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Psychiatric Commitment

Psychiatric Commitment is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Psychiatric “civil commitment”: The state-sanctioned involuntary hospitalization ofmentally disordered individual
  • Voluntary psychiatry hospitalization: Voluntary psychiatric admission of competent adult who agrees to hospitalization
  • Commitment criteria (review specific laws in your state):
    • Individual is mentally ill (many states exclude mental retardation, antisocial behavior, medical illness, and substance abuse)
    • Likelihood of serious harm defined as:
      • Substantial risk of physical harm to self
      • Substantial risk of physical harm to other persons
      • “Gravely disabled”: Inability to care for basic needs, including food, clothing, shelter, medical care, and safety
    • No less-restrictive alternative to hospitalization would attenuate risk
  • 2 stages of commitment:
    • Emergency detention and admission (sometimes called emergency hold)—an emergency admission with minimum of legal process. Usually 72 hr
    • Longer-term commitment—requires judicial approval of continued confinement in an adversarial proceeding where patient may have legal representation

Etiology

  • Underlying genetic/biologic predisposition to psychiatric illness
  • Precipitating psychosocial events can trigger onset or worsening of symptoms
  • Substance abuse can worsen symptoms or lead to disinhibition causing worsening safety concerns

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Citation

Rosen, Peter, et al., editors. "Psychiatric Commitment." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307407/all/Psychiatric_Commitment.
Psychiatric Commitment. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307407/all/Psychiatric_Commitment. Accessed April 24, 2019.
Psychiatric Commitment. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307407/all/Psychiatric_Commitment
Psychiatric Commitment [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307407/all/Psychiatric_Commitment.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Psychiatric Commitment ID - 307407 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307407/all/Psychiatric_Commitment PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -