can anyone tell me what the regs are for admitting some one to a psych unit?

peaceful · Jan 16, 2005

Not sure what you are asking? The usual criteria is potential harm to themselfs or others. I work in the field & rarely see someone admitted to the psych ward because of misdiagnosed physical problem, although that of course is a potential. There are concurrent physical problems that influence a psychiatric diagnosis such as thyroid or improper med management, the list would be endless. Tell me more what you mean. Do you think people are being admitted to psych wards unfairly? I certaintly do not think it is all a scam, quite the opposite, we have too many people with serious problems in our psychiatric hospital.

years ago they would have to have them physically examined to rule out a physical problem, has this changed? can we now just admit people directly to a psych unit for court commitment without a physical and keep them there for over 48 hrs. against their will? are we going backwards instesd of forward with mental illness? or is this all just a scam?

elkpark · Jan 16, 2005

The laws regarding involuntary commitment vary from state to state, so you would need to talk to someone familiar with the laws in your state.

I believe, though, that there is a fair amount of consistency among the states about the key elements of involuntary commitment -- that the person must be ruled to be a danger to her/himself or others by a magistrate or judge, must be examined by a physician who agrees that the person is dangerous, and must then have a hearing with a judge and an attorney to represent her/his interests to determine how long the person can be held in the hospital (if at all).

In my state (for example), someone must go before a magistrate and present testimony specifying in what way(s) the person is dangerous to her/himself or others. If the magistrate agrees that the person appears to meet the legal criteria of "dangerous," a warrant is issued to the police or sheriff's office, directing them to pick up the person and take them to the nearest inpatient mental health facility. The person must be examined by a physician (typically in a hospital ED, including a physical exam if the person is willing to allow that), and the physician must agree that the person is so dangerous that s/he should be held against her/his will, otherwise the commitment petition is dropped. Then, the person is transported or admitted to the actual psychiatric unit. There must be a second physician's evaluation (typically, a psychiatrist on the unit), who must also find that the person is dangerous enough that s/he must be held against her/his will (there would also be an admission physical exam, the same as for any other patient in the hospital). Then, there is a hearing within 10 days, presided over by a judge and including a public defender (attorney) who represents the patient. The patient, the psychiatrist treating the patient, and the original person(s) who filed the petition (gave testimony before the magistrate) in the first place -- if they choose to be present and testify -- all testify to the judge about the circumstances leading up to the hospitalization and the patient's current condition, and the judge rules on whether the person has to stay in the hospital, and if so, for how long (up to a maximum of 30 days). The judge can also rule that the person is not dangerous enough to justify being held involuntarily, and order the hospital to release the person immediately (which does happen sometimes). Again, each state has its own specific laws and there is some variation among states. I'm only familiar with the process in my own state.

The current system, while not foolproof or perfect, was developed in response to past abuses and is a big improvement over what used to happen to people just a few decades ago. I'm not sure what you mean when you talk about going backwards instead of forwards, or a scam. Are you referring to some particular experience that you are aware of and have concerns about?

You may be able to get a more specific answer if you can be more specific about your concerns.

Malt123 · Jan 16, 2005

Not sure what you are asking? The usual criteria is potential harm to themselfs or others. I work in the field & rarely see someone admitted to the psych ward because of misdiagnosed physical problem, although that of course is a potential. There are concurrent physical problems that influence a psychiatric diagnosis such as thyroid or improper med management, the list would be endless. Tell me more what you mean. Do you think people are being admitted to psych wards unfairly? I certaintly do not think it is all a scam, quite the opposite, we have too many people with serious problems in our psychiatric hospital.

I don't think it I know it. here if some one calls the cops and tells them your "thinking " about suicide the cops come haul you off and they take you right to a psych ward, no physical,no dr. untill the next day and that is a psych dr. that sees you for 15 minutes and they keep you 48 hrs if its not on the weekend, then they force you to sign a paper giving them permission to talk to your family or they won't let you out. No urine test to see if a UTI is present or drugs, and no blood work like you said checking for any thyroid ect. problems.

