State Facilities

I work in a state psychiatric facility. The difference between a state facility and an inpatient psych unit at a hospital is that an inpatient unit at a hospital can choose who they admit. A case is presented from an emergency (usually where a patient must present for evaluation before placement) to the hospital psychiatric unit, if they have one. Said unit can refuse admit based on acuity, past experience with this patient, lack of insurance (although the latter is rarely admitted to by unit MD). In addition, a patients stay is voluntary, they can sign themselves out AMA, or perhaps be IEA'd to a state hospital.

A state hospital, on the other hand, must take all who present to an ER and are deemed a threat to themselves or others, regardless of acuity, dx, past experiences and/or lack of insurance. State hospitals are also the only place where a patient can be admitted against their will, usually by IEA (involntary emergency admission). Said patients will see a judge within 3 business days. The judge will decide, based on knowlege provided by patient and of the petitioner of the IEA, whether the patient is truly a threat to self/others leading to continued confinement or if the threat to self/others is unfounded. In the latter case, the patient is released that day.