Measure content performance. Develop and improve products. List of Partners vendors. Can you be committed to a psychiatric ward at a hospital or a mental hospital against your will? What if you are feeling suicidal? What should you know about both short-term emergency detention and long-term commitment?
The short answer is that you can be committed to a mental hospital against your will if you meet the criteria set forth by the state in which you live. The exact criteria vary, but often include the requirement that you must present a danger, either to yourself or others, before you can be committed.
The exact process for commitment varies from state to state. Additionally, each state has procedures in place that prevent you from being detained without just cause, such as requirements for medical certification or judicial approval. Who can initiate the process of having you committed also varies from state to state and depends on the type of commitment being sought.
It's important to note that there is also a significant difference between emergency detention—committing a person for a short period of time—and longer periods of commitment.
Suicidal thoughts and feelings along with the belief that you are in immediate danger of hurting yourself would fall under the umbrella of reasons for a short-term commitment or involuntary hospitalization for depression. Other criteria that may be considered include whether you are able to take care of yourself and whether you are in need of treatment for your mental illness.
Some states do not require that a person be in danger of hurting themselves or others, and involuntary hospitalization may be considered if a person is refusing needed treatment for mental illness.
The definition of mental illness also varies from state to state. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call For more mental health resources, see our National Helpline Database. A short-term emergency detention, such as detention immediately following a suicide attempt, can generally be requested by anyone who has witnessed the situation that you are in, including friends, family, or the police.
Even though almost anyone can initiate the process, most states do require either medical evaluation or court approval in order to ensure that you meet that particular state's criteria. The allowed duration of emergency detentions vary from state to state but are most often limited to 24—48 hours before a civil commitment proceeding must be initiated. Some states have longer detention periods that can range from four to 10 days.
Forced hospitalization means keeping someone in the hospital against his will. Patients can challenge their forced hospitalization. This is used in emergency situations for people who present a grave and immediate danger to themselves or to others because of their mental state. They can be kept in the hospital against their will for up to 72 hours without permission from a judge. To learn more, read our article Forced Hospitalization in Emergencies 72 hours.
This is used to keep people in the hospital for a psychiatric exam. People cant be kept up to hours. To learn more, read our article Forced Hospitalization for a Psychiatric Exam. This is when two psychiatrists decide someone should stay in the hospital because they present a danger to themselves or others. In France, Coldefy and Curtis [ 29 ] analyzed the geographical locations of specialized psychiatric hospitals from — with a stronger focus on the earlier period.
Limitations of classical models of spatial diffusion, the processes of the conservation and transformation of geographical spatial structures, were found although not consistent with all the different phases of development of psychiatric institutions. The developmental process of these psychiatric hospitals seems to be associated with the national policies, social representations, and medicalization of care of mental illness, urbanization and economic growth.
The authors therefore suggested that a political ecology approach, a model that takes into account the relationship between political, economic and social factors with environmental issues and changes, might be more appropriate to understand the vast development of French psychiatric care [ 29 ].
As Figure 2 reveals, the theme of bricks and mortar has constantly been in part discussed in the literature over the time period covered in this review. However, relatively few papers have focused on this theme prominently compared to others.
The narrow focus may have been triggered by the deinstitutionalization movement and the negative perception of the institutions as dehumanizing and damaging for the mentally ill. Despite the negative connotation people have formed about institutions, it appears that mental health professionals have always been concerned about this aspect of mental health care as it is an underlying principle of moral therapy — it defines the physical place where care is provided and where treatment is give to patients and thus has always been part of the debate.
Before the radical shift from large psychiatric hospitals to community-based services, the physical building of large mental hospitals defined institutional care [ 1 ]. Although there has been a tendency to open wards up and allow patients free movement, many psychiatric hospitals still operate to some extent as a safeguarding system, and a considerable amount of care is still provided behind locked doors [ 30 — 32 ].
For instance, large numbers of Swedish inpatient psychiatric wards are locked [ 33 ] and 22 out of 87 acute wards in London were locked permanently according to a study in [ 34 ]. This occurs despite evidence from a German study that a closed entrance door to an acute psychiatric ward did not reduce absconding [ 35 ]. In an ethnographic study of three acute wards in London, Quirk and colleagues found that entrance doors may also be locked temporarily to prevent patients from escaping while some patients might be required to transfer to a locked, intensive care unit [ 20 ].
On wards that have more of a permeable nature, instead of locking patients up, an alternative method has been employed to manage the risk of patients running away or self-harming — a staff member is appointed to observe the patient closely at all times.
