Mental health involuntary commitment Process

[ronin12]

I just wanted to get an idea how this process works in different states. let me introduce our process.
for filling of report Nurse, sw,psychologist has to go in person to court to file application in front of judge.it requires 2 to 3 hours of day.
for hearing, treating physician has to go to court and it eats up 2 to 3 hours. Today I wasted 3 hours in this process tomorrow will have to go through this non sense again as it is in different county. I am new to this state/place and it is a shocker for me as to time i spent out of my clinical work..
please briefly describe your experiences/procedure to help understand variations in different states.

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[Regnvejr]

In South Dakota, you put someone on hold by being a qualified provider and declaring someone on a hold. You follow up by filling out a hold form and fax it to the county Board of Mental Illness. Within 24 hrs, they send an outside evaluator to look at the patient and this person then recommend to the board whether to continue or cancel the hold. When the board meets at the hospital, you go in and answer the questions, then family a.o. speak etc., but you don't sit through it. They later tell you the result.

In Wyoming, again, declaring someone on a hold makes them be on a hold. Paperwork is filled out and is sent to the courts, and they set up a hearing within 72 business hours at the place the patient is located. Defense atty. assistant district atty, court commissioner, patient and you (or the therapist, or both) for anywhere from 10-50 minutes, with decision right then.

 

[whopper]

Today I wasted 3 hours in this process tomorrow will have to go through this non sense again as it is in different county.

Are you a state employee? Welcome to the wonderful world of having your time wasted, but still having to do the same amount of work by the end of the week.

The court holds you for 5 hours and you can't get your work done on the unit? Too bad.

I've had the same thing happen to me while working for a state facility last year. Happened about 8 times. In one occurrence, the court dropped the case but never told me. I sat waiting there like a shmuck for 5 hours. Every hour I asked the baliff if my case was coming, and he told me to just sit down and wait.

In most places, and in most hospitals with an involuntary unit, the judge comes to the unit and does the case there. However in state facilities which can cover multiple counties, in some cases they want the doctor to drive to the other county's courtroom.

Where I worked last year (and this year as a fellow) there is a courtroom in the facilities. What the facility does is they have an employee in the courtroom, and that person beeps the doctor about 15 minutes before they need to testify. So in that case the doctor's time is not wasted.

However whenever I had a patient (or evaluee) that was not civilly committed, but there for criminal reasons, I had to go to the downtown court. I had to go to the other county's court if the judge requested it. In those cases I typically had to wait 1-2 hrs. Worst case 5 hrs. Another bad case I drove to a county that was 2 hrs away, waited an hour and the defense lawyer hadn't even read the chart and asked for the hearing to be held 2 weeks later. The judge ok'd it. So then I had to drive 2 hrs back to work, and leave 8pm (day usually ended 4pm) to get the work on the unit that I missed. No overtime pay.

Its 2 weeks later and the defense lawyer still hadn't read the chart. The idiot asked for the hearing to be delayed again (and I drove 2 hrs again that day, and waited an hour). The judge this time refused saying that the lawyer was wasting everyone's time.

I mentioned this in other threads. So many psychiatry residents are so interested in forensic psychiatry simply for the money. The bottom line is you need to develop good experience by doing forensic work, usually at a state facility before you can do a lot of private work. You get paid just as much as the non forensic psychiatrists who don't have to go to the downtown courts or the out of county courts. However you have to do these things, its a big time waster and you don't get paid to sit there for 5 hrs. When court's over those same 20 patients, the treatment teams, the administrative meetings, etc you have to do in a week, you still have to do them.

On occasion I'd get a patient's family call me up to complain that they waited for 5 hrs. I'd tell them I have no control over that, and if they are unhappy they have to complain to the judge or elected officials in the local government. That would often cause the family even more frustration which they often took out on me.

I developed a policy. I'd give them the explanation (in a calm voice), and if they continued to complain, I'd say "please call your local elected officials. If you have nothing else to say, I will hang up now. Thank you."

 

[ronin12]

mine is non forensic/non state hosp , routine mental health commitments. courts do not accept faxes, they want someone in person.
for hearing they require psychiatrist to be there in court or a third party facility. judge can deny initial applicaiton without any reason, it as heppened. judge can also deny commitment .I am bit surprised despite lack of psychiatric knowledge they make these decisions.
wonder about their liability ?

 

[whopper]

am bit surprised despite lack of psychiatric knowledge they make these decisions.
wonder about their liability ?

You have to give them some slack. They didn't go to medical school or do psychiatric residency.

They don't have any monetary liability as far as I know. An attending of mine said something to the effect of "You got a white coat, they'll try to sue you out of house and home. You got a black coat you're immune."

