Previously, I wrote about how someone's patterns of thinking can affect their behavior. When it comes to psychiatric hospitalization, consideration of the interactions between moods, thoughts, and behaviors is part of the emergency psychiatric evaluation. The physician who first examines the patient must determine whether the patient they are seeing needs to have a more in-depth psychiatric evaluation, and where those services might be available.
Due to the demand for hospital beds, the decision to admit someone to a psychiatric care facility is usually connected to the idea that they may be put at risk if discharged to a lower level of care.
In a perfect world, when a patient first presents for emergency psychiatric care, they are able to participate in a meaningful conversation about their treatment plan. Ideally, a physician will be able to speak with the patient about what care is available in their current setting, and why transfer to a psychiatric CSU/PES or hospital is recommended. If the patient then provides meaningful informed consent to psychiatric hospitalization, they are considered to be admitted for psychiatric care on a voluntary legal status.
Unfortunately, many people arrive to ERs too ill to meaningfully participate in care planning. Sometimes, information from the community suggests that the patient's behavior may be unpredictable or unsafe. Both of these situations might suggest that the patient needs a psychiatric evaluation from a specialist, even if they are unable or unwilling to provide meaningful informed consent.
In California, an appropriately credentialed professional may request the involuntary evaluation of a patient for potential mental health needs, per the Lanterman-Petris-Short Act of 1967 if there is probable cause. This generates hold paperwork, that then allows the patient to be transferred to a setting where the patient can be evaluated by a psychiatrist. These patients are considered to have an involuntary legal status.
Therefore, when discussing whether a person will be admitted to a psychiatric hospital, care teams often converse about a person's legal status and whether they are a voluntary or involuntary patient.
If a person's condition improves, this may also mean that they are able to participate in care planning or be safely moved to a lower level of care. In these cases, the patient can be transitioned from an involuntary to a voluntary status, to reflect their improved condition.
The interface between psychiatry and law is complex, and not able to be covered in a single blog post. There is actually an entire subspecialty of psychiatry called forensic psychiatry that focuses the legal regulation of psychiatry. Also, the laws govern involuntary evaluations change from state to state. But hopefully this provides a brief overview of a set of terms that are frequently used when discussing a person's admission to a psychiatric hospital.
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