This discussion aims to discuss the ethical and legal considerations of involuntary hospitalization, the due process of civil commitment in adolescents and adults, and explain how this topic concerns psychiatric-mental health practice for children, adolescents, and adults.
Involuntary hospitalization and due process of civil commitment
In the United States, involuntary hospitalization, also known as civil commitment, is a legal intervention where individuals who pose a danger to themselves or others or are gravely disabled (unable to provide basic needs for food, clothing, or shelter) due to a psychiatric illness or substance abuse can be detained in a psychiatric hospital or receive supervised outpatient treatment for some length time (Gi Lee & et al., 2021).
Under California law, short-term emergency detention often referred to as a “5150”, is when a person is held in legal custody for 72 hours. Only designated personnel, such as deputy officers, members of a mobile team, or mental health workers for psychiatric evaluation, can place a person on a 5150 legal hold. After the 72-hour legal hold, a psychiatrist will evaluate the individual, after which the individual may be placed on a 14-day ‘5250’ involuntary hold or can agree to be admitted or discharged. The subsequent step is expected to continue if a court or psychiatrist orders a commitment extension for up to 14 days, subject to legal review (Gi Lee & et al., 2021). Within four days after the patient is placed on a 14-day involuntary hold, there must be a certification evaluation hearing, also called a probable cause hearing. The hospital/facility must present a substantiation as to why the patient necessitates further psychiatric management. The patient is aided by a patient’s rights advocate who can rationalize why there is no need for an additional hospital stay. A hearing deputy will decide whether or not there is probable cause to hold the patient in the hospital/facility against their will for a period not exceeding 14 days.
Suppose the hearing officer decides there is probable cause, and the patient disagrees with the decision. In that case, the patient has the right to request a Writ of Habeas Corpus and have a hearing in the Superior court of the county where the patient is being held. The hospital may keep a patient for 180 days after the 5250 legal hold if they are still a danger to themselves or others. In tremendous cases, when an adult has an extensive history of mental illness and non-adherence, family members or professional personnel may request an LPS (mental health) conservatorship; this gives an adult legal authority to make choices for a seriously mentally ill individual who cannot care for themselves.
The purpose of commitment is to guarantee treatment for individuals who need treatment to alleviate the symptoms of psychiatric disorders that contribute drastically to an individual’s higher risk of harm to self or others (Nussbaum, 2020). A psychiatric patient with involuntary hospitalization often has overlapping vulnerabilities of language, sexual orientation, religion, and disrupted education. These vulnerabilities may either withhold vital services or deliver services coercively (Nussbaum, 2020). Mental illness affects a person’s ability to make rational decisions and live a normal life. Sometimes, a patient’s capability to make choices is so incapacitated by a psychiatric illness that practitioners manage them against their will to restore their ability to make reasonable choices (Nussbaum, 2020).
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