Health Care Quarterly:

Anatomy of a crisis: Understanding involuntary hospitalization

Maybe you’ve heard something like this:

“That kid was hospitalized today. Police came and placed her on a hold. She was a danger to herself.”

What does that mean?

Holds are involuntary detentions, known as Legal 2000s in Nevada, that are triggered when a mental health professional determines someone poses serious harm to himself or others or is “gravely disabled.”

There are myriad issues that can be at play, including addiction. Laws governing holds vary significantly in the criteria for commitment, length, and type of treatment, according to the Harvard Health blog. The blog reported Jan. 24 that the number of states allowing people to be committed for substance use disorder rose from 18 in 1991 to 31 in 2018, a 71 percent jump.

At a distance, these crises, viewed on social media or television, can seem upsetting. Up close, they can terrify friends and family who may not understand what being hospitalized really means.

How does it work?

Generally speaking, a hold is triggered by a professional when someone is determined to pose an immediate, serious danger to himself or others based on something the person has said, written or done.

In these cases, a mental health professional will be called in to assess the person and decide whether to send the person to a hospital. This is a serious decision. Putting someone on hold is a legal action that removes an individual’s right to self-determination.

If the person cannot be safely assessed on location, police may be called in and the person in crisis may be detained and taken for assessment and placement. The acting out that can lead to an involuntarily hold probably isn’t isolated and may stem from drug use.

If an involuntary hold is ever required for a young person, parents need to understand the clinical and legal decisions they’ll face. Here are some tips.

The basics

If a qualified mental health practitioner determine someone is a danger to himself or others or is “gravely disabled,” the professional can place that person on an involuntary

72-hour hold.

After the 72 hours, a clinician who feels a patient is still at risk can petition a specialized judge to ask for more time. During this process, the person has right to petition for himself.

A few factors play into holds. One is timing and location: Where and when does the hold start? At the emergency room? At the police station? Or when the patient has been placed in psychiatric hospital bed? It can take hours or days to get an open bed.

Another is the perceived danger level: The hospital’s clinical team is trying to hold a client and assess danger while still waiting to reach a judge (which can also take time).

Parents need to keep focused on the next step and remember that they, and their loved ones, have rights.

Continuum of care

So many families want to “return to normal” after a hold and hospitalization. This is always a mistake. The issue that triggered the hold will still be around afterward and will need attention and treatment.

Plan ahead for the posthospitalization period. Do your research. Make your calls.

• Ensure coverage. Determine which programs or professionals are affordable, covered by your insurance and can admit your young person immediately after he or she is discharged from the hospital. Make sure you obtain your insurance providers’ authorization for the care you are requesting.

• Mind the paperwork. Gather all the historical data, paperwork, files, notes and charts from any prior providers including the hospital. This paperwork will help you support the in-progress treatment and support insurance authorization. For most insurance plans, if it’s not documented, it never happened.

• Read. The internet is chock-full of articles about how parents in similar situations handle their crises.

• Help yourself. Find a support group. Get your own therapist. Surround yourself with people of experience and expertise who can support and guide you through this process.

Getting support from others can help you help your child — and preserve your family.

Mendi Baron, LCSW, is the CEO of Ignite Teen Treatment.