Involuntary commitment in psychiatric facilities

When someone is dealing with severe mental health issues—the kind where they’re genuinely putting their own life, health, or safety at risk (or honestly, everyone else's too)—it isn't just a random decision. A licensed physician has to issue an official referral along with a formal written explanation detailing why involuntary commitment is absolutely necessary after an evaluation. (See Section 22, Subsection 1,
Section 23, Subsections 1 and 2). In that explanation, the doctor covers more than just the patient's basic info; they have to note the location and time of the exam, who called the doctor in, and the people providing collateral history. They also include a quick rundown of the patient's psychological, physical, and neurological status, their findings, the diagnostic impression, and the specific reasons why staying in the facility is required. This document is then authorized by the Secretary of Health.
Hospitalization referral.
Proposal for discharging someone under involuntary commitment?
...

A psychiatrist can hold an individual in a psychiatric facility without their consent if they deem it necessary to detain them for a maximum of 72 hours. Once that period expires, the patient must either be discharged or undergo a formal process for involuntary hospitalization.

If someone is involuntarily committed—meaning they are hospitalized against their will—they are released once treatment is complete, as dictated by the county court order. This typically lasts 30 days from the date of admission. If further care is required, the court may extend the involuntary commitment for an additional 30 days.

So, if an involuntary hold gets extended beyond that initial 30-day mark—I’m assuming the attending psychiatrist has to officially confirm the diagnosis and provide valid medical grounds for keeping them there? Or does the director of the psychiatric facility have to step in, lay out the reasons for the detention, and sign off on it?
For instance—say someone, while in the middle of a mental health crisis, commits a serious disciplinary infraction, like an unprovoked physical assault on someone else. If they haven't reached remission yet—meaning they're still unstable, aggressive, or delusional, and there's legitimate concern that they pose a danger to themselves or the community—is their hospitalization legally extended under those circumstances?
Also, what happens if there's a criminal case pending against them, or if they've undergone a competency evaluation in the meantime? Does that create enough justifiable suspicion to warrant extending their treatment or stay?
Or...? Thanks.

A diagnosis will certainly be established. Involuntary hospitalization will be extended for another 30 days if the individual remains in an acute psychotic state, lacks insight into their condition, or continues to pose a risk through self-harm or aggression toward others.

If criminal proceedings are initiated against them, or if a psychiatric evaluation is conducted in the interim, would there be justified grounds to extend their treatment or hospitalization?
Or...? Thanks.

Could you clarify this for me? What kind of evaluation are we talking about? Is it for fitness for duty or legal competency? Are we discussing forensic psychiatry at this point?😕 And what specific reasons?🤷

So, I was actually thinking about forensic psychiatry, okay? Could you please clarify things a bit? If you can, I’ll give you a specific, recent example to work with.

I mean, I know it shows up in cartoons sometimes, but a friend of mine lives alone with her mother, and it’s obvious the woman needs a legal guardian to live an independent life. She constantly needs reminders to take her meds—she’s already been diagnosed with schizophrenia or has psychotic episodes—but she just fights back with these delusions, claiming that other people "already took her medicine."
The whole incident likely happened because she wasn't following her prescribed treatment plan. (Either she forgets because of the illness, or she thinks, "I feel much better now," and decides on her own to just stop taking them.)
She started spiraling, locked herself in the apartment, and left all the faucets running until water was flooding through the doors and into the hallway. A police patrol was called—though who knows what she actually saw during her episode—but the reality is that she used a knife in some sort of perceived "self-defense" and seriously injured an officer.
Now, my guess is she’s been involuntarily hospitalized and sent for a psychiatric evaluation, since she’s actually been under observation at a facility near a Small town in the Midwest for a few years now. I don't quite get what this current "observation" entails (at least according to her daughter), because to me, it seems pretty clear that the evaluation resulted in a court order for mandatory treatment—but I don't want to upset my friend, because living with a parent like that is incredibly draining.
Could someone please explain how this works?

I see. Now I understand. She was found to be mentally incompetent after committing the crime, so she has clearly been declared unfit. As such, she lacks legal capacity, and the court is mandating compulsory psychiatric treatment and confinement within a forensic psychiatric facility. Therefore, this isn't just standard involuntary hospitalization.

Yeah, exactly.
But what actually happens next for someone dealing with an illness like that?
How does it work for a legal guardian—what kind of criteria are they looking at?
Is it strictly necessary for it to be their own child taking care of them?
And if someone is declared incompetent, is there a way for that to change after a year or two—say, if symptoms fade or the condition recedes (though that’s rarely the case here)?
How long does it take before a medical board reviews the situation again?
I mean, is a person in that position basically stuck under lock and key forever?

Look, don't quote me on this, but if I recall correctly, mandatory psychiatric treatment and confinement can last for a maximum of five years. An individual can be released sooner if the reasons for their commitment are no longer valid, though that process must be initiated by their psychiatrist in a Small town in the Midwest.

