How To Get Out Of Involuntary Commitment

This information has been compiled by NAMI Main Line PA (https://namimainlinepa.org/). Nothing in this document should be considered legal advice; for legal advice, you should contact an attorney. The information below applies to adults at least 18 years old in Pennsylvania, especially the greater Philadelphia area.

For resources to cope with, prepare for, and prevent a crisis, see https://namimainlinepa.org/resources-for-coping-with-preparing-for-and-preventing-a-crisis/.

For a quick overview of the procedures for voluntary and involuntary commitment, see http://mces.org/pages/crisisint_faq.php.

This page includes:
How to Get an Evaluation for Admission to a Psychiatric Hospital
The Psychiatric Evaluation
Voluntary Psychiatric Admissions
Involuntary Psychiatric Admissions
Mental Health Courts
Additional Information

How to Get an Evaluation for Admission to a Psychiatric Hospital
This section focuses primarily on the procedures in Philadelphia County. The facilities available for evaluation for admission to a psychiatric hospital may be different in other counties; some additional information for other counties in southeastern Pennsylvania is provided below.

Crisis Response Center (Also known as a "CRC")
In Philadelphia, individuals who are experiencing a mental health crisis can go to a Crisis Response Center for a psychiatric evaluation. Crisis Response Centers are open 7 days a week, 24hrs a day (please see http://dbhids.org/contact/crisis-response-centers/ for a full list of CRC locations in Philadelphia). CRCs can transfer patients to any inpatient hospital that has an appropriate bed available and accepts the patient's insurance.

If the person experiencing a mental health crisis is in the Philadelphia suburbs, see https://namimainlinepa.org/resources-for-coping-with-preparing-for-and-preventing-a-crisis/.

Emergency Departments
Individuals experiencing a mental health crisis can also go to any hospital emergency department. Emergency departments vary in the services available. Some emergency departments have mental health professionals on-site who can perform psychiatric evaluations and admit individuals to inpatient psychiatric hospitals if they feel this is appropriate. There are also emergency departments that do NOT have mental health professionals available. Physicians in these facilities will instead assess individuals to ensure that they are medically stable and will then arrange for a psychiatric evaluation by telehealth or refer the person to another facility for psychiatric evaluation. Depending on the circumstances, the person may be transported by ambulance to a psychiatric facility for evaluation or the person may be given information about where to go for psychiatric evaluation.

Psychiatric Inpatient Hospitals
There are also psychiatric hospitals that have intake or admission centers and individuals can go to these centers for evaluation by a mental health professional and direct admission to that hospital if a bed is available. Some hospitals require or prefer that you call to schedule an intake for admission to ensure that the hospital has an appropriate bed available.

The Psychiatric Evaluation
A mental health professional will evaluate an individual who goes to one of the above facilities and will determine whether the patient is appropriate for an inpatient psychiatric unit. Acute inpatient psychiatric hospitalization is intended for individuals whose thoughts and behaviors pose a substantial risk to themselves and/or others. The information provided by the individual seeking treatment and information provided by family and/or friends can be considered when determining the most appropriate treatment setting.

Voluntary Psychiatric Admissions
Voluntary admission to an acute inpatient psychiatric hospital (also known as a "201") occurs when a person goes for psychiatric evaluation and the evaluating mental health provider and patient agree that the patient would benefit from hospitalization and meets criteria for hospitalization. (A patient may also be voluntarily admitted for a subacute inpatient hospitalization; see Types of Inpatient Hospitals section of https://namipamainline.org/inpatient-hospitalization/.)

The patient is required to sign a consent form that is sometimes called a "201." The 201 form documents the patient's rights and describes the inpatient hospital experience. By signing the form, the patient agrees to being hospitalized on a locked unit.

If the patient later requests discharge, the hospital can hold the patient on the unit for up to 72 hours until a mental health professional can evaluate the patient for safety concerns. The patient will be discharged if the evaluating mental health professional determines that the patient is safe for discharge. If the mental health professional evaluates the patient and feels that he/she is at risk of harm to self/others or unable to care for self, the mental health professional can convert the admission to an involuntary admission ("302"). The patient will then be brought to mental health court within 5 days and the court will determine whether the patient can be legally held on a psychiatric unit. (See section on Mental Health Courts below.)

Involuntary Psychiatric Admissions
Involuntary admission to an acute inpatient psychiatric hospital (also known as a "302") occurs when the patient does not agree to hospitalization on a locked inpatient psychiatric unit, but a mental health professional evaluates the patient and believes that, as a result of mental illness, the patient is at risk of harming self or others, or is unable to care for self. The person must pose a "clear and present danger" to self or others based upon statements and behavior that occurred in the past 30 days.