Nurse Ratched, RN · Jan 16, 2005

A doctor still has to write the admission order. Police aren't permitted to just show up and bring someone in without an order. That implies that a doctor agreed with the assessment that the person was a danger to him/herself.

I work on a combination medical psychiatric unit, so sometimes folks are admitted who wind up being wacky because of a physical ailment, but still need to closer monitoring of a locked unit. That doesn't mean they don't get a physical workup.

PJMommy · Jan 16, 2005

You must have more psych wards there.... We are lucky to find a mental health bed for the legitimately mentally ill pts we see in our med/surg critical care unit.

UM Review RN, ASN, RN · Jan 16, 2005

Why do you ask, Malt?

Malt123 · Jan 16, 2005

Why do you ask, Malt?

seen it happen and I called all over trying to find out if this was actually legal. a doctor never saw the Pt., no prior work up, nothing, just slapped them into a psych ward and made them sign a paper stating that they could talk to their family or they wouldn't be discharged.

I am just having problems with the way this state functions. It seems like no one has any rights unless you have money or some kind of power.

medpsychRN · Jan 17, 2005

Every state must have some written mental health code. I'm sure the details vary from state to state. The code defines involuntary admissions and what has to take place before someone can be held against their will.

In Illinois, a patient has to be evaluated by a psychiatrist before admission and a certificate completed. The nurse or family member can fill out the petition. A second psychiatrist sees the patient within 24 hours (except on weekends and holidays) and completes the second certificate. Court papers are immediately filed on the next business day and a court hearing scheduled. Sometimes this can take a week as the court has an already full schedule.

None of the docs like to go to court! So they are not going to keep someone against their will unless there is a very good reason.

You are required on admission to provide the patient with a list of telephone numbers for advocates and provide a telephone for them to use.

If this is happening in your area, there has to be a place where it can be reported.

PMHNP10 · Jan 17, 2005

At the hospital I work at (in CA), if a pt comes into the ER (whether voluntarily or by police escort) where they are assessed by the MD and a crisis evaluation is ordered. The crisis team (either a RN or MFT--marriage and family therapist) interviews the pt. and contacts the psychiatrist on call where a plan of care is developed--whether to admit the pt. or send home on referrals. There are times when even pts who are brought in on holds are released. For a hold to be legal, the pt. must be a danger to self/others or gravely disabled (unable to provide food, clothing, shelter for self).

When I was working in Dallas, a pt. would be brought into the ER of one of our neighboring hospitals where they would be medically cleared and at some point in the process, a MD would speak with the MD on call and do a doc to doc. If the pt was brought in voluntarily, the case would go before a judge (and he'd have to sign the hold papers) before the pt could even be brought to our hospital floor.

So as others have said, things vary greatly from state to state, although in my experience a MD has to at some point write orders for admission (or provide telephone orders) before the pt. can step onto the unit.

Bjo · Jan 20, 2005

In Ohio, the law says that a person can be involuntarily committed to a psychiatric unit if a physician or other mental health professional (such as a social worker) signs an emergency application for admission. We don't accept anyone who hasn't been prescreened by the emergency room or someone from the mental health board. Once the person is past the crisis they are discharged. Or they may choose to sign a voluntary admission which means that they can't be probated. The laws are very specific to try and protect people from being admitted to a psychiatric unit unjustly. However, we do get court committments which is a whole other story in itself.

nurseT · Jan 22, 2005

In Ohio, the law says that a person can be involuntarily committed to a psychiatric unit if a physician or other mental health professional (such as a social worker) signs an emergency application for admission. We don't accept anyone who hasn't been prescreened by the emergency room or someone from the mental health board. Once the person is past the crisis they are discharged. Or they may choose to sign a voluntary admission which means that they can't be probated. The laws are very specific to try and protect people from being admitted to a psychiatric unit unjustly. However, we do get court committments which is a whole other story in itself.

What is a court committment and if that happens, who pays for the hospital stay?