Commitment to mental health facilities explained

People who are aware that a mentally ill individual who is deemed to pose a danger to himself or others can be involuntarily committed to a mental health facility don’t always fully understand the legal process for doing so.

While the laws differ from state to state, all have involuntary-commitment statutes. Involuntary commitment has been compared to incarceration and consequently has procedural safeguards to protect the rights of the individual.

“In Maryland, in the case of a family who is seeking to have a family member involuntarily committed, someone must appear before a district court judge to explain the situation and why they believe this person needs medical attention,” says Jason Frank, an attorney with the Lutherville-based firm Frank, Frank & Scherr. “If the judge is convinced an evaluation is necessary, the police, armed with a written petition, will pick the individual up and taken him to the emergency room.”

At the emergency room, Maryland law requires that the individual is evaluated by two physicians or one physician and a clinical psychologist. (Those over the age of 65 must be assessed by a geriatric evaluation team.)

“If the doctors determine that the person has a mental disorder, needs inpatient care or treatment, presents a danger to his life or the life and safety of others, is unable or unwilling to be voluntarily admitted to a facility and that there is no available less-restrictive form of intervention that is consistent with the welfare and safety of the individual, he is then transported to a mental health facility, such as Sheppard Pratt [Hospital], for an evaluation,” says W. Lawrence Fitch, director of Forensic Services at the Maryland Mental Hygiene Administration and clinical associate professor of psychiatry at the University of Maryland Medical School.

“People with or without insurance are first sent to a private facility, although they may eventually be transported to a state facility if a longer hospitalization is required. On the other hand, those who are coming from jail will go directly to a state facility.”

Fitch adds that mental health professionals can simply call a law enforcement officer to take an individual directly to the emergency room.

Upon arrival at the mental health facility, the individual has the option of being voluntarily or involuntarily committed. “Most are voluntary commitments,” says Fitch. “Federal law says that if one has ever been involuntarily committed, he no longer has the right to own a firearm. However, someone who voluntarily commits himself retains the right to own a firearm.”

“I believe that one can be held for as long as 10 days — with various extensions — for this evaluation at a psychiatric facility,” says Frank. “If the physicians determine that someone needs to be involuntarily committed, they must present the evidence before an administrative law judge. According to the Maryland Court of Appeals, there must be clear and convincing evidence for involuntarily commitment.”

In the case of an individual who has voluntarily committed himself but has had a change of heart and requests that he be released, the hospital has the authority to keep him for three days in order to seek an involuntary commitment, notes Fitch.

However, the individual who is being committed against his will still has the right to seek an appeal with the circuit court within 30 days of the administrative law judge’s decision. “He has the right to request a jury a jury trial,” notes Fitch.

Assuming the jury agrees with the involuntary commitment, the individual is returned to the psychiatric facility, where he can be held for up to six months from the time of the initial commitment before a new evaluation is required.

Mary Medlin is a freelance writer based in Baltimore.