Get Someone Committed to a Mental Hospital

Someone you know has possibly become a threat to themself or others. This is the threshold of behavior that once crossed, instigates the need for action. You care about this friend or loved one and your involvement has become an obligation that is racked with complexity. Most people are not well-versed on what to do if someone needs to be admitted to a mental hospital. Whether an intervention or involuntary judicial or emergency commitment is required, learning what to do in each instance will prepare you for the road ahead.

Steps

Conducting an Intervention

1. Determine if an intervention is appropriate. An intervention occurs when friends and family who are concerned about someone join together (sometimes with a doctor, counselor, or intervention specialist) to try to help the person understand the consequences of addiction or behavior. The intervention group often asks the person to accept treatment or offers to help find a solution to the problem. Examples of addictions that may warrant an intervention include:
   • Alcoholism
   • Prescription drug abuse
   • Street drug abuse
   • Compulsive eating
   • Compulsive gambling
   • For other mental health concerns (such as depression, anxiety, or suicidal tendencies), an intervention can be too embarrassing or misunderstood.
   • For someone that is a harm to themselves or others, calling 911 is the best option - no intervention needed.
2. Clarify if the person wants help. Basic human rights allow a person to ask for and accept help. Those same rights allow a person to reject the help they might need. The person may not think they have a problem, but their demonstrated behaviors tell you otherwise. Part of your role will be to help convince them that they need the help and need to accept it.
3. Develop a plan of action. Prior to the intervention, develop at least one treatment plan to offer to the person. Make arrangements ahead of time if the person is going to be escorted to the mental health facility directly from the intervention. The intervention will mean little if they do not know how to get help and does not have the support of loved ones.
4. Stage the intervention. Help comes in many forms, and must be forced sometimes. It is a hard decision to make, but one that is necessary if the person’s mental condition has spiraled out of control and the person’s life is in danger. While an intervention will likely be overwhelming to the person, the intent is not to put the person on the defensive.
   • Those who will participate in the intervention should be carefully chosen. The person’s loved ones can describe how the situation is affecting them.
   • You will likely have to ask the person to attend the meeting at the location where the intervention is supposed to take place without revealing the reason.
5. Convey the consequences of refusing help. Be prepared to offer specific consequences if the person rejects seeking treatment. These consequences must not be empty threats, so the person’s loved ones should consider the consequences to be imposed if she does not seek treatment, and be willing to follow through.
6. Prepare participants for the emotional upheaval. Participants should prepare specific examples of how the loved one’s behaviors have hurt the relationship. Often, those staging an intervention choose to write letters to the person. A person with a mental illness may not care about their own self-destructive behaviors, but seeing the pain her actions inflict on others can be a powerful motivator for seeking help.
   • An intervention may also include the person’s colleagues and religious representatives (if appropriate).
7. Suggest an in-patient program. Contact several mental health facilities and inquire about their services. Don’t be afraid to ask specific questions about their daily schedules and how the center handles relapses.
   • If an intervention is not necessary, assist the person in researching both the mental illness they are suffering, and recommended therapy and drug treatment plans. Be supportive and allow the person to feel in control of the impending activities.
   • Tour the suggested programs and keep in mind that the more receptive the person is of the treatment plan, the better the chances of successfully managing their illness.
8. Visit the person when appropriate. If the person is admitted to an in-patient treatment program, there will be rules for visitation that will need to be clarified. Understand that you need to allow the person to participate on her own without influence from anyone on the outside. The staff will inform you when to visit and the visit will likely be deeply appreciated.