Besides placing a patient in a locked care unit, seclusion, restraint and sedation are also identified as interventions to monitor and control the high-risk and potentially dangerous behaviors of a patient who is experiencing a severe psychotic episode [ 36 , 37 ]. Admitted residents are not allowed to leave the psychiatric institution without being officially released or discharged. Besides exploring locked facilities as one type of psychiatric treatment model, legislation has also been set up for the practice of involuntary placement or treatment of people with mental illness.
The mental health law and legal framework for involuntary placement or treatment varies across Europe. Significant numbers of patients in Europe are involuntarily admitted to psychiatric hospital units [ 39 ]. Frequencies of compulsory admission were found to vary across the European Union [ 40 ].
However, law and practice does not always coincide. Katsakou and Priebe [ 41 ] found that many patients feel retrospectively that the involuntary admission was justified while another study revealed a significant proportion of formally voluntary patients feel coerced [ 42 ].
The variation across countries might be related to differences in legislation between countries [ 43 ]. Therefore, it is critical to regulate any psychiatry practice that limits the autonomy of an individual. Restriction of freedom of choice and social integration of patients with mental illness may also occur in community psychiatric treatment settings.
In England and Wales, the Mental Health Act , which was amended in considerably, allows individuals with a mental disorder to be admitted to hospital, detained or treated against their will for both their own health and safety or for the protection of the general public.
Compulsory community treatment was introduced as one of the amendment to the Mental Health Act In Germany, the advantages and disadvantages of closed psychiatric homes in Berlin were discussed recently in a debate paper [ 45 ]. Reumschuseel-Wienert argued for closed psychiatric homes because community psychiatric facilities are not capable of providing sufficient care for patients with severe limitations, such as a lack of insight into their illness, an inability to regulate or control their emotions, or to structure their time and the organization of their self-care.
Crefeld, on the other hand, suggested that it is not unknown that patients with severe mental impairments often need help to cope with everyday life. He claimed that it is difficult to provide person-centered treatment in closed psychiatric homes because this form of care generally offers all residents the same consistent care package regardless of whether the individual residents need it or not.
As the numbers in Figure 2 show, the attention to the theme of policy and legal framework emerged after the year Before this, little attention was paid to this aspect of institutionalization. This may be because most mentally ill people are no longer treated in large mental hospitals in remote areas as a result of the changing pattern of mental health care — the closure of large mental hospitals, the decline of psychiatric hospital beds, short stay admissions and the development of care in community.
Therefore the emphasis has then shifted towards more on the legal aspect, such as the rise of compulsory treatments [ 40 ]. Institutional care can also be characterised by the service organization and the responsibility that mental health professionals have for patients. Besides safekeeping the patients, many treatment and care elements such as shelter and protection are also provided on modern inpatient hospital wards [ 46 ].
Inpatient treatment for instance offers the chronic mentally ill patients, whose symptoms cannot be controlled in an outpatient program a structure in which treatment can effectively control their symptoms. For instance, antipsychotic medication has been considered as a primary inpatient treatment modality.
It has been seen as helpful and effective in suppressing psychotic symptoms in the hospital, but also as potentially hindering community adaptation on discharge. For this reason, Talbott and Glick argue it is essential to reduce medication at some point after discharge [ 46 ]. While many mental health professionals perceive psychiatric institutions as a treatment model that is isolating the mentally ill, in the late s, the treatment environment provided by inpatient wards has been considered potentially beneficial for patients [ 47 ].
Linked to this, psychiatric institutionalization has been seen as providing protection and care to patients who are chronically mentally ill [ 46 , 48 — 51 ]. It has been highlighted that even the best community care does not offer enough care and protection for the many chronically mentally ill and the need for sanctuary and asylum can only be provided as an institution of some kind [ 48 ].
Wasow claimed that institutionalization does not necessarily cause dependency; rather it provides a permanent, structured, supervised housing for the chronically mentally ill [ 48 ]. In addition, institutional care protects this vulnerable population from the prejudice and the hostility that they might experience in the larger society.
Samuel, a typical case of a single patient, who spent 36 years in a large mental hospital in Northern Ireland, was reported as an example of a patient utilizing the hospital as a lodging house. Meanwhile he did odd jobs such as gardening for his fellow churchgoers and went to church regularly in his last ten years [ 51 ]. He had been an involuntary patient for the first 25 years of his stay and then refused to be discharged from the institution because he was happy with his life at the time.
A more recent way to understand institutionalization in psychiatry is in terms of the relationship between staff members and patients. In the present day, psychiatric care does not rely solely on hospital facilities.
As a result of the large reduction of psychiatric hospital beds and the re-focus of institutionalized care to community treatment, more people with severe mental illnesses are treated in community-based settings [ 9 , 54 ]. There are several residential alternatives although they cannot be considered as an optimal option for all patients to acute inpatient psychiatric services [ 19 ].
