Hospitalization, within a private/state psychiatric hospital or psychiatric floor of a general hospital, provides intensive treatment which can involve observation, diagnosis, changing and adjusting medications, ECT (Electroconvulsive Treatment), and/or overall stabilization.
If the person and their doctor agree that inpatient treatment is appropriate, the consumer can be admitted and receive treatment in the hospital. If the person is ill and refuses treatment, involuntary admittance is also an option.
Initially, it should be noted that having a family crisis plan with steps to prevent a crisis, and/or handle a crisis once it occurs, can help prevent emergencies from escalating.
However, sometimes it is not possible to find urgent treatment at a mental health center or private doctor, or a situation has escalated to the point where someone’s safety is at risk. At this point, emergency room treatment may be the most appropriate option. Situations that might require a trip to the emergency room include:
- A suicide attempt
- Assault or threatening actions against another person
- Hearing voices, paranoia, confusion, etc
- Drugs or alcohol use
If calling 911, tell the operator that it is a “mental health emergency” and ask for emergency responders with Crisis Intervention Team (CIT) training. Many first responders will approach a mental health situation differently if they know what to expect. When the authorities (usually the WPD) arrive, the person in crisis will be taken (whether voluntarily or involuntarily) if they behave in a way that shows that they are 1) a danger to others, 2) a danger to himself or herself, or 3) gravely disabled.
- Danger to self: can be manifested by words or actions that indicate the intent to commit suicide or inflict serious bodily harm on oneself, or actions which place the person in serious physical jeopardy.
- Danger to others: Can be manifested by words or actions that indicate the intent to cause bodily harm to another person.
- Gravely disabled: A condition in which a person as a result of a mental disorder is unable to provide for his or her basic needs for food, clothing or shelter.
The person in crisis will then be transported and admitted to a designated psychiatric inpatient facility where they will be held for up to 72 hours against their will. This is referred to as a 5150 or 72-hour hold. After paperwork and answering questions about insurance, medical history, etc., medical staff will assess the urgency of the situation and conduct a psychiatric examination to establish a “working diagnosis”. While under observation, the person most often receives