Psychiatric Commitment

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

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  • 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


  • 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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