Involuntary commitment. What comes to mind when you hear this word? Chaos and confusion? Fear and pandemonium? Loss and grief? For many parents, having to commit your child to a hospital against their will is something that doesn’t fit into the schema of adults. The thought, the action is unfathomable. How could a child, someone who is barely familiar with the operations of life, be so out of control that a hospital would have to be contacted for help? The experience is heart wrenching for many loving and caring families.
For many families, it’s difficult to identify the many reasons why hospitalization might be necessary for a child. Parents are often conflicted about contacting hospitals because the idea of having a “health” emergency related to behavior is difficult to comprehend. Many parents have asked me the following questions during their first family session with me: Why would a hospital need to be contacted for a child who is threatening to kill me? Why would a hospital need to be contacted for a child who is extremely aggressive, controlling, and overbearing? Why would an ambulance need to take my child to a hospital if he physically assaulted me in my house, shouldn’t the police be called? These are very legitimate questions from parents, but what most parents fail to realize is that a psychiatric hospital often deals directly with and is trained in crisis management involving behavioral outbursts that cannot be controlled in the immediate environment (e.g., the home, school, community). Hospitals for psychiatric problems are trained in working with kids who struggle to control their impulses which places others and themselves in danger. Of course, there are barriers to how, when, and in what circumstances your child can be admitted. But once admitted, there are things you should know.
Children under age 14:
Once a child is admitted to a psychiatric hospital the treatment course or recommendations will dependent entirely on the psychiatric evaluation conducted, the child’s history, the child’s behaviors that led to the hospitalization, and recommendations from previous hospitals or treatment centers. A child, under the age of 14, will most likely be what is called 302’d or involuntary committed. This is the process by which an adult (parent, grandparent, therapist, psychiatrist, etc.) makes a call to a hospital for an ambulance to pick up the child and take them to the hospital. In many cases, police will accompany an ambulance to the place the emergency call was made and back to the hospital for an evaluation. The waiting time for a bed or evaluation can total between 24-72 hours in some hospitals. In many cases, hospitals may even turn families away due to a lack of beds or space. Other hospitals, might offer you food and comfort while waiting in the waiting room or “standing by” for a room/bed. Still, other hospitals will refer you to another hospital or center for follow up treatment.
Children age 14 and older:
Sadly, many parents go through this experience knowing very little and often have no clue as to what to expect next, especially with youngsters who are 14 and older. Believe it or not, more problems often occur with older youths who are aware of their “legal right” to make treatment decisions or who are being told they can change their fate with one word from their own mouths. In many states, children age 14 and older (despite being under the legal age of 18 or 21) can make treatment decisions such as:
- Whether they’d like to stop or start medication
- Whether they’d like to start or stop seeing a therapist
- Whether they’d like to sign themselves in or out of the hospital
- Whether they’d like their guardian or parent to know what is happening in treatment
The fact that children age 14yrs and older can make treatment decisions makes getting these youngsters, who are still very immature and unable to make appropriate decisions, the help they truly need.
Involuntary commitment or 302: A 302 is more of an emergency-based type level of care. The individual will most likely reject treatment and refuse to comply with recommendations. A youngster may “throw a fit” and engage in more aggressive behaviors if a parent or guardian mentions hospitalization. A 302 often involves police and is often the process sought after other treatment options have been tried such as residential treatment, outpatient therapy, or medication management. A 302 is commitment is pursued against the person’s will. This is not something the individual or child will want to do. The 302 process is often more difficult with 14 year olds because they can either reject the treatment completely or sign themselves out when they decide to.
Even more difficult with the 302 process is the fact that hospitals can determine level of need. In other words, hospitals can determine, based on behaviors exhibited or the child or parents input during the psychiatric evaluation, if hospital treatment is needed at that time. A child must be “a danger to himself or others” which is a very broad hospital and state policy that can be interpreted in many ways. A parent may believe that their child is a danger to himself or others because he tried to electrocute himself after being told to do homework. A hospital may reject a family for treatment if the evaluating clinician or doctor does not believe the child will be in imminent danger. “Imminent danger” is often interpreted by hospitals and states to include suicide attempts (where there is an intense thought, plan, and attempt such as being inches away from jumping over a bridge or slashing a wrist causing a deep wound) or attempted homicide (where injury has occurred or proof that another individual is in imminent danger). “Imminent danger” can mean many things to many people, which is why many hospitals often disagree with families who believe their child or their family is in imminent danger. To states and hospitals, imminent danger is determined when injury or death is very close to occurring. In many cases, death, suicide, and injury has resulted from individuals being turned away from hospitals because they did not appear to be in dire need of services at the time.
It is important to note that a patient is typically admitted for no more than 48-72hrs.
Voluntary commitment or 201: A 201 is appropriate for a 14 year old youngster or older. The process will include signing themselves into the hospital for treatment. The individual will arrive in the emergency room with a parent or guardian and sometimes without a parent or guardian. The individual signs paperwork that will allow them to receive treatment for a certain length of time, often more time than what is offered in a 302. The individual and treatment team will determine the exact length of stay. Parents or guardians can also admit their child on a 201 basis without the police being involved or other aspects of the law.
As you can see, the hospitalization process is fraught with complications, legal statutes, age restrictions, and many other complications that keep families bound by the system. For information on what questions you should ask and what you should be aware of, click here for a previous discussion on this topic.
For more information on our failed mental health system, check into my recent presentation on the topic by clicking here.
As always, I look forward to an interesting discussion.
I wish you well