Massachusetts Psych Laws - involuntary admission, etc.

[AlterEgo]

I'm going to be starting an external elective in psych ER next month in Boston. I wanted to read up on the criteria for involunatary admission and other pertinent laws or protocols for the state. So far my googling keeps turning up legal-ese that I can't decipher too well.

Thanks

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[Doc Samson]

Very straightforward. Essentially, an involuntary psychiatric admission requires a section 12 (a 12a gets someone to the ED for eval, a 12b [the reverse side of the 12a] is completed on admission). The 12a can be completed by any healthcare professional or police officer, the 12b requires a psychiatrist (or psychiatry resident). 3 basic criteria for involuntary admission: danger to self, danger to others, or inability to effectively care for themselves in the community. Once admitted, the patient awaits court hearing: ~2-3 weeks back when I was a resident (OPD and Jesus had just graduated), then the judge decides yea or nay.

A section 10 and 11 is for voluntary admission.

A section 35 is for a 30 day involuntary substance abuse admission (quite rare).

 

[Shalom77]

I thought you could only involuntarily hold someone for up to 72 hours without a hearing if they are challenging the admission.

Here's a link:

http://www.mass.gov/mhlac/hospitalization_discharge.pdf

 

[Doc Samson]

I thought you could only involuntarily hold someone for up to 72 hours without a hearing if they are challenging the admission.

Here's a link:

http://www.mass.gov/mhlac/hospitalization_discharge.pdf

In practice, I don't think I ever saw this happen (again, this was some time ago) - it may've been handled by the hospital attorneys without needing our attendance.

 

[Shalom77]

I'm not sure when Jesus or OPD graduated but there was a major reform of MA commitment regulations/laws in the late 1990s (maybe it was 2000?). Prior to that things were much looser and one could hold someone for up to 24 days without court review.

 

[OldPsychDoc]

I'm not sure when Jesus or OPD graduated but there was a major reform of MA commitment regulations/laws in the late 1990s (maybe it was 2000?). Prior to that things were much looser and one could hold someone for up to 24 days without court review.

Although I'm quite sure that Jesus would go nowhere but Mass Gen for His residency, OPD is blissfully unaware of laws outside his upper midwest state. Possibly MA is similar to here where there is a 72 hr limit without court review, but a pt can be held longer once the county has placed a court hold pending the actual hearing.

 

[Anasazi23]

Not only this, but if a patient demands release, or submits a 72-hour letter right after the local court hearings or judge availability, they're forced to wait until the next available hearing. That could be a week or two depending on the area you're in. In Manhattan we have psych court every Tuesday, so if a patient submits a letter on a Tuesday afternoon, they basically have to wait a week to be heard, though technically they are supposed to be heard or released within three days.

 

[Shalom77]

Although I'm quite sure that Jesus would go nowhere but Mass Gen for His residency...

I would have thought that Jesus would have preferred the House of G*d residency program (given that he probably trained before the merger of the Harvard programs.)

 

[Doc Samson]

I would have thought that Jesus would have preferred the House of G*d residency program (given that he probably trained before the merger of the Harvard programs.)

Absolutely right... OPD likes to keep pigeonholing me as an MGHer, but that was my fellowship. I did my residency at the venerable House of God.

 

[AlterEgo]

Thanks for the low-down. I must say goodbye to the Baker acts BA-52, BA-32 and Marchman acts I knew so well from Florida.

3 basic criteria for involuntary admission: danger to self, danger to others, or inability to effectively care for themselves in the community.

I'm assuming the patient also has be acting this way due to a psychiatric illness.


What if any treatment, can be initiated during an involuntary admission observation period.

 

[Doc Samson]

Thanks for the low-down. I must say goodbye to the Baker acts BA-52, BA-32 and Marchman acts I knew so well from Florida.



I'm assuming the patient also has be acting this way due to a psychiatric illness.


What if any treatment, can be initiated during an involuntary admission observation period.

Yes, it has to be 2ndary to mental illness. The patient has the right to refuse all treatment during the observation period. Once the judge signs off on the treatment plan then whatever's on there can be administered involuntarily. You have to submit a list of meds with dosage ranges that the pt's attorney often loves to pick apart ("800 mg of Seroquel. That sounds like a lot!"). The major sticking point I've encountered is when you ask for ECT - that tends to lead to a lot of red-tape.

 

[CarleneM]

A helpful link to all the mass psych laws (well not including child abuse which is in a different chapter- Chapter 119) is chapter 123 of the MA laws, the mental health laws :http://www.mass.gov/legis/laws/mgl/gl-123-toc.htm

to the OP- I'm a harvard med student that just finished a month long elective at the MGH psych ed. I am wondering if you are doing the same elective in august? feel free to pm me with any questions....It was the best rotation of med school, always an adventure....

 

[Doc Samson]

A helpful link to all the mass psych laws (well not including child abuse which is in a different chapter- Chapter 119) is chapter 123 of the MA laws, the mental health laws :http://www.mass.gov/legis/laws/mgl/gl-123-toc.htm

to the OP- I'm a harvard med student that just finished a month long elective at the MGH psych ed. I am wondering if you are doing the same elective in august? feel free to pm me with any questions....It was the best rotation of med school, always an adventure....

😱😱 Could it be? An HMS going into Psychiatry?

 

[CarleneM]

😱😱 Could it be? An HMS going into Psychiatry?

Yup. there's actually more of us out there than you may think this year. You'd think this would be frowned upon, as its not derm, plastics or rads but I haven't found this to be the case.

HMS even has a new loan forgiveness program ($60,000 forgiven) for HMSers going into psychiatry, family practice or primary care called the Joseph Martin Loan forgiveness Initiative. Attitudes are slowly shifting....

 

[Doc Samson]

Yup. there's actually more of us out there than you may think this year. You'd think this would be frowned upon, as its not derm, plastics or rads but I haven't found this to be the case.

HMS even has a new loan forgiveness program ($60,000 forgiven) for HMSers going into psychiatry, family practice or primary care called the Joseph Martin Loan forgiveness Initiative. Attitudes are slowly shifting....

I've never found it to be "frowned upon", but there just seemed to be a very small percentage of HMS students that ever considered psychiatry as a career choice. Not to say they weren't eager to learn, but it was a lot of "what should I know about Psychiatry if I'm going into urology/derm/rad onc/medicine/whatever?" That loan forgiveness program sounds great, should be quite a boon to the psychiatry residencies.