Psychiatric Emergency

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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

There are inquiries about what a family can do in the event that there is a psychiatric emergency. It is an extremely serious question about which there seems to be a lot of confusion and anxiety. This confusion often has to do with whether or not a person can be hospitalized against their will and what the consequences might be of calling for a hospitalization. While this topic has been written about before it is being addressed again in order to meet what seems to be a public need.

First, it is important to understand that it is not possible to have someone "committed" to a psychiatric hospital against their will,


as they once were many decades ago. In fact, most psychiatric hospitalizations, when they do occur, are relatively brief, lasting no more than a couple of weeks and in a few circumstances, a few months but nothing more. Today, there is great concern about protecting the rights of all patients and, most particularly, the mentally ill.

On the other hand, there are times when a person can be brought to a hospital even in the face of their opposition. There are two circumstances in which an unwilling person can be brought to the emergency room:

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1) If a person poses a danger to self they can be brought to the hospital for evaluation. Posing a danger to one’s self means that there is a real threat of suicide. A real threat of suicide includes having a specific plan about how they will attempt suicide or have purchased the weapons or poisons with which to carry it out. Since the average person is not a psychiatrist it is safer to err on the side of caution by reporting a suspected suicide attempt to both the family and police.

2) If a person is posing a threat to other people they can be brought to the hospital for evaluation. If for some reason an individual has become deranged and is brandishing a weapon and threatening people either in or outside of the home they need to be seen by psychiatric staff. The causes of such deranged behavior can vary from drug abuse that has affected the brain to a stroke, Alzheimer’s disease or other dementing process, brain tumor or other physical illness or mental illness. If a mentally ill person stops taking their medication they can suffer a relapse and descend into psychosis. Drug abuse can have an equally destabilizing effect on those with mental illnesses.

Once in the emergency room a patient will be interviewed and assessed by psychiatric staff to determine whether or not they need hospitalization or can be stabilized in the emergency. There are those times when a patient can be held for 72 hours without being formally admitted in order to do further evaluation and make a final determination as to whether further hospitalization is necessary or not.

Medical staff is cautious about the disposition of psychiatric cases in which self harm or harm to others could occur. Staff wants to protect the patient, patient’s family and the public at large. Therefore, they do not take lightly the decision to return a patient to their home. At the same time they do not want to unnecessarily hospitalize a person due to the cost of a long term hospital admission.

The best of all circumstances when there is a psychiatric emergency is the patient being willing to go to the emergency accompanied by family or friends. While this does happen it is unfortunately true that being in a clouded mental state prevents people from using good judgment. Therefore, too many psychiatric emergencies result in people being brought to the emergency room unwillingly.

If a person is clearly threatening suicide or homicide it is perfectly within anyone’s rights to call 911 and ask for help. In calling it is important to state the nature of the emergency in very clear terms. The 911 team will send out a police car and an emergency ambulance vehicle as well. Both police and EMTS evaluate the danger and decide if a visit to the ER is warranted.

It is both difficult and painful to have a loved one taken away by 911 staff when such emergencies occur. No one enjoys seeing a family member removed from their home and hospitalized. On the other hand it is important to keep in mind that the reason for taking such action is to protect this individual as well as the other family members.

Your comments are welcome.

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