extremely depressed or suffer from a psychotic illness. In addition, no one can be forced to take medications against their will. For example, there have been cases where family members dropped Haloperidol or other antipsychotic medications into the orange juice or coffee of a mentally ill family member who was non-compliant with medications. Over and again, when these cases went to court, the rulings were in favor of the patients and against the family, no matter how well meaning the family was.
Having said that patients have rights, it is important to realize that there are exceptions to the rule about being held in the hospital and given medications against one’s will. The exceptions are when patients are examined by psychiatric staff members and are deemed a danger to themselves or others.
So, what can you do if you are a family member and believe that your loved-one is threatening suicide or homicide? In this case it is permissible to call 911, and ask for help. If the police and ambulance staff agree that there is a threat, the patient will be taken to the psychiatric emergency room of the nearest hospital, where they will be further evaluated. In some cases, a patient can be held for 72 hours to further evaluate their mental status and their potential for committing a dangerous act. That 72 hour evaluation period is also used to determine whether the patient has a true psychotic or depressive illness or is reacting to drug abuse. Drug abusers are either referred for drug detox in the hospital or for drug rehab in the community.
The evaluation of patients for suicide or homicide is done through a Mental Status Exam. During this exam, the patient is asked many questions, usually by a psychiatrist or psychologist.
It must be stressed that people will not be held against their will unless a team of nurses, psychologists, and psychiatrists conduct a full evaluation and decide that it is too dangerous to let the patient leave the emergency room. If they are sent to the inpatient unit, they are placed on medications until they stabilize, referred out to services in the community, and discharged if they are not considered to be a threat.
It is also true that if the 911 team does not agree that the person is a threat, they may not take them to the hospital.
Usually, it is best if a person recognizes that they have a problem and report to the hospital emergency room on their own initiative.
Patients will be discharged from the hospital once they are judged by the hospital staff to be stable on their medications, which means they are no longer a threat to themselves or others. They are referred for continued treatment in the community. However, no one can force a patient to continue treatment or medication.
The bottom line is that all patients have rights. The lobbies, rooms and public areas of all hospitals have posters clearly listing patient rights. These posters are in Spanish and even other languages. This protects everyone, including all of you who are reading this web log. These patient rights extend to medical treatment as well as psychiatric treatment.
Please send in your comments and questions about this critically important topic.