Guiding a Judicial Commitment

1. Clarify the law. Involuntary commitment implies you are taking a person’s freedom away. This serious procedure varies from state to state, but in general, involuntary commitments are either judicial or emergency and require input from a doctor, therapist, and/or the court. Often, after a suicide attempt, temporary commitment is mandatory.
   • Every person has the right to the least restrictive treatment, which isn’t always the most beneficial treatment.
   • Here is a link you can use to look up specifics and what is required on civil/judicial commitment by state: http://www.treatmentadvocacycenter.org/get-help/know-the-laws-in-your-state.
2. Visit the city or county courthouse. Do this in the district where the person has a residence. Ask the clerk for the proper petition forms. You can complete them there or take them home and return at another time. Once the forms are complete submit them to the clerk.
   • You will be asked to describe the behavior the person is exhibiting that would support this person being formally committed to a mental facility.
3. Attend the hearing. If there is not a reason for immediate commitment, a hearing will be scheduled, and the judge will make the final determination based on any evidence presented. Once the papers are filed, you will have little direct influence on what happens though you will likely be called upon to testify at the hearing.
   • The person may be ordered by the court to undergo a mental health evaluation, which may or may not result in the court ordering treatment. If so ordered, the person may be committed to receive treatment or ordered to undergo supervised outpatient treatment.
4. Secure a restraining order if necessary. The person in question may have serious problems with being placed in an inpatient mental health facility. If there is not an immediate resolution, and you feel you are in potential danger, seek a restraining order against the person to restrict her contact. If she violates that, you can ask the police and mental health professionals to intervene.
5. Prepare for attorney involvement. The person has the right to get a second opinion, and if not completely impaired, will likely argue that she should not be committed. Be prepared to talk about the situation with her attorney, health care professional, or other advocates.
   • If it comes to this, it would be wise to secure the services of an attorney yourself.
6. Anticipate an early release. Be aware that the person may get released from the mental health facility without you knowing, or being prepared. The person’s demands and demonstration of “healthy” behavior, a doctor’s orders, or lack of insurance coverage can be reasons for early release.
   • You can sometimes block a premature discharge by strong advocacy such as pleading your well-documented case to the doctor in charge. If you're truly committed to this course of action, you will need to be a strong voice for yourself. If the person is somebody close to you, remember that this is in everyone's best interest in the long run.
   • Cutbacks in both services and staff have significantly shortened hospital stays. If you can participate in discharge planning, insist on real, demonstrated signs of progress, real, insurance-authorized supports for recovery, and real protections for you and the person.
7. Gather supporting documentation. If you are seeking immediate commitment and there is no immediate danger, you will likely be required to provide evidence to justify your request. This may be the statement of a licensed physician, or sworn statements by other witnesses that the person in question could be a danger to themselves or to others.
   • If the judge agrees, local law enforcement will detain and escort the person to the local mental health facility, and a hearing will be scheduled for further resolution.

Expediting an Emergency Commitment

1. Assess the situation and call 911. Whether it is a first time occurrence, or there is a history of situations requiring the authorities, be confident in your assessment of the severity of the situation. Emergencies are not a time to feel embarrassed or coy when the situation involves a person with a mental illness. It may be a matter of life or death.
   • Describe the situation in a calm and detailed manner. Be very clear about the situation, and do not increase the likelihood any potential threat. Law enforcement personnel are trained to prevent injury or death to others; however, tragic consequences can occur at the expense of the person with a mental illness.
2. Be an advocate for the person. When speaking on the phone and when the emergency responders arrive, you need to explain that the person suffers from mental illness and that you are the person’s advocate. Make it clear that this person deserves compassion and respect to avoid potential harm.
   • It will be up to you to ensure that all parties are aware that the person suffers from mental illness. This will help avoid potential unfair treatment and harm to the person.
3. Facilitate teamwork for a positive outcome. Be helpful to those trying to provide assistance. The person is likely to be agitated, upset and afraid of being taken away. Who wouldn’t be? The consensus is that you are all working as a team to help this person get the help she needs.
   • You will need to reassure the person by saying, “These people are here to help you and they want the best for you. I want the best for you too. I know this might seem scary, but this will all work out.”
   • If a crime has been committed the person will likely be taken in and processed.
   • If the person violates a restraining order the police will arrest the person. They may bring in an emergency services team, which will include a physician who can commit the person.
4. Accompany the person to the hospital. If it is appropriate to ride in the emergency vehicle with the person to the hospital, then do so. Drive or get a ride to the hospital where they are taking the person for evaluation. You will need to be present to provide essential health related information they will need to perform a psychiatric evaluation.
   • This might be very difficult, but you must find the courage to help this person.
   • Keep in mind that you would appreciate the same accommodation should something like this happen to you.
5. Let the process happen. The moment is difficult when you realize that the only way the person can be helped is if they admit her for further evaluation. An emergency hospitalization for mental illness in a treatment facility will be temporary in nature. There are many things to be considered. Depending on the circumstance, a person can be held involuntarily for 72 hours or longer.
6. Mobilize all resources for future events. Once the person is committed, you will have limited time to organize and put a plan into action. Where will the person stay when they are released? Are children involved, and if so who will they stay with? What out-patient treatment will the person need? Are there any support groups or organizations that can provide guidance?
   • Although the person might be held for a 72 hours period, they may be released early and without your knowledge. Anticipate this and ask the doctor or nurses, “If she is released prior to the end of the 72 hour hold I need you to contact me as soon as possible.”
   • They may not share this information if you are not family or authorized to hear private medical information per HIPAA regulations.