The only thing (as far as I know) that can be done in cases where people don't like the judge's decision is to take the issue to the media to prevent that judge from being re-elected or re-appointed, or to appeal the case.

In fact I've seen some cases where the doctor thought the patient was no longer committable, but didn't want to be the person signing the discharge paper for various reasons. E.g. the schizophrenic person when stablized is an antisocial psychopath or sociopath. In those cases, the doctor kept the person in the hospital, and waited for the commitment hearing, and let the judge be the one to discharge the patient. That pretty much effectively nullifies the doctor's liability from the discharge (though I can think of several exceptions).

The good thing about the judge that handles the involuntary commitment cases in my current county is he's smart and his knowledge of mental health is better than a layman's. If he ever comes across something he hasn't heard of, he looks it up in the DSM, or checks it up online from a good source during the trial. There were even a few cases where he did something along the lines of a mental status exam, and his impression was as good as a psychiatrist. The same judge has handled commitment cases for years, and is very skilled in this area.

I have had one case where a judge who had no knowledge of mental health had to handle a mental health case. I requested forced medications in a criminal trial for a person who was not competent to stand trial due to schizophrenia. The judge handled criminal cases and was not used to dealing with mental illness cases. Despite this, he did his homework, studied the appropriate landmark case that dealt with the issue (U.S. v. Sell), and rendered a decision based on the principles from that case.

 

[tennreb]

Anyone with a South Carolina medical license can have someone committed. Just fill out the state form, have the notary sign it (usually the chaplain on call at night or unit secretary during the day), and fax it to the probate court of their county of residence. They are committed for up to 10 business days before they must be seen by a judge. How probate court is held depends the county. If the pt resides in Charleston county, they are taken to the court and examined by two licensed professionals (one of whom must be a psychiatrist and is most often a moonlighting resident). If they are from any other county, they are examined by two members of the treatment team (two residents) who make a recommendation to the court as to continue committment indefinitely or drop committment. The judge then holds court on the unit in the conference room and nearly always abides by the recommendation of the designated examiners.

 

[ronin12]

Anyone with a South Carolina medical license can have someone committed. Just fill out the state form, have the notary sign it (usually the chaplain on call at night or unit secretary during the day), and fax it to the probate court of their county of residence. They are committed for up to 10 business days before they must be seen by a judge. How probate court is held depends the county. If the pt resides in Charleston county, they are taken to the court and examined by two licensed professionals (one of whom must be a psychiatrist and is most often a moonlighting resident). If they are from any other county, they are examined by two members of the treatment team (two residents) who make a recommendation to the court as to continue committment indefinitely or drop committment. The judge then holds court on the unit in the conference room and nearly always abides by the recommendation of the designated examiners.

Very Impressive system. thanks for sharing.

 

[whopper]

The website psychlaws.org used to have a very easy to access list of most of the states in the US that had their mental health laws online. You just clicked the state, and it gave you the laws (in full form), and a synopsis of them.

For better or worse the site was taken over by the treatment advocacy center. If you put in psychlaws.org, you'll be redirected to the TAC website.

http://www.treatmentadvocacycenter.org/index.php

The TAC website does have information on all the states's laws, but its not as user friendly as the old psychlaws.org site. I have used the new site, and have spent a lot more time trying to find what I need.

However its still the best site I know of if you want to see other state's mental health laws.

 

[Faebinder]

Anyone with a South Carolina medical license can have someone committed. Just fill out the state form, have the notary sign it (usually the chaplain on call at night or unit secretary during the day), and fax it to the probate court of their county of residence. They are committed for up to 10 business days before they must be seen by a judge. How probate court is held depends the county. If the pt resides in Charleston county, they are taken to the court and examined by two licensed professionals (one of whom must be a psychiatrist and is most often a moonlighting resident). If they are from any other county, they are examined by two members of the treatment team (two residents) who make a recommendation to the court as to continue committment indefinitely or drop committment. The judge then holds court on the unit in the conference room and nearly always abides by the recommendation of the designated examiners.

Wow. That IS impressive.

In new jersey here. Special facility. Screener sees the person to declare the need for psychiatric treatment. Two physicians (one has to be a psychiatrist) have 72 hours to send out involuntary commitments to the judge. This commits them to 1 week. Usually the judge signs with a glance at them (they can deny it of course but hasn't happened so far, although they did warn of denial if the handwriting continues to be bad for some people). After 1 week a judge comes to the hospital on a Friday and court happens. Usually recommends what the attending recommends and the next due court is in a month but by then the patient is either home or day program or state hospital.

