Involuntary Psychiatric Holds: Our Complete Guide to the Process
You might never need to know what it is or how to do it, but if you ever do, it could save you or someone you love.
Having this essential knowledge could make the difference between getting through a mental health crisis safely or suffering through something terrible without help.
What is this important information you should know? It’s how to get emergency psychiatric care when you or someone else needs it—especially when you or someone you love aren’t willing or able to sign up to get it. Knowing how to do this can literally be a lifesaver. And we’re here to help you learn how.
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What Do You Do When Someone Needs Help But Won't Get It?
What do you do when someone’s in a mental health crisis, at risk of harming themselves or others, but can’t or won’t sign up for treatment?
One thing you can do is have them placed on an involuntary psychiatric hold. This allows that person to be kept safe until they’re seen and evaluated by a mental health professional, even and especially when they don’t understand that they’re in a crisis or need help.
It can be a scary and stressful process for everyone involved, but it’s also an essential mental health intervention that saves lives.
If you fear someone is at risk of hurting themselves or someone else because of a mental health condition, there’s something you can do.
All 50 states and the District of Columbia have laws in place that allow police or private citizens to get people in need of emergency mental health care placed in a treatment facility, held, and treated until they are no longer dangerous.
Not everyone knows about this process, and when people do know a little bit about it, what they know is often shrouded in mystery and myth. We’re here to help debunk those myths and explain what an involuntary psychiatric hold actually is, when it’s appropriate, who it’s for, and how it can help.
This article provides an overview of how the civil commitment process works and will help you understand when and how you should use it. Read on to learn essential facts about a hidden part of the mental health system that saves lives every day.
What Is an Involuntary Psychiatric Hold?
An involuntary psychiatric hold is a legal process that allows others to intervene to keep someone safe when they’re having a psychiatric emergency.
It’s what happens when a person is held in a psychiatric or healthcare facility—usually an emergency room at a local hospital, but sometimes another kind of mental health facility or even a jail, if they are already incarcerated in one—until they can be evaluated by a mental health professional to determine whether they need inpatient mental health care to keep them safe.
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An involuntary psychiatric hold is known by different names in different states. For example, it’s known as an “emergency custody order” in Virginia and a “5150” in California.
There are a few different ways a person can be placed on a psychiatric hold. One is that they could be taken into custody by a police officer who then transports them to an appropriate location (usually an emergency room) and holds them until they can be evaluated.
When this happens, the person on the hold is not under arrest. The officer detains them as part of a civil process until they are evaluated by a mental health professional and either discharged or civilly committed. Officers can do this if they suspect a person has a mental health condition and is in need of care to keep them safe.
Loved ones, relatives, mental health professionals, or concerned citizens can also initiate a psychiatric hold. You usually do this by going to a magistrate to request one (the magistrate has to agree and sign off on it). We’ll explain how this process works and how you can initiate it later in this article.
DEEP DIVE
What Is an Evaluator Trying to Determine?
When a mental health professional evaluates someone who’s on an involuntary psychiatric hold, they’re trying to determine:
- Whether the person actually has a mental health condition (either an established, chronic condition or a temporary one induced by something like stress or substance use), and
- Whether that mental health condition puts the person they’re evaluating at risk of harming themselves or others.
That risk of harm can be direct—such as a person threatening to harm or kill themselves or someone else—but it doesn’t have to be.
A person could also meet criteria for involuntary treatment if they’re unable to care for themselves due to a mental health emergency.
For example, they might be at imminent risk of harm due to reckless behavior (like wandering in traffic) or because they’re not getting necessary treatment for a serious medical condition.
If the evaluator determines that a person on an involuntary psychiatric hold is not in need of further care (in other words, it’s safe for them to leave and go home), they note this down and the person is released.
If the evaluator determines that a person on an involuntary psychiatric hold is in need of further care to keep them safe, they note this down and proceed to the next part of the process: civil commitment.
What Is Civil Commitment?
One of the least understood parts of the mental health system is the process of involuntary hospitalization, also known as “civil commitment.”
A lot of people don’t realize it’s still possible to have a person placed in psychiatric care against their wishes, or “committed.”
But it’s still an essential part of the mental health system for many reasons. One is that it’s sometimes the only way to keep someone who’s in crisis safe until they get to the other side of that crisis.
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“Commitment” is an older term that’s not used as much in everyday language anymore, but it’s still frequently used in clinical and civil legal settings.
It refers to the process of having someone held in an inpatient mental health facility to receive involuntary mental health care until they no longer meet “commitment criteria”—meaning they’re no longer at risk of harming themselves or others because of a mental health condition.