Following Up

1. Remain strong and focus on healing. The person may be very close to you: a parent, spouse, or child, perhaps. If she has a mental illness, you're not hurting her by having her committed—you are giving her an opportunity to heal, or at least get the treatment she needs. You are also doing this in a way that will prevent her from causing physical or emotional injury to others.
2. Seek professional help for yourself. If you are struggling to manage the stress and anxiety related to helping a friend or loved one with a mental illness, find someone to talk to who can help. Psychologists and Psychiatrists are available in your local area and can be located through the American Psychological Association and the American Psychiatric Association.
3. Accept the person back into your life. Once released, a person who must manage mental illness will need structure in her life. You can be a big part of making that happen. A welcoming attitude might be exactly what the person needs. Every person has a need to feel a sense of belonging, and you can foster that for the person.
4. Ask the person about her progress. Make it clear that you are genuinely concerned for the person and want her to be successful. It is important that she takes her medication, and attends therapy or support group meetings. These are likely to be a requirement of any treatment program.
   • Help the person be accountable to her program. Ask her if there is anything you can do to help her stay committed to attending. Be kind, but don't let her slack off.
5. Recognize the resources you have gained. Be resourceful if the person needs your help in the future. Mental illness is a disease therefore it can be managed, but not cured. Relapses will most likely happen, and everyone involved should not consider a relapse a failure. However, treatment will be needed following each relapse.
   • Once you go through the process of helping a person with a mental illness, you will have the know-how, confidence and information necessary to help others.
6. Realize you are not alone. There is a tendency to think you are the only one who experiences the thoughts and feelings you are having. You must understand that many others have felt exactly what you are feeling and have struggled with getting a person with a mental illness the help they need. Fight the urge to push yourself to the outside where you might isolate yourself and not get the help that you need.

Tips

• Your personal safety is paramount. While the vast majority of people with a mental illness are not violent, they are unpredictable and may not be themselves when having a psychotic break.
• Never lie. Don't ever try to commit someone who isn't a danger to themselves or others. You might wind up flipping the situation onto yourself when it backfires.
• Treat people who have experienced an episode of mental illness like you would anyone else recovering from a serious illness. Give a get well soon card, a few flowers or support her in their recovery.
• Local law enforcement is aware of mental illness, and may have training in dealing with it, or may be able to refer you to somebody who does. You should not let shame or stigma keep you from getting information that could be helpful.
• Encourage the person to admit they need help. Ask if you can help in any way.
• There is a difference between criminal behavior, and someone with mental illness. Don't try to commit someone who should be going through the jail system.

Warnings

• Mental illnesses often affect judgment. As many as half the people with psychotic illnesses—schizophrenia, bipolar, psychotic depression—will not admit or actually do not know they have a mental illness. They will not seek help for themselves unless they realize their problem. In the meantime, they may tend to "self-medicate." This usually translates to substance abuse.
• Maintain your self-preservation. If this is a family member or someone you love and care for, you should stay with them as long as you can, but you should disengage before it ruins your life.
• Be certain the person can withstand the destabilizing effect that going through the court and commitment process has on her life. Will this interfere with their future ability to secure employment? Will she lose her job, relationship, or housing?
• Your friends or relatives might resent you for trying to get the person committed. You are not to blame for this situation. Set boundaries and understand anger is part of the acceptance process.
• The person committed will likely be discharged with a prescribed medication, and it will be up to her to take it. So there could be fall back.
• Realize that committing someone is for a limited time-frame, it could last hours, a few days, probably no more than a few weeks. Once the person is out of crisis, they will be released.
• Are you suffering from caregiver burn out, or fearful of your loved one becoming a burden to your resources? Are you blowing things out of proportion? Could this problem be resolved by setting stronger personal boundaries? Get the help you need.
• Prepare yourself for a possible loss. Suicide is caused by mental illness and is the 10th leading cause of death in America. Understand the stress may be hard on your friend or relative and try to be understanding.

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Sources and Citations

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