A psychiatric hold describes a medical stay at the hospital or a psychiatric facility in which the person's mental state is evaluated. Determinations are made about the nature of the person's mental illness and the ability of the person to function independently. Mental disorders cause perceptual distortions that greatly impact a person's ability to function, care for themselves or adhere to safety rules for themselves and others. The United States legal system gives each state the authority to protect and care for citizens who can't do so themselves, and psychiatric holding periods are the legal system's way of determining which citizens fit into this unique category.
Any competent adult can voluntarily seek psychiatric treatment at a hospital or mental health facility. If someone is struggling with suicidal or violent thoughts, then they can request help and an evaluation immediately. Voluntary admissions usually require a 72-hour holding period for professional evaluation. Once the 72-hour hold is lifted, patients can request a discharge or further care. Minors can sign themselves into a voluntary hold in an emergency, but the legal guardian must be notified within 24 hours. Voluntary psychiatric hospitalization can be requested in situations where the individual is experiencing a temporary mental episode, undergoing an adjustment in medications or in need of a recovery period from a mental health crisis.
In recent years, the public has watched in dismay as superstars like Amanda Bynes and Kanye West spiraled out of control and landed in hospitals under involuntary holds. Involuntary holds describe situations where an individual is placed under psychiatric care without consent because of a debilitating mental illness. Nearly every state requires a 72-hour holding period in a mental health facility for professional evaluation. Experts evaluate the individual to determine if long-term treatment is necessary or if the individual is willing to consent to voluntary treatment. If personnel determine that the individual requires long-term involuntary treatment, then typically a formal courthouse hearing is the next step. The practice is overwhelmingly considered to follow the due process of law, but many opponents argue that the present system fails to adequately address the rights of the accused.
Criteria for an Involuntary Hold
The standard criteria for placing a person under an involuntary psychiatric hold is that the individual must either be a danger to themselves, a danger to others or suffer from a grave disability as a result of a mental illness. Gravely disabled persons are admitted involuntarily when they are mentally incapable of providing for their own basic needs and are either deteriorating quickly or unable to be cared for by loved ones. Someone is considered a danger to themselves if they have acted in ways that indicate a lack of self-control, judgment and overall ability to satisfy their basic needs. The individual may have attempted or threatened suicide or attempted to mutilate themselves. The individual's actions indicate a reasonable probability of harm if left untreated. Involuntary holds are also placed when the patient is exhibiting menacing, threatening, violent or aggressive tendencies that create a risk of bodily harm to themselves or others. As heartbreaking as the truth is, involuntary psychiatric holds are necessary because individuals suffering from severe mental illnesses often exhibit limited and inaccurate insight into their own condition.
Modern-day mental health care advocates recognize that temporary mental crisis issues are much more common than previously believed. In every human society, there are individuals who cannot act in their own best interest. When loved ones are unable to adequately care for the person, then the state will act in the best interest of the person in creating the best mental health care plan available. The time used to make this critical decision is referred to as a psychiatric hold, and it is designed to protect both the individual and society.