We have long since outgrown the days when people were placed in psychiatric facilities indefinitely.
Psychiatric hospitals still exist, but they are now primarily places for short- or medium-term care, not long-term care. People who may need longer-term treatment have to be re-evaluated every so often and are legally required to be released as soon as they no longer meet criteria for inpatient care.
However, while we no longer institutionalize people indefinitely, we still sometimes need to place people in a mental health treatment facility until they are well enough not to be in one.
DEEP DIVE
Is Mental Illness Dangerous?
Less than 5 percent of violent acts are committed by people with serious mental illness (SMI). In fact, people with SMI are more likely to be victims of violent crime than perpetrators—ten times more likely than people in the general population.
However, this doesn’t mean people with SMI are never violent or dangerous. Sometimes, a person’s mental health condition can deteriorate to a dangerous point.
For example, a person with a psychotic disorder might stop taking medications, develop violent delusions, and start hearing voices telling them to hurt themselves or others. A person with a mood disorder might become so hopeless they decide to hurt themselves or others.
This is why we still have and use the civil commitment process: to intervene when someone’s at risk of harming themselves or others so they can get the care they need to keep everyone—including, and often especially, themselves—safe.
We’ve never stopped needing to have a way to help people who are in a mental health crisis but who, because of that crisis, can’t or won’t voluntarily agree to get the help they need to keep them safe.
The complicated nature of mental illness means that many people who might otherwise agree to get the mental health care they need—and see the wisdom of receiving it if they were well—are unable or unwilling to agree to it when they’re in the middle of a mental health crisis.
Civil commitment is the process that makes it possible for loved ones or other concerned individuals to help someone in those circumstances get the life-saving care they need.
How Does the Civil Commitment Process Work?
How the civil commitment process works varies from state to state. However, the process generally follows the same basic steps.
First, a concerned party asks law enforcement (or medical or mental health professionals) to help them place a person who is at risk of harming themselves or others in a psychiatric facility. Next, a mental health professional interviews the person to determine whether they need to be committed.
If the mental health professional concludes that the person meets commitment criteria, the person is placed in a psychiatric facility for a predetermined amount of time. They then receive a commitment hearing, where a judge and mental health team decide if they need to continue receiving treatment in that facility.
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A Step-By-Step Guide to the Commitment Process
While there are differences in the commitment process depending on where you live, the following steps generally describe how it works in most states.
- A private citizen, mental health professional, or police officer initiates an emergency psychiatric hold so a person can be evaluated for involuntary hospitalization.
- A police officer takes a person into custody on an emergency hold and brings them to a secure facility, usually a hospital emergency room, where they can be evaluated.
- A judge or magistrate issues a court order authorizing the person to be detained for a limited period of time while a mental health evaluation is completed.
- A qualified mental health professional (QMHP) performs an evaluation to determine whether the person meets civil commitment criteria. The QMHP typically interviews the person and other relevant parties and reviews available reports and records.
- The QMHP completes a pre-screening report and submits it to a judge or magistrate.
- If the report recommends commitment, and the judge or magistrate agrees, the court issues an order for a person to be involuntarily hospitalized pending a formal commitment hearing.
- The state seeks placement in an accepting facility. This process can take hours, days, or—in extremely rare circumstances—even weeks. How long a person can be held at the place where they were evaluated while waiting for a bed at an accepting facility varies from state to state.
- A facility accepts the person on an involuntary commitment order and the person is transported to the accepting facility.
- Within a set period of time that varies from state to state, the person who has been admitted for involuntary treatment must have a formal commitment hearing. This often takes place at the facility where they are being treated rather than in a courtroom.
- If a judge or special justice upholds the commitment at the hearing, the person is then committed to inpatient care for a set period of time, often up to 30 days.
- Hospital staff can release the person prior to the end of the commitment period if they are psychiatrically stable before that point. They can request a recommitment hearing if the person has not stabilized within the commitment period.
In summary, a person is placed on an involuntary psychiatric hold and evaluated. If the evaluator determines the person should be committed, they receive a commitment hearing.
At that hearing, the judge decides if they agree that the person needs to be committed. If they do, the person is committed to treatment until they are safe to be released—usually, no longer than 30 days, but usually much less than that.
Regardless of which state you live in, you can expect to have to wait for at least several hours before you know if the person being evaluated is going to be admitted on a temporary hold.
You then have to wait (usually for a few days) for the commitment hearing before you know whether they’re going to be committed.
It’s important to understand that it’s rare for people to be committed for long periods of time. Even if the person is committed for a full 30 days, they’re really only committed for as long as it takes to get well. It’s common for them to be stabilized and released before that—they are often only in treatment for a few days.
