laws surrounding involuntary commitment for psychiatric treatment in CA?

July 12, 2006 5:23 PM

What are the laws surrounding involuntary commitment for psychiatric treatment in California?

I am asking on behalf of a co-worker, whose sister (an adult, in her 40s) is very mentally ill: severely bipolar, plus my co-worker is beginning to see signs of schizophrenia (both of which run in her family; several cousins commited suicide and other family members apparently attempted). My co-worker's sister is becoming progressively worse: self-mutilating incidents, escalating threats of suicide (which she says she won't actually carry through on because she doesn't want to go to hell), paranoia, property destruction at my co-worker's house (where they both live - there is no longer any other family left alive) such as spray painting the walls, ripping out landscaping, etc. The sister categorically refuses medical treatment and medication. (She has seen doctors in the past but will no longer go.)

My co-worker is at her wit's end - she is the only family member left, and lives with her sister who now persistenly abuses and threatens her (I overheard the sister *screaming* on the phone at my co-worker for about 25 minutes today). She herself is on antidepressants just to keep functioning - otherwise she says she fears she'd start to become suicidal herself, just to escape from her sister's abuse. She said to me today that she's beginning to consider what it would take to have her sister commited to a psychiatric hospital for treatment - but has no idea where to start or what the laws/process/etc. for such a daunting thing are. Where to start?

posted by anonymous to law & government (6 comments total)

Start with Code 5150.
posted by Zed_Lopez at 5:29 PM on July 12, 2006

A friend of mine goes through this periodically with his brother and there are a number of things she can do:

call her GP or family doctor
contact NAMI California
if she or her sister are in imminent danger- call the police.

Any of these people can advise her on involuntary committing her sister, obviously the police are the last resort but they do deal with this kind of thing a lot and they are not ogres. Normally.
posted by fshgrl at 5:38 PM on July 12, 2006

"...she's beginning to consider"? With all due respect to your friend, while she agonizing over whether and how to act, two lives are careening out of control. She's been in this hell so long that she's lost the ability to tell "bad" from "hella urgent do something right NOW".

1) You have a friend who is talking suicide. That has to be taken seriously, especially given the stresses she is under and the family history of mental illness. Consider this an urgent life and death situation. If your friend won't agree to immediately consult a mental health professional TODAY about that, call NAMI or the county mental health dept (phone book blue pages) to get her help.

2) You know of someone who is an ongoing danger to herself, has a track record of harmful activities, and who is threatening her own life and possibly is a threat to others such as her sister. This allso to be taken dead seriously. Same advice: either your friend makes the call TODAY, or you do.

Your friend is clearly way out of her depth and apparently has been for some time. That's heartbreaking. With professional help, they both can find more stability. Someone needs to get both these women some assistance before it's too late. Be that friend. Even if it means she never speaks to you again, care enough to risk the friendship over something this important. Please.
posted by nakedcodemonkey at 6:20 PM on July 12, 2006

P.S. Once the call is made, literally within the hour they can be in treatment if necessary. If they can't afford it, the county will foot the bill. Preventing people from killing themselves and each other is one of those good ways we invest tax dollars.

//speaking from personal experience
posted by nakedcodemonkey at 6:24 PM on July 12, 2006

The mechanics of the involuntary commitment process are covered in the link from Zed_Lopez above. But don't be lulled into thinking this problem is going to be handled entirely by a phone call to the cops, who will come and take the lady causing the problems to the hospital, where she'll be fixed up.

Bi-polar disorders occur with a huge range of symptoms, and an equally large range of long term treatment compliance by those who suffer from these conditions. It generally takes a lot longer than the initial 72 hours evaluation period discussed extensively in the above link to medically establish medications for a bi-polar sufferer, and evaluate the patient thereafter. So, these cases often get into involuntary commitment situations, which can be and frequently are challenged by the patient. Unless the treating facility has made direct observations of behavior where the patient is an immediate danger to themselves or others, the patient can frequently prevail at the involuntary commitment hearing, and be released, even if Against Medical Advice. There's no law against being miserable and muttering on the street, if that's what a person prefers to treatment, so long as they are not demonstrably a danger to themselves or to others. So, the sister who is the caregiver in this situation may well need to be prepared to appear at an involuntary commitment hearing, ready to provide convincing evidence of the troubled sister's behavioral problems.

This is a tough thing for family members to do, since they may have very equivocal feelings at that point about being the person to "put away" their family member, even if they believe it is the right thing to do. This is particularly true for family members who have been primary care givers, since it can also seem to be a further admission of their own failures as a care giver. So, the care giver sister needs to be prepared for all that, and willing to carry through legally as needed, if it comes to that.

Bi-polar disorder is a bitch from a community based treatment perspective. The condition itself works against patients remaining medication compliant over the long term, and without the right medications, and careful, continuing medication management, the chances of a severely impacted patient remaining in any kind of stable home situation are minimal. But clearly, something has to be done in this situation, to save the sanity, if not the life, of the care giving sister. She needs to make the call, and she needs to follow it up as needed, to get her sister effective long term help, regardless of how difficult that may be for her. Good luck.
posted by paulsc at 9:08 PM on July 12, 2006

A doctor can "5150-hold" a person without their consent, causing them to be involuntarily detained for up to 72 hours, if in that doctor's judgment the patient is in imminent danger of harming himself or another person. This danger can be through harmful intent (malice, suicidality), or through diminished capacity (delirious, can't tell right from wrong due to mental retardation or severe psychosis, etc.) If that person tries to leave they can be detained with drugs, leather restraints, locking them in a room, etc.

Extending that 72 hour hold can be done via court order. In places where this is routinely necessary, like the L.A. County Hospital psych ward where I trained as a med student, a judge actually comes by every day or two and stops off at the bedside with the doctor. The doctor says his piece, briefly, saying why the person should still be detained. Often the patient agrees. If the patient does not agree, the patient gets a chance to speak to the judge.

Long term psychiatric hospitalization can be very expensive for the family members to pay for, in which case it's often quite humane and rehabilitative.

There are also free alternatives. In my experience, I would recommend that every other reasonable and unreasonable alternative be fully exhausted, and then maybe try some other things, before committing a loved one to such a place.
posted by ikkyu2 at 12:22 AM on July 13, 2006