CA Involuntary Commitment Procedure

[adaptation1]

Hi,

I'm moving to California and learning more about the involuntary commitment procedures -- specifically, the flow from an outpatient perspective.

I come from a state where it's very easy to begin committing the patient from the outpatient setting. Something to this effect: 1) If considered gravely disabled or harm to self or others, file an 72 hour hold on patient and send to the ER 2) At the ER, another physician will be re-evaluate patient to determine whether to continue the 72 hour hold 3) If the hold is continued, patient will be hospitalized inpatient, where a coroner may extend the hold to 14 days.

Can anyone explain how the involuntary commitment works in CA, specifically in terms of the responsibilities of the outpatient physician?

Thanks!

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[birchswing]

Coroner?

All my suspicions about psychiatric hospitals confirmed.

 

[Mass Effect]

I don't mean to tell you your state's procedure, but I'm pretty sure you don't mean coroner.

 

[wolfvgang22]

Yes, he or she probably does mean coroner. Coroner's sometimes have more duties than just dealing with death. Louisiana is one state where the coroner is involved in psychiatric holds.

 

[FlowRate]

Yes, he or she probably does mean coroner. Coroner's sometimes have more duties than just dealing with death. Louisiana is one state where the coroner is involved in psychiatric holds.

This seems so odd. Are they typically psychiatrists with the title coroner or pathologists as in the usual understanding of the term?

 

[downwithDTB]

Your state sounds quite burdensome to me! I prefer the old "call 911 and let the cops and the ED do the hold" approach.

Not to be too tangential, but there are many benefits to living in states that respect physician training: find a medical examiner, no mid-level independent practice, phsyician initial hold and judge to keep it state and prosper in health and leadership across the board!

 

[downwithDTB]

This seems so odd. Are they typically psychiatrists with the title coroner or pathologists as in the usual understanding of the term?

A coroner is an elected official and the salary is usually not great; therefore it's almost never a physician. Rather, it's some person who wins an election and gets to hire physician (or PA or whoever they want) medical examiners and then can override any phsyician decision. In some states, they can act as mental health judges as well. A completely obsolete elected official that should be done away with in favor of mental health judges and phsyician MEs.

 

[adaptation1]

Yes, I do mean coroner -- they are often general practitioners, NPs and psychiatrists.

But back to California...! Anyone?

 

[clozareal]

Each county determines who can become certified to write involuntary psychiatric holds. For the most part, you as the outpatient psychiatrist can write a 5150 which is our legal term for a 72-hour involuntary psychiatric hold and send them to the emergency room (walk them over, call an ambulance, etc). That's all you need to do from the outpatient setting. Your clinic should have a policy regarding this. Some counties have it where only police can write a 5150 and bring the patient to the ED. It's hard to say what your responsibilities will be without knowing which county you will work in.

The ED will take care of admission to an inpatient psych facility when they arrive there unless you have direct admitting privileges which feels rarer these days. After the 72 hours ends, a determination will be made on whether a 14 day hold (called a 5250 in CA) can be placed. A certified hearing officer (not a coroner) will make that determination with the psychiatrist as the plaintiff and the patient and usually a public defender as the defendant.

 

[adaptation1]

Perfect. Thanks!