Moreover, patient-nurse relationships are recognized as an essential aspect of therapeutic psychiatric in-patient care [ 56 ]. Priebe and his team found in an observational prospective study that involuntarily admitted patients with initial satisfaction with treatment were associated with more positive long-term outcomes [ 58 ].
They concluded it is important for clinicians to consider patients initial views as a relevant indicator for their long-term prognosis of involuntarily admitted patients. Staff and patients in community treatment teams such as assertive outreach engage in an obligatory close relationship, as the aim of community services is to provide treatment to people who do not seek it themselves.
Whether services are being provided on wards or in the community, these intense relations between staff and patients may also define institutionalized care, particularly if the social interaction among members of an institution is mandatory as a result of involuntary admission. The relationships between the clinical staff and patients as well as among patients themselves are unequal in terms of social power. Members of staff are required to keep an eye on the admitted patients on a regular basis to ensure patients are not in any danger.
It has been found that staff members behave more paternalistically towards patients within highly formalized institutions, but are more in agreement with patients in less formal ward environments [ 20 ]. Also, depending on the culture of the wards or mental hospitals, patients can either be motivated to speak or made quiet by staff [ 20 ].
Relatedly, the paternalistic relationships between staff and patients are also shown through the use of coercion. A variety of forms of coercion informal or formal is frequently practiced by clinical staff to ensure medication adherence [ 60 ]. In a mixed methods study, Katsakou and associates [ 40 ] identified that roughly one third of the voluntary patients felt coerced into admission and half of them continued to feel coerced into treatment a month later.
Patients felt less coerced if their satisfaction with inpatient hospital treatment also increased. Formal coercive treatment outside hospitals such as community treatment orders are also commonly accepted and practiced [ 43 ]. The theme of clinical responsibility and paternalism emerged in the s but as the numbers in Figure 2 suggest, attention to this theme increased substantially in the s.
In this decade, the majority of the identified papers included this theme. This may be explained by the general debate during this time frame on how to best care for patients or serve those service users most in need — the act for balancing the rights of the patients and the responsibilities of the clinical professionals.
Institutionalization in psychiatry can also be characterised by symptoms exhibited by patients in response to being treated in an institution, i. Initially it was recognized as a syndrome in inpatient psychiatric facilities, and is now used to describe a set of maladaptive behaviours that are induced by the tensions of living in any institution [ 37 , 64 — 66 ].
Wing and Brown [ 64 ] defined institutionalism as the association between the poverty of the physical environment and severity of primary symptoms of the illness and secondary disabilities that are not part of the illness itself, and identified three variables that increase the damaging effect: the social pressures that stem from an institution, the length of time that the resident was exposed to these pressures, and the level of predisposition that the resident brought [ 63 , 67 ].
The objective was to test the notion that there is an association between the social conditions of psychiatric hospitals and the clinical state of the patients. Wing and Brown found that patients with schizophrenia had fewer negative symptoms when they were treated in hospitals with richer social environments and opportunities. In addition, these patients showed distinctly fewer disturbances in verbal and social behaviour.
In contrast, patients with the least social interaction, fewest activities to take part in, and the least access to the outside world were the most unwell. Patients who reside in any institutional setting such as psychiatric hospitals or prisons are often socially isolated or have limited access to the outside world.
In other words, individuals in institutions may lose independence and responsibility, to the point that once they return to life outside of the institution, they are often unable to manage everyday demands.
Institutional environments can be perceived as humiliating, and admissions to acute psychiatric wards can be stigmatizing and non-therapeutic [ 72 ]. Many inpatients upon admission adapt to their environment intrinsically, particularly those who live for prolonged periods in restricted environments.
They become dependent on receiving care from services, lose their confidence to make decisions and consequently become institutionalized. SBS can be characterized as the loss of normal role functioning with a varying degree of exclusion from typical family or community roles. The features are similar to the negative symptoms of schizophrenia. SBS can be the by-product of any treatment that removes the patient from his or her regular social environment i. Thereafter, your child has a right to a hearing to determine whether hospitalization will continue.
At any point during the stay, if your child feels their rights are being violated, they can request an attorney. However, they are not entitled to free legal counsel as public defenders are reserved for criminal cases. Generally, your child will only be discharged when stable and the treatment team determines that your child is no longer an immediate threat to themselves or others.
However, this does not mean that your child is completely well. Your child will need to continue with treatment and may require extensive therapy, daily outpatient treatment, ongoing medical evaluations, and medication.
Psychiatric hospitalization is the beginning, and not the end, of treatment. Your child might have to be hospitalized several times before you see progress. If your child wants to get better, it is a wise strategy to provide emotional support and a friendly ear during hospitalization.
However, you are under no obligation to pay for treatment, allow your child to live with you, or offer any specific help. Geller, J. Psychiatric Quarterly , 77 1 ,
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