Sounds like our attendings are spoiled here 😀

 

[alina_s]

In Washington state, physicians can't commit patients at all. Is this the only state that does it this way? We can call the county-designated mental health professionals, who have 6 hours to show up if the patient's in the ER, 24 hours if they are already admitted to a medical or psych bed. The CD-MHP's decide whether the patient presents an acute danger to themselves or someone else or is gravely disabled as a direct result of their treatable mental condition and only they can detain (or not) the patient. If the patient is detained, there is a court hearing at the off-site court in 72 hours. The court clerk can almost never tell you ahead of time whether the hearing has been cancelled or what order the hearings are scheduled. Often, the lawyers don't talk to the patients until they've been transported to the court by ambulance, so you get to spend a productive few hours sitting in one of a very few chairs in the hallway while they sort out the case. One of my classmates had a productive morning sitting there only to have the case dismissed (and patient released) because the MHP hadn't served the patient his papers within 6 hours, although the patient was evaluated within 6 hours. I spent a quality 5 hours there on Christmas eve.
In New Mexico, I could detain patients on my first day of internship. The hearing was scheduled within 5? 7? days if the patient was detained in the ER and it was scheduled slightly later if the patient was already in the hospital. The judge didn't come to the hospital, but most hearings in town happened at the psych unit at the university hospital, and the hearings were at a scheduled time (wonder of wonders).

 

[whopper]

In Washington state, physicians can't commit patients at all.

Technically its a judge who does the commitment. A doctor can only petition for a commitment, and then the patient is held until a judge decides. During that time the patient is held, kind of like a suspect being held in jail until his criminal court hearing. (Not a good analogy since patients are in a hospital to be treated, while a suspect is held to keep him/her from fleeing and harming society).

Of course in effect, to the patient they don't care because they're still held against their will. Call it a hold, call it involuntary commitment, its usually the same to them.

 

[ronin12]

Washington state seems closest to our state in amount of bureaucratic hurdles. This is one aspect of psychiatry which can be a pain in certain states. I have another hearing coming up and had to go to 3rd hospital. will take good 2 to 3 hours of my time.

 

[Faebinder]

I hate sounding callous but these are my honest thoughts.

This thread has sure made me take involuntary commitment time wasted into prespective when I scout for work in the future. 2+ wasted hours unpaid are not going to happen to me without a serious compensation. Good luck to the state dealing with the mentally ill person's family when they harm themselves or when the mentally ill harm others. I dont know how other people put up with this wasted time, that's very bad. If this was a typical business, it would be ruined.

 

[Regnvejr]

You do what you need to for your patients.

 

[whopper]

You do what you need to for your patients.

True, but the court should not waste a doctor's time either.

Like I said, where I work, there is a courtroom in the facility. In several inpatient units, the judge will go to the unit, and they will convert a room into a courtroom.

However if you are driving out of your way, getting your time wasted, and have nothing to show for it, that's not fair. The court should do things to accommodate a doctor. For example, if the doctor is present, they should get that case out of the way first. Its not unfair or pretentious of us doctors to want that. Every time I had to sit in court, if a patient on my unit got dangerous and the staff beeped me, I could not answer because I couldn't make a phone call in court.

Several courts already do this. Several courts where there often aren't lawyers (such as in traffic court), the judge will allow cases where the lawyers are present to get them out of the way first so the lawyers won't have to wait.

When one does private forensic work, you bill per hour. So if the court makes you wait for 5 hrs before you go to the stand, yes you can get paid. There are several things that waste time in this field. E.g. if you go to the jail to see a prisoner, the cops might think you're a defense lawyer, and then they make you wait 3 hrs before they let you see the prisoner just to bug you. Several of them see defense lawyers in a bad light. So while you sit there, oops--another few hundred dollars an hour while you sit there and wait. They make you wait another hour? Oops, another few hundred dollars.

However you still got to pay your dues for years before you can be that high paid forensic psychiatrist expert witness. It's also a field where you should not go into it looking forward to being that hotshot hired gun. A hired gun IMHO is a paid liar, no better than a scumbag politician (forgive me for being blunt).

And like I said...If you're not doing private work, you sit there, your time is wasted. You don't get paid anymore, and you still have just as many responsibilities. You still have to see just as many patients. Its as if your day in court was a regular day in terms of the workload you have to do, plus you went to court. The court wastes 5 hrs of your time? You'll still have to go back to the unit and leave 5 hrs later than you would have if you did not go to court.

 

[ronin12]

Philosophically I do agree with mental health courts,as they provide a sense of checks and balances to the pts.
for all honesty, filling involuntary hospitalization petition is not the brightest aspect of my day, as it again slows down my work routine ,on top of it going to a court room for a lousy "testimony" and wasting chunk of my time is out right redicolous. judges and lawyers are legal experts rather mental health professionals, they have limited ability to cross examine or challenge psychiatrist's assesment on clinical grounds, that's why for most part they go along what you reccomend. It is not worth wasting hours out of my work day.