There are two parts to a 302: evaluation and admission.

Any person (including police and doctors) can petition or request an involuntary psychiatric evaluation for another person. The person requesting the evaluation is known as the "petitioner." A request for an evaluation can be made by going to any CRC or by calling a mobile crisis team to come to the petitioner's home (seehttps://namimainlinepa.org/services-in-sepa-2/intro-to-services/ for resources).

The petitioner will describe the behavior that is concerning. It is important for the petitioner to think ahead of time about what he/she will write. The petition must include specific witnessed behaviors and statements in the past 30 days that show the patient poses an imminent danger to self or others.

This description will then be reviewed by the Office of Mental Health and the petition for evaluation will either be approved or denied. Petitions by police officers and doctors do not require approval by the Office of Mental Health.

If the petition is approved, the petitioner will be given further instructions about how to have the person transported to a CRC for an involuntary psychiatric evaluation (patients are usually transported by police). The person will then be evaluated by a mental health professional and the mental health professional will determine whether the person meets the requirements for an involuntary admission to an acute inpatient psychiatric hospital.

Mental Health Courts
If a person is admitted involuntarily, the patient will either be discharged within 5 days or brought to mental health court within 5 days (120 hours) to request a longer commitment (a "303"). The decision to discharge the patient or request a longer commitment is made by the treatment team based on concerns for safety of the patient or others. The mental health court will determine whether the patient can be legally held and treated on a psychiatric unit. The proceedings at mental health court may be called a "commitment hearing."

Hearings are non-public and confidential. If the patient objects to having family present and the family did not petition the 302, the family may not be permitted to attend the hearing. If the patient wishes to have a family member present, the person may be admitted to the hearing as an observer. If family members want to provide information supporting the hospitalization, they are encouraged to give the information to the hospital presenter and let the presenter provide the information at the hearing. This process helps to reduce conflict between the patient and family members. If family members have information supporting the discharge of the patient from the hospital, they should give this information to the lawyer or advocate who is representing the patient and this person will present the information at the hearing.

Commitment hearings are administrative hearings. This means that they are much less formal than judicial hearings and formal legal rules, such as the rules of evidence (i.e., hearsay information), do not apply. The purpose of the hearing is to gather as much information as possible so the court can decide whether probable cause exists to believe that the person is a danger to self, danger to others, or unable to care for self.

The 302 petitioner is expected to be present at the hearing and the judge or administrative hearing officer will likely request from the petitioner additional information about the events leading to the commitment.

It is the responsibility of the hospital presenter to explain to the court: (1) the events and the patient's behavior leading up to the patient's hospitalization; (2) the patient's behavior during hospitalization which illustrates his or her mental disorder and his or her dangerousness or grave disability; (3) previous psychiatric history; (4) living arrangements before hospitalization and plans after discharge; (5) the patient's diagnosis; and (6) the medications currently prescribed and whether the patient is taking these medications.

It is the responsibility of the lawyer or advocate who is representing the patient to present the patient's point of view and to make the best possible case for the patient's discharge from the hospital.

If the judge or administrative hearing officer determines that there is probable cause for the patient to remain in the hospital based upon one or more of the certification criteria, he or she will inform the patient of this decision and the reasons for it.

If the judge or administrative hearing officer determines that there is no probable cause to believe the patient meets one or more of the certification criteria, he or she will inform the patient and hospital representative of this decision and will explain the reason for it. If the hospital and the patient agree, the hospital then may accept the patient as a voluntary patient. If not, the patient must be discharged from the hospital.

For additional information about the Delaware County Mental Health Crisis Court, seehttp://www.delcohsa.org/mh_adult/mh_court_brochure.pdf.

Additional Information
For information about commitment for longer-term inpatient treatment (304b and 305), see https://www.alleghenycounty.us/Human-Services/Programs-Services/Disabilities/Mental-Health/Involuntary-Commitment.aspx.

For additional general information, see:

https://www.alleghenycounty.us/Human-Services/Programs-Services/Disabilities/Mental-Health/Involuntary-Commitment.aspx
http://www.acba.org/public/Legal-Briefs-040312
https://namimainlinepa.org/wp-content/uploads/2016/09/MentalHealthProcedures-ACT-Checklist.pdf
http://mces.org/PDFs/MCES_Quest_June_2003.pdf.

Page last updated, August 2020.