Psychiatric Petitions & The Commitment Process

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Psychiatric Petitions & The Commitment Process

  1. 1. Psychiatric Petitions & The Commitment Process Teresa Chahine MSN, PMHNP Oakland University, School of Nursing
  2. 2. Process of Psychiatric Admissions Adult Formal Voluntary Admission • Admission form signed by patient who is agreeable to seeking inpatient psychiatric treatment. • Patient’s must be their own legal guardian to sign a voluntary admission form. • The voluntary admission form allows the hospital to continue to hold a patient for up to 3 days after patient gives written notice of intent to leave hospital if staff do not feel patient is ready for discharge. Adult Involuntary Admission • The process of filing a “petition for hospitalization” to begin court proceedings for treatment of an individual who is refusing or cannot give formal consent. • A physician/psychiatric/psychologist must file a “clinical certificate” that verifies patient’s clinical presentation and danger to self/others. • Both the petition and the clinical certificate are submitted to probate court in the county the patient is in. • A hearing occurs within 7 to 10 days of admission both the patient and the healthcare organization are represented by attorneys that present the case to the judge for decision.
  3. 3. What is a “petition for hospitalization”? • A petition is the initial process of involuntary psychiatric treatment. • Petitions are completed for any patient that there is concern for their health or welfare as it relates to: suicidal/homicidal behavior, and/or inability to care for self due to mental illness, and is ambivalent or refusing mental health treatment. • Ideally, patient’s family member, friend or professional staff completes the petition. The person who completes the petition knows the patient’s situation and has witnessed events, situations or verbalizations which illustrate the need for psychiatric treatment. • The petition requires the patient to remain in the hospital until the individual is evaluated by a physician/psychiatrist/psychologist and finds patient psychiatrically cleared to be discharged.
  4. 4. Co-morbidities: Substance Abuse And Psychiatric Symptoms • The law states that you cannot force treatment under the Michigan Mental Health Code for substance abuse. • Only people who are found guilty of a crime associated with substance abuse can be ordered by a civil court to receive rehabilitation treatment. • In the clinical setting, assess behavior that is potentially dangerous even in a monitored substance abuse program: • Is the individual exhibiting psychotic symptoms? • Can delirium (from withdrawal) be ruled out? • Has the individual made a serious, impulsive act of self harm while under the influence? • Is the individual still feeling like harming themselves or harming someone else when not under the influence? • What type of supports and resources does the individual have in their life? • When documenting on a petition, focus on what the individual is doing, besides the substance abuse, that is endangering themselves or others? (i.e not eating, not bathing, wandering, overdosing…etc)
  5. 5. Fast Facts on the Involuntary Patient • Anyone over 18 years of age can fill out a petition on an adult patient for whom they have concerns of harm to self or others. The petitioner must have witnessed the behaviors and be accurate on this form because it is a court document. • Behaviors described on the petition should be recent, within the last 2 weeks. Historical behaviorof self harm or harm to others should only be listed after the present dangerous behaviors are described. • The petition is legal for 10 days only. • The petition must be treated like writing a check; no scribbles; draw a line through your error and initial it. Do not punch holes in the document. • Completing a petition is not committing the patient. You are ensuring that the patient received a psychiatric evaluation.
  6. 6. …More Facts on the Involuntary Patient • The physician’s certificate is only good for 24 hours. A physician must re-evaluation and a new certification is to be completed to continue to hold the patient prior to filing the papers with probate court. • Hearings are set within 7 days (excluding Sundays and holidays) after papers have been filed with probate court. • The patient will have a chance to accept treatment without a court hearing. The psychiatrist may deem the patient able to sign a formal voluntary admission form. The second chance is through a deferral meeting with a court appointed attorney prior to a court hearing. • Court orders are recommended treatment with limitations in the hearing. These orders are usually short term 30 to 60 days. The patient may be discharge if stable prior to maximum days indicated by a court order. • An alternative treatment order holds the patient accountable for continued outpatient treatment. If this treatment is not followed by the patient, re- hospitalization will occur.
  7. 7. When is a Court Order a Court Order? • A court order is something that occurs after the patient has been psychiatrically hospitalized and had a probate court hearing. • In a medical-surgical setting, nurses may come across a “court order for examination”. This document is one that is used to “go get” or ensure that the patient who is unwilling to come in for a psychiatric evaluation on their own. This document only ensures that a psychiatric evaluation will be completed. It is not an automatic admission. • Once a patient has had a hearing and an court order has been issued, the order may be a combination of inpatient and out patient treatment with a time restriction or both. • Court order treatments are a matter of public records and as such are not privy to HIPAA or privacy acts. Individuals that have at some point in time been court ordered for treatment will have this information appear in court documents or by police during a routine traffic stop.
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