DEEP DIVE
What Part of the Commitment Process Differs From State to State?
Some of the elements of the commitment process that vary from state to state include:
- Who can initiate a temporary hold or involuntary detention
- Whether a judge must approve the temporary detention or hold
- How long a person can be held pending pre-screening or evaluation
- The rights of the person being held under an emergency hold or commitment
- The timing and location of the formal commitment hearing and who can attend
- How long a commitment order signed by the judge can last before another hearing is necessary to keep a person in the hospital
If you’d like to know more about the specific process in your state, you can call a local mental health crisis and information line. You can also find more information about how these laws work in different states on the Treatment Advocacy Center’s website.
The most important things to know about how commitment works in your state are who can initiate the process and how.
You may be able to initiate it yourself or you may need to reach out to a mental health professional or the police to ask them to start the process.
In 21 states, “any interested person” can initiate the civil commitment process by petitioning for an involuntary psychiatric hold. In 24 states, a relative can start the process.
Several other states that don’t allow relatives to petition for an involuntary hold allow a mental health professional to do so. Some states reserve this right for psychologists or psychiatrists, while others authorize any qualified mental health professional to petition for a temporary hold.
Most states that allow private citizens to request an involuntary psychiatric hold simply require the individual requesting the hold to file a written petition with the court.
Some states require the individual requesting a hold to “show probable cause before a judge or magistrate that emergency commitment criteria have been met.”
This basically means that you need to go to a court and fill out a form, and some courts may need more information than others.
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For More Information on Your State's Process
If you’re not sure what your state requires you to do to request an emergency evaluation (or you’re not sure who is able to request one), you can look up state-specific information on the Treatment Advocacy Center’s website.
If you’re not sure whether you can file a petition yourself, the easiest and most universal way to initiate an involuntary psychiatric hold is to call 911 or otherwise get a police officer to come to the scene and initiate a hold.
In all states, police can detain anyone who poses an imminent threat, and 38 states “explicitly authorize police and peace or parole officers to initiate the emergency [psychiatric] hold process.”
To start this process, you can call 911 and explain to the dispatcher that you are concerned that a person is mentally ill and at risk of harming themselves or others. Tell them that you would like to have an officer place them on an involuntary psychiatric hold so they can be evaluated for civil commitment at a local emergency room or other appropriate setting. Do note that the officer may not follow your recommended course of action.
HEADS UP
The Risks of Calling the Police During a Mental Health Emergency
Sometimes, the safest—or only—thing you can do in a mental health emergency is call the police. This is especially true if the person you’re calling about has a weapon and is threatening themselves or someone else with it.
However, there is also a risk involved when you do. There have been many high-profile cases in which police who were called to the scene of a mental health emergency killed the person they were called to help.
These include cases where there was another option besides using deadly force. This reflects an unfortunate discrepancy between how officers are trained to respond to threats and how they would be trained to respond to a mental health emergency had they received such training.
Fortunately, many states and cities are seeking to address this issue by training officers to respond differently to mental health emergencies. One popular option is establishing Crisis Intervention Teams in which police partner up with mental health professionals for mental health emergency calls.
In any case, consider your circumstances carefully before calling 911 to request police intervention in a mental health emergency.
In some cases, it’s your only safe option. In other cases, alternative methods of getting the person to an emergency room for an evaluation (or even to have mental health professionals come to where the person is) may be appropriate and available.
Depending on your circumstances, you may be able to call a state or local mental health crisis line for help instead of 911. You can go to our state mental health services page and select your state to find the crisis line you should use.
What Are the Potential Outcomes of the Commitment Process?
There’s no guarantee that the civil commitment process will end in commitment. While getting a person admitted for involuntary inpatient mental health treatment is one potential outcome of requesting an involuntary psychiatric hold, there are many other potential outcomes as well.
In states that require a court order to proceed, a judge can reject a petition for a hold. If you call 911 to request an officer-initiated hold, the officer who responds may not agree that a hold is appropriate and may arrest the person instead if they have broken any laws. Alternately, the officer may not agree that there is a legitimate concern and may not take the person into custody at all.
If a hold is approved, the mental health professional who conducts the evaluation may determine the individual does not meet commitment criteria. Even when an evaluator does recommend commitment, a judge may disagree and refuse to order it, in which case the person will be released.
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Mental Health Crisis Lines: An Important Resource
The first number you probably think of to call when there’s an emergency of any kind is 911. In some mental health emergencies, 911 is indeed the best—and safest—option.
