Voluntary Admissions

Voluntary Admissions

To be admitted voluntarily, an individual makes direct application to the institution for services and may stay as long as treatment is deemed necessary. The person may sign out of the hospital at any time unless the health-care professional determines that they may be harmful to self or others after a mental status examination and recommends that admission status be changed from voluntary to involuntary. Even when admission is considered voluntary, it is important to ensure that the individual comprehends the meaning of their actions, has not been coerced in any manner, and is willing to proceed with admission.

Involuntary Commitment

Although the term involuntary hospitalization is preferred by some over the term involuntary commitment or civil commitment, this process needs to be conducted with respect to state and federal law. Because involuntary hospitalization results in substantial restrictions of the rights of an individual, the admission process is subject to the guarantee of the Fourteenth Amendment to the U.S. Constitution that provides citizens protection against loss of liberty and ensures due process rights. Involuntary hospitalizations may be made for various reasons. Most states commonly cite the following criteria:

■ The person is imminently dangerous to themselves (i.e., suicidal intent).

■ The person is a danger to others (i.e., physically aggressive, violent, or homicidal).

■ The person is unable to take care of basic personal needs (the “gravely disabled”).

Under the Fourth Amendment, individuals are protected from unlawful searches and seizures without probable cause. Therefore the person recommending involuntary hospitalization must show probable cause why the client should be hospitalized against their wishes; that is, the person must show that there is cause to believe that the client would be dangerous to self or others, is mentally ill and in need of treatment, or is gravely disabled.

Emergency Commitments

Emergency commitments are sought when an individual manifests behavior that is clearly and imminently dangerous to self or others. These admissions are usually instigated by relatives or friends of the individual or by police officers, the court, or health-care professionals. Emergency commitments are time-limited, and a court hearing for the individual is scheduled, usually within 72 hours. At that time, the court may decide that the individual may be discharged or, if deemed necessary and voluntary admission is refused by the person, an additional period of involuntary hospitalization may be ordered. In most instances, another hearing is scheduled for a specified time (usually in 7 to 21 days).

The Mentally Ill Person in Need of Treatment

A second type of involuntary commitment is for the observation and treatment of mentally ill people in need of treatment. These commitments typically last longer than emergency commitments. Most states have established definitions of what constitutes “mentally ill” for purposes of state involuntary admission statutes. Some examples include individuals who, because of severe mental illness, are

■ Unable to make informed decisions concerning treatment

■ Likely to cause harm to self or others

■ Unable to fulfill basic personal needs necessary for health and safety

In determining whether commitment is required, the court looks for substantial evidence of abnormal conduct—evidence that cannot be explained by a physical cause. There must be “clear and convincing evidence” as well as probable cause to substantiate the need for involuntary hospitalization to ensure that an individual’s constitutional rights are protected. As mentioned earlier, the U.S. Supreme Court, in O’Connor v. Donaldson, held that the existence of mental illness alone does not justify involuntary hospitalization. State standards require a specific effect or consequence caused by mental illness that involves danger or an inability to care for one’s own needs. These individuals are entitled to court hearings with representation, at which time determination of commitment and length of stay are considered. Legislative statutes governing involuntary commitments vary among states.

Involuntary Outpatient Commitment

Involuntary outpatient commitment (IOC) is a court-ordered mechanism used to compel a person with mental illness to submit to treatment on an outpatient basis. As these laws have evolved, they have taken a more “preventive approach.” In this scenario a person with mental illness who is not currently dangerous, and therefore not legally committable to a hospital, could be ordered to community treatment on the basis of a complex clinical assessment and prediction about the future. Examples of eligibility criteria (SAMHSA, 2019) include those outlined in North Carolina’s state statutes:

■ The person must have a mental illness.

■ The person is capable of surviving safely in the community with available supervision from family, friends, or others.

■ Based on the person’s psychiatric history, the person is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness.

■ The person’s current mental status or the nature of their illness limits or negates their ability to make an informed decision to seek voluntary admission or comply with recommended treatment.

The Gravely Disabled Client

Many states have statutes that specifically define the “gravely disabled” individual. For those that do not use this label, the description of the individual who is unable to take care of basic personal needs because of mental illness is very similar.

Gravely disabled is generally defined as a condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from an inability to provide for basic needs such as food, clothing, shelter, medical care, and personal safety. Inability to care for oneself cannot be established by showing that an individual lacks the resources to provide the necessities of life; rather, it is the inability to make use of available resources.