The discussion regarding guardianship belongs here where you will find all the relevant information.

Oh, you are just being so sweet 🙂

Hello

To start off, I really want to commend you for opening this discussion topic.

It seems to me that individuals struggling with mental health issues in America—and honestly, all over the world—are frequently mistreated and even abused by psychiatrists. In our institutions, the treatment of both adults and children often lacks basic respect and feels quite inhumane.
For instance, if you look at a pediatric psychiatric hospital in Washington, D.C., you'll find that while there are indeed sick children there, about 90% of the patients are actually just kids who have been rejected, whether by their parents or guardians, or perhaps kicked out of foster care. These are perfectly healthy, normal children who are being forced to take various stimulants that carry significant negative health consequences. If a child refuses to take the medication, they might be restrained to a bed and given an injection. It feels as though these children are held for long periods—sometimes two months for no apparent reason—though I suppose the real reason is that the state makes a tidy profit from their Medicare filings. On top of that, the staff can be quite derogatory, calling patients inhuman names. Those inside the facility rarely get to leave, and the overall conditions are substandard, arguably worse than what one would expect for an animal.
And that’s not even mentioning the psychiatric medications themselves, which often seem useless; they appear to exist primarily to generate profit by essentially selling smoke and inventing conditions like ADHD or various other non-existent personality disorders.

I’d highly recommend checking out this resource (especially the video on the site): http://psihijatrija-ubija.info/

Best regards!

So what's the move? Like, how do we actually stop this or get behind it?

I seriously doubt that such a bombastic scenario is actually realistic.🙂

CNN, how does the government even make money off "insurance premiums" when private health insurance in America is practically non-existent? Most people are covered through Medicare, which is state-run. That means the government is essentially paying itself, so it’s actually in their best interest to cut costs rather than increase them. You can see this trend everywhere lately—shorter hospital stays, rushed post-op recoveries, and a massive push toward home care instead of actual clinical treatment...

bluemason3 said:I seriously doubt that such a bombastic scenario is actually realistic.🙂

CNN, how does the government even make money off "insurance premiums" when private health insurance in America is practically non-existent? Most people are covered through Medicare, which is state-run. That means the government is essentially paying itself, so it’s actually in their best interest to cut costs rather than increase them. You can see this trend everywhere lately—shorter hospital stays, rushed post-op recoveries, and a massive push toward home care instead of actual clinical treatment...

The point is they're making a profit, period. It doesn't matter who they're taking it from or how they do it. 😍

I honestly think it’s all just Masons and some messy walls at this point 🧐 😬

This isn't really the right thread for this—I know, I know—but I’m hoping someone here might actually have an answer... We have someone who spiraled into a severe depression, dealing with intense anxiety, restlessness, and constant fear. In an attempt to "fix" things, she turned to alcohol, which led to some minor incidents—nothing criminal, nothing illegal, just messy. She eventually took the initiative to check herself into psychiatric care. The treatment has been working, and you can clearly see her moving in a better direction. But here’s the catch: we’re approaching the 80-day mark, and the doctor is already saying they can't keep her inpatient any longer. The problem is, she doesn't feel ready to face the world yet. My question is: is there any specific law, regulation, or set of guidelines that covers this? Is there a way to file a formal petition, a request, or anything at all to extend her stay?🤷

Should we be looking at involuntary hospitalization for this person, or maybe just sending volunteers over every single day to clean up her place—assuming she’ll actually let them through the door? 😲
http://www.nytimes.com/article/elderly-woman-living-in-hoarding-conditions/1012577/

Arthur Morales18 said:Hello

To start off, I really want to commend you for opening this discussion topic.

It seems to me that individuals struggling with mental health issues in America—and honestly, all over the world—are frequently mistreated and even abused by psychiatrists. In our institutions, the treatment of both adults and children often lacks basic respect and feels quite inhumane.
For instance, if you look at a pediatric psychiatric hospital in Washington, D.C., you'll find that while there are indeed sick children there, about 90% of the patients are actually just kids who have been rejected, whether by their parents or guardians, or perhaps kicked out of foster care. These are perfectly healthy, normal children who are being forced to take various stimulants that carry significant negative health consequences. If a child refuses to take the medication, they might be restrained to a bed and given an injection. It feels as though these children are held for long periods—sometimes two months for no apparent reason—though I suppose the real reason is that the state makes a tidy profit from their Medicare filings. On top of that, the staff can be quite derogatory, calling patients inhuman names. Those inside the facility rarely get to leave, and the overall conditions are substandard, arguably worse than what one would expect for an animal.
And that’s not even mentioning the psychiatric medications themselves, which often seem useless; they appear to exist primarily to generate profit by essentially selling smoke and inventing conditions like ADHD or various other non-existent personality disorders.