However, there’s another number you can call: a state or local mental health crisis line. These hotlines are usually part of the public mental health system and are specifically designed to help people get emergency mental health care when they need it.
There’s no hard and fast rule about when you should use an emergency mental health hotline and when you should call 911. But if you don’t think there’s an imminent danger of harm if police don’t show up immediately, it can be worth calling a crisis line. The person who answers can help you determine whether police need to be called, among other things.
Some states have statewide mental health crisis lines, while others have different local hotlines depending on which county, city, or region you’re in. You can go to our state mental health services page and select your state to find the crisis line you should use.
An officer may choose to arrest the person after finding out they don’t meet commitment criteria if they’ve broken the law, but in many cases, the person will simply be able to go home. If evaluation by emergency room doctors reveals that the cause of the concerning behavior was medical, the person may be admitted to the hospital for inpatient medical treatment instead.
Sometimes, the evaluator will recommend an alternative course of action, such as having the person agree to follow a safety plan or set up an appointment with a therapist. However, the only thing other than inpatient commitment that can be enforced by the court is mandatory or involuntary outpatient treatment in states whose laws permit it.
When commitment is ordered, the person may not be held or treated in the accepting facility for very long. The facility will release the person as soon as they’re stable enough to be released, which may happen in just a few days, or even after they’ve been there less than 24 hours. In some cases, the person may need the full 30 days of treatment that was ordered.
Who Can Be Committed?
People can only be committed if they have a mental health condition and they’re at risk of harming themselves or others. And they can only be committed for as long as they pose that risk. This wasn’t always the case.
According to the Treatment Advocacy Center, “Prior to the 1960s, obtaining involuntary treatment was straightforward. Typically, state laws hinged on a simple determination that the person required care and allowed commitments to be continued indefinitely without ongoing judicial oversight.”
This means the only requirement for someone to be institutionalized against their will before the 1960s was for them to be mentally ill. Following the deinstitutionalization movement and several legal cases in the 1960s and 1970s, this standard was changed.
Now, state laws require that people receive treatment in the least restrictive setting possible and that they should only be involuntarily hospitalized under very specific conditions.
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What Are the Criteria for Commitment?
While laws vary from state to state, all state laws include two basic criteria for commitment.
The first is that a person must have (or be suspected of having) a mental illness.
The second is that a person must be at risk of harming themselves or others.
This means a person who is acting erratically or threatening others can’t be committed if their behavior is known or believed to be caused by something other than mental illness.
People who pose a threat for reasons other than mental illness must instead be arrested and placed in police custody if there are grounds for arrest. (In most states, people can be arrested for making violent threats even before those threats have escalated to assault.)
DEEP DIVE
Could Civil Commitment Prevent Mass Shootings?
The problem of mass shootings in America is often defined in the media as a mental health problem and a sign we need more and better mental health care.
However, while we do need more mental health care, this is an unfair and usually inaccurate characterization of the root cause of these terrible and tragic events.
Most mass shooters don’t meet any clinical or legal definition of mental illness. Instead, most are driven to violence by personal vendettas or ideologies that sanction violence.
Unfortunately, targeting mental illness as the reason for these events has revived an inaccurate stigma that mental health advocates have been speaking against for decades.
While people fear that people with mental illness are more dangerous than others, the truth is that people with mental illness are more likely to be victims than perpetrators of violence.
Some people with mental illness can and do become violent, but it’s an exception to the norm. Less than 5 percent of violent acts are committed by people with serious mental illness.
There are times when commitment has kept others safe from someone who actually was mentally ill and dangerous, and there are times when it can—and hopefully will—do so in the future.
There might well be cases when commitment could stop an act of mass violence. This is one important reason we still have it. But in most cases, the people it’s saving from harm are the people being committed.
States vary on how they determine if a person is at risk of harm. In some states, people can only be committed if they pose an overt and immediate risk of violence toward themselves or others. However, most states also allow people to be involuntarily hospitalized if they are at risk of harming themselves or others inadvertently due to “grave disability.”
For example, in most states, people can be committed if they are unable to care for their basic needs or are at risk of deteriorating to the point of becoming dangerous if they are not treated right away.
Conclusion
The commitment process temporarily suspends a person’s rights and should not be taken lightly. If it’s safe to talk to the person you’re concerned about, take the time. You may find that they need help but not the kind you thought.
If you find a person is not at immediate risk of harm, and does not have symptoms severe enough to merit inpatient treatment, consider using the search tools on OpenCounseling to find affordable local therapy and to help them set up an appointment.
If you do find that they need immediate help and aren’t able or willing to get it, reach out. Commitment can save lives when used wisely and well.