Does a psychiatrist have the authority to send patient to hospital?

September 24, 2015 10:37 AM

Daughter (here's her backstory) may be on the verge of a psychotic episode - definitely not taking meds as prescribed, e.g., too much of some, not enough of others. Her dad and I would like to see her return to the hospital to stabilize her meds and deal with issues that weren't dealt with during the past 3 (!) hospitalizations, but she does not want to go.

We can probably get her into her psychiatrist today to get prescriptions renewed. If he observes alarming behavior (i.e., whatever behavior would get one sent to the hospital for their own good), does he have the authority to call the police and have her taken to the hospital?

(If I called him with this question, he wouldn't get back to me for days. I'm hoping to know what's possible before we call for the emergency appointment.)

posted by zombies puppet to Health & Fitness (6 answers total)

I don't know the laws in your city and wouldn't presume to answer. But I strongly suggest you call a mental health crisis hotline in your area. It's their job to know exactly what the involuntary commitment process is and who can initiate it, and to be available to tell you about it immediately. They can walk you through what you need to know.
posted by Stacey at 10:43 AM on September 24, 2015 [2 favorites]

Please reach out the National Alliance on Mental Illness or the Treatment Advocacy Center.

Overall, if a person is not in imminent danger, it's decidedly unlikely that a psychiatrist would unilaterally attempt to have them committed, especially if they're just there for a med check, but the requirements for commitment ("whatever behavior would get one sent to the hospital for their own good") vary widely from state to state. Here is a list of summaries of those standards, with each state's relevant statutes listed in the "Relevant Code Sections" column.
posted by divined by radio at 11:30 AM on September 24, 2015 [1 favorite]

I am so sorry that you and your daughter going through such an awful experience in recent months. You must feel so terrified and powerless right now. I don't know if you've been able to find support resources for yourself during these past few months, but it is very helpful to have someone in your corner that you can unburden to and strategize with.

I'm not a mental health professional, lawyer, or any of that--just someone who' been through the child-with-mental-health-problems rodeo more than a few times. My comments:

(1) I'm not sure that, in the eyes of her psychiatrist, psychotic behavior alone, or mentioning suicidal thoughts, is enough to warrant having her sent to the ER against her will. The standard concept is being an immanent threat to herself or others. I won't say that a psychiatrist would never initiate an involuntary hospitalization on a patient for discussing, e.g., suicidal ideation, but in general I'd suspect that without a clear plan to substantially harm themselves or someone else, and clear intent to act on that plan in the near future, a psychiatrist is not going to intervene in that way. It's not a crime per se to be psychotic or delusional, to feel angry or hostile, to be med non-compliant or engage in risky behavior, etc.

(2) If YOU feel she is behaving in a way that constitutes an immanent threat to herself or others, YOU can bring in the police yourself. Anyone can, really--it's not a special power that outpatient psychiatristics have, although there are baked in complications about liability and duty of care that your ordinary joe on the street does have to think about. Calling the police on your own kid is a literal tough call, and in the short run your daughter may feel a lot of distrust and anger directed at you for making that call. But you may want to weigh that off against what would happen if that distrust and anger were directed toward her outpatient MH providers.
posted by drlith at 11:35 AM on September 24, 2015 [1 favorite]

This really depends on the state and jurisdiction in which you live. In most places, a psychiatrist can basically send someone to an ER for an evaluation, and is authorized to call the police to come to transport the person. The police may or may not show up timely. They will likely not make sure the person stays for an evaluation.

In most places, either by law or by custom at this point (after the systematic dismantling of our country's mental health network), the authority to take these actions is based on a standard that assesses the danger of the person at issue. Merely being disorganized (in the clinical sense) and decompensating, does not usually meet that standard.
posted by OmieWise at 11:48 AM on September 24, 2015

It sounds like you're asking if the doctor can put your daughter on an involuntary hold. This varies from state to state, so google or call Nami. Where I work, involuntary holds can be placed if it's felt that the person is a danger to him- or herself and/or a danger to others and/or gravely disabled, which means that due to their psychiatric illness the person cannot seek food, shelter, and/or clothing. Again, depends on the state, but there are times that people are, for example, clearly psychotic... But if people where I work don't meet th criteria above, they cannot be held against their will. (As OmieWise and others mentions.)

Again, get very familiar with the mental health laws in your state and ask for help in deciphering their nuances. They are ultimately there to protect patient autonomy and rights, but can be very frustrating for family members.
posted by namemeansgazelle at 6:34 PM on September 24, 2015

Just wanted to add that if you should do your research about the best to try to trigger an involuntary commitment. In particular, find out if there is a special department within the police trained to handle psychiatric emergencies - if there is, you definitely want to know the magic words to ask for that. Otherwise, be very careful that you don't give the police the idea that your daughter might be a danger to others - there have been enough unfortunate encounters between untrained police and the mentally ill that you want to do what you can to make sure that don't play any role in creating that kind of catastrophe. NOT saying never call the police, just saying do some homework now (maybe with NAMI) to help you if the need arises.
posted by metahawk at 10:21 PM on September 24, 2015