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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Psychiatric Emergency

Allan N. Schwartz, LCSW, Ph.D. Updated: Jul 5th 2007

There are inquiries about what a family can do in the event that there is a psychiatric emergency. It is an extremely serious question about which there seems to be a lot of confusion and anxiety. This confusion often has to do with whether or not a person can be hospitalized against their will and what the consequences might be of calling for a hospitalization. While this topic has been written about before it is being addressed again in order to meet what seems to be a public need.

First, it is important to understand that it is not possible to have someone "committed" to a psychiatric hospital against their will,

as they once were many decades ago. In fact, most psychiatric hospitalizations, when they do occur, are relatively brief, lasting no more than a couple of weeks and in a few circumstances, a few months but nothing more. Today, there is great concern about protecting the rights of all patients and, most particularly, the mentally ill.

On the other hand, there are times when a person can be brought to a hospital even in the face of their opposition. There are two circumstances in which an unwilling person can be brought to the emergency room:

1) If a person poses a danger to self they can be brought to the hospital for evaluation. Posing a danger to one's self means that there is a real threat of suicide. A real threat of suicide includes having a specific plan about how they will attempt suicide or have purchased the weapons or poisons with which to carry it out. Since the average person is not a psychiatrist it is safer to err on the side of caution by reporting a suspected suicide attempt to both the family and police.

2) If a person is posing a threat to other people they can be brought to the hospital for evaluation. If for some reason an individual has become deranged and is brandishing a weapon and threatening people either in or outside of the home they need to be seen by psychiatric staff. The causes of such deranged behavior can vary from drug abuse that has affected the brain to a stroke, Alzheimer's disease or other dementing process, brain tumor or other physical illness or mental illness. If a mentally ill person stops taking their medication they can suffer a relapse and descend into psychosis. Drug abuse can have an equally destabilizing effect on those with mental illnesses.

Once in the emergency room a patient will be interviewed and assessed by psychiatric staff to determine whether or not they need hospitalization or can be stabilized in the emergency. There are those times when a patient can be held for 72 hours without being formally admitted in order to do further evaluation and make a final determination as to whether further hospitalization is necessary or not.

Medical staff is cautious about the disposition of psychiatric cases in which self harm or harm to others could occur. Staff wants to protect the patient, patient's family and the public at large. Therefore, they do not take lightly the decision to return a patient to their home. At the same time they do not want to unnecessarily hospitalize a person due to the cost of a long term hospital admission.

The best of all circumstances when there is a psychiatric emergency is the patient being willing to go to the emergency accompanied by family or friends. While this does happen it is unfortunately true that being in a clouded mental state prevents people from using good judgment. Therefore, too many psychiatric emergencies result in people being brought to the emergency room unwillingly.

If a person is clearly threatening suicide or homicide it is perfectly within anyone's rights to call 911 and ask for help. In calling it is important to state the nature of the emergency in very clear terms. The 911 team will send out a police car and an emergency ambulance vehicle as well. Both police and EMTS evaluate the danger and decide if a visit to the ER is warranted.

It is both difficult and painful to have a loved one taken away by 911 staff when such emergencies occur. No one enjoys seeing a family member removed from their home and hospitalized. On the other hand it is important to keep in mind that the reason for taking such action is to protect this individual as well as the other family members.

Your comments are welcome.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

Reader Comments
Discuss this issue below or in our forums.

Help for the Mentally confused - - Sep 5th 2014

When a person has a mental problem such as Bipolar-Depression and are getting worse and as a parent you try to get help for them. It gets very frustrating to see that geting help that they need either takes to long or nothing happens. I thought that there were programs to help these people. I  am sad to see that a country as advanced as we are in technology either make it to difficult to get help or don't have the appropriate programs to help the cituation.

its very difficult to have to hospitalize a family member - never will forgive myself - Jan 29th 2011

Again , i ran across my comments i had posted earlier regarding my brother, its very difficult to have to hospitalize a family member ,,, id also like to point out that danger to self or others are not the only reasons for calling for help  for help whether you call 911 or a crisis intervention,  You should call if the person shows signs of confusion or is not themselves, not making sense  i know this is hard to distinguish sometimes especially since these may be some of the persons psychotic features of their illness however , when in doubt call 911 have some kind of plan if youre caring for a mentally ill person, or are a friend or coworker of one, its our duty ,, it may just save their life

knowing when the get psychiatric help - Never will forget /never will forgive mysef - Jan 21st 2011

Im sorry to hear about your experiences however too many psychaitric emergencies  go unnoticed today until its too late... specifically by family members of the mentally ill person, we as family members became desensitized to the yo yo effect of the  illness and get so used to the pts symptoms that  we fail to act  i know i was one of them , and i lost  my brother... if i had made that one call to the emergency room my brother may be alive today ..  i knew he had a Hx of noncomplicance with his meds  yet i failed to act ,, I believe it cost my brother his life ...    

committment - - Dec 11th 2009

it is easy to get a person committed. it has happened to me many times.

Overinstitutionalization - - Oct 5th 2008

I would say that 72hr hold should only be used for people who are a clear danger to themselves or others, i.e. attempted suicide or homicide.  I was locked up for suicide ideation, no actual plan or anything.  My roommate while I was there was abducted from the hospital for joking about suicide whilst on the phone, as in "If I have to wait any longer, I'll kill my self".  I got abbysmal medical care during my stay, and came out more depressed than when I went in.  Not to mention the social stigma of the event.  It is in many ways like being a criminal.

Opposing opinion - Brittani Warren - Feb 25th 2008
As a young person who has personally experienced the travesty of being taken into state custody for running away from home, and thrown into a mental hospital for attempted suicide, I disagree with some of the information posted in this article. During my visit to the institution, which lasted over 3 months, I was ill treated, became involved in more violent acts then ever before, & was made to be a zombie in the wake of all the medications being pumped into my system. Placed there against my will, I was forced to undergo physicological treatments, as well as social-skills strengthening activities. None of these have thus far helped me in my average daily life, as I have been realeased for nearly 2 years now. Also, while in the mental hospital, I was deeply angered by the lack of medical attention I received. For 2 & 1/2 months I dealt with a medical problem, that was not addressed by the doctor once. Upon finally taking notice of my dispair, he simply referred me to see another doctor, 3 weeks later. By then, the problem had receded & no longer bothered me. Basically, I would just like to say that America's hospitals & institutions for the mentally ill are a joke. No real help was provided to me during my stay & I see no true evidence of any of these places actually helping anyone they incarerate.

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