I’d highly recommend checking out this resource (especially the video on the site): http://psihijatrija-ubija.info/

Best regards!

Psychiatry kills. That’s just a cold, hard fact. But then again, actual lunatics kill too. About 50 years ago, there was this chilling story floating around San Diego about a specific case: A patient was placed in a mental institution, but he managed to break out. He ended up fleeing illegally to the States, eventually finding his sister's apartment in New York City. He broke in and—using a knife—murdered his sister, her husband, and their three children, aged 16, 13, and 10. He even killed the dog. Then, he vanished down to Florida, where he successfully hid for ten months posing as an immigrant from Cuba. It took that long for anyone to finally track him down and make the arrest. That is the kind of damage a VERY INTELLIGENT MADMAN can do. 😲 🙂🙂

dustyangler79 said:This isn't really the right thread for this—I know, I know—but I’m hoping someone here might actually have an answer... We have someone who spiraled into a severe depression, dealing with intense anxiety, restlessness, and constant fear. In an attempt to "fix" things, she turned to alcohol, which led to some minor incidents—nothing criminal, nothing illegal, just messy. She eventually took the initiative to check herself into psychiatric care. The treatment has been working, and you can clearly see her moving in a better direction. But here’s the catch: we’re approaching the 80-day mark, and the doctor is already saying they can't keep her inpatient any longer. The problem is, she doesn't feel ready to face the world yet. My question is: is there any specific law, regulation, or set of guidelines that covers this? Is there a way to file a formal petition, a request, or anything at all to extend her stay?🤷

That is quite a long duration for inpatient care. One must be careful with psychiatric patients to avoid the development of hospitalism, which often becomes the very reason a patient feels unready to leave. While a hospital provides a "protected environment," it is not a permanent residence. As an alternative, I would suggest a 30-day program at a Day hospital. This serves as a transitional period where she could attend individual and group psychotherapy during the day while sleeping at home at night.

Benjamin Taylor6 said:Should we be looking at involuntary hospitalization for this person, or maybe just sending volunteers over every single day to clean up her place—assuming she’ll actually let them through the door? 😲
http://www.nytimes.com/article/elderly-woman-living-in-hoarding-conditions/1012577/

The CDC should have contacted her local LOM, which would have then conducted a home visit to perform an assessment, issue a referral for psychiatric inpatient care, and call for an ambulance.
The rest of the procedure is standard: if she refuses hospitalization, it becomes involuntary. This also raises the inevitable question of guardianship and placement, as she clearly lacks the capacity to care for herself.

driftinggull21 said:The CDC should have contacted her local LOM, which would have then conducted a home visit to perform an assessment, issue a referral for psychiatric inpatient care, and call for an ambulance.
The rest of the procedure is standard: if she refuses hospitalization, it becomes involuntary. This also raises the inevitable question of guardianship and placement, as she clearly lacks the capacity to care for herself.

That sounds great in theory, doesn't it? But in practice, it’s a complete disaster. The neighbors of that absolute piece of work from Venice have already reached out to every single local agency in the city—I mean, they've gone through the ringer—and yet, absolutely nobody has stepped up to handle the situation. It’s infuriating. And honestly, why would they? A GP or a psychiatrist would be taking a massive professional risk just by getting involved. At the end of the day, it would just turn into one of those sensationalized medical dramas you see on TV, where everything is exaggerated and nothing actually gets resolved properly. Rest in peace, Ms. Murdoch. It’s a miracle we haven’t officially branded our entire healthcare system as Nazi by now—honestly, at this rate, that might be the only logical conclusion left to draw.
And here’s exactly why: I honestly can't wrap my head around how people still fall for this kind of nonsense—it’s like watching a slow-motion train wreck where everyone is cheering for the impact. You see it all the time in these online debates, where someone thinks they’ve delivered some profound truth, but in reality, they’re just shouting at clouds. It reminds me of that one time I was stuck in traffic outside of Chicago—just sitting there, staring at the bumper of a minivan, thinking about how much energy we waste on things that don't actually matter. Anyway, back to the point. We have to stop pretending that these institutions are actually looking out for us. They aren't. Whether it’s the way the local government handles urban planning or how the big corporations squeeze every last cent out of the consumer, the pattern is always the same: profit or power over people. Always. And if you think for one second that anyone is coming to save you, you’re living in a fantasy land. It’s frustrating, really. You try to explain the logic, you try to lay out the facts—and what do you get? Silence or, worse, complete derision from people who clearly haven't read a book since high school. It makes you want to just close the laptop and go for a long walk, though even then, you can't escape the sheer absurdity of modern life. People just want easy answers, and when they don't get them, they turn into trolls. It's exhausting. Truly.

Just let the man live his life however he sees fit—honestly, why is everyone so obsessed? You all really need to mind your own business and focus on what you're doing instead of breathing down someone else's neck.