If you or a loved one has schizophrenia, you may worry about involuntary hospitalization. That’s when you’re put into a hospital even if you don’t want to go. Here are some key things to know about the process and your rights.
“With schizophrenia, people can lose the capacity to understand that they’re suffering from symptoms, and that they need help or that help could benefit their health,” says Debra A. Pinals, MD, chair of the American Psychiatric Association Council on Psychiatry and Law.
Our society recognizes there are times when people cannot protect themselves, she says.
“That’s why every state has laws that allow for the involuntary hold, evaluation, and treatment of people with severe mental illnesses. It’s not meant to be a punishment, but a way to keep vulnerable people safe until they get better,” says Pinals, who is also a professor of psychiatry and clinical adjunct professor of law at the University of Michigan in Ann Arbor.
Why Does Involuntary Hospitalization Happen to People With Schizophrenia?
Schizophrenia is a brain disease that can cause you to:
- Lose touch with reality
- Hear voices that others don't hear
- See things others don't see
- Believe things that aren't based in reality
- Have very disorganized thoughts
These symptoms can make you not able to understand that you need treatment for your schizophrenia. When this happens, you may reach a point where you could harm yourself or others. As many as 5.6% of people with this mental illness die by suicide, for example.
When you stay on your schizophrenia medications, these symptoms and events are less likely. “Unfortunately, the illness itself can cause people to lack insight about their condition and lead them to stop treatment. That raises the risk for [getting worse] and for involuntary hospitalization,” Pinals says.
How Does Involuntary Hospitalization Happen to People With Schizophrenia?
The laws that govern involuntary hospitalization and your rights are different in each state. In most states, the basic standard for hospitalization against your wishes is that a doctor or psychologist and a judge think there’s evidence that you’re a risk to your own health or safety or to that of others.
It can also happen if these people decide you’re “gravely disabled,” or unable to care for yourself in a way that doesn’t harm your health, well-being, and safety.
Sometimes, you can be hospitalized against your will for schizophrenia based on federal rather than state law. This might happen if you’re accused of a crime, involved in a legal case within the federal justice system, or have been found not guilty due to insanity.
In some states, a police officer who believes you pose a danger to yourself or others can take you to a hospital for an evaluation right away. Most state laws also allow any person, such as a family member or neighbor, to ask for a court-ordered mental health evaluation.
Depending on the state, involuntary hospitalization can take different forms and have different names, such as:
An emergency hospitalization for evaluation, psychiatric hold, pickup, or 72-hour emergency admission. This can happen if you’re in a mental health crisis and a doctor (and in some states a police officer) thinks you need an evaluation right away. If so, you could be admitted to a hospital against your wishes for a short time. Usually, you’ll be there for a few days.
An involuntary admission or an inpatient civil commitment. Your doctors may think you need to stay in the hospital after your evaluation time has run out. If so, and you still refuse the treatments they recommend, you’ll have to go through a court hearing. Two doctors and the judge must agree that you are still a risk to yourself or others to extend your hospitalization.
Can I Avoid Involuntary Hospitalization for Schizophrenia?
If you agree to treatment, you may be able to stop your involuntary hospitalization. This has several benefits:
- You don’t have to go to court.
- There’s no need for anyone to present evidence that you fit the bill for hospitalization against your wishes.
- You avoid the loss of rights that may happen with involuntary hospitalization, such as the right to keep firearms.
What Happens During Involuntary Hospitalization for Schizophrenia?
First, you’ll be assigned to a team of health care providers who will decide on your treatment needs and keep a close watch on your well-being. This team usually includes:
- A psychiatrist
- A psychologist
- A nurse
- A social worker
- A pharmacist
- Occupational and other therapists
- Other specialists as needed
Your team will start to work with you as soon as you’re admitted. Their goal will be to move you toward recovery and hospital discharge. They will probably prescribe a combination of treatments:
Your medical team will evaluate you often to see how you’re doing and if you’ve improved enough for discharge. Most of the time, you can decline some treatments.
“The goal is to engage you in your own care, and informed consent remains part of that process for certain treatments,” says Pinals.
How Long Does Involuntary Hospitalization for Schizophrenia Last?
“Discharge planning begins the day you’re admitted,” says Pinals. “People are often scared they’ll be hospitalized forever, but many actually leave within days. Very rarely does someone [with schizophrenia] need long-term involuntary hospitalization.”
As noted, you can be kept against your will for emergency evaluation for only a few days. If your medical team believes you need care beyond that time, they’ll ask for a court hearing. The judge will decide how long your involuntary hold can last. This can be weeks or months, depending on the state.
But that doesn’t mean you’ll have to stay in the hospital for the entire time, says Pinals.
“An initial commitment is not a sentence,” she says. “It’s the time a judge gives until you must return to court so it can determine if you still meet your state’s criteria for involuntary commitment. It doesn’t mean you won’t be discharged earlier – a doctor can decide to discharge you the next day, for example.”
What Are My Rights When It Comes to Involuntary Hospitalization for Schizophrenia?
Rights vary from state to state, but you’re usually entitled to:
- Quick notification of your rights
- The right to ask for voluntary commitment
- A rapid hearing to challenge your involuntary hospitalization
- An attorney to represent you in any court hearings
- Be in the least restrictive environment possible
What Other Help Is Available for Involuntary Hospitalization for Schizophrenia?
If a mental health crisis is possible, advance directives (legal documents that, if you can’t make decisions for yourself, explain how you want those choices to be handled) can help you protect yourself. You must have them drawn up while you’re still legally able to make medical decisions.
Options include:
A health care proxy or health care power of attorney. These allow you to state in advance who you want to make medical decisions for you when you’re not legally able to make your own.
A psychiatric advance directive (PAD). This legal document states what treatment options you agree to if you’re in crisis and can’t legally make medical decisions. It can also state who you would like to make medical decisions about your care when you’re in a mental health crisis.
Things to Keep in Mind
Not all states have a specific provision for PADs, but you can still ask your lawyer to draft one based on your state’s laws for health care directives or living wills. Check the National Resource Center on Psychiatric Advance Directives to learn about state-by-state laws and how to get started.
Tell your doctors and hospital staff – and, if relevant, police officers – about your PAD or other mental health care advance directives. Keep your loved ones up to date, too, and make sure they have copies of your directives. These legal documents can give them a tool to help you should the need come up. They may also help prevent involuntary hospitalization.
Pinals notes that most hospitals have patient advocates who can help you or your loved ones understand your rights and resources. She also recommends visiting the National Alliance on Mental Illness website. It provides information and help for families that have loved ones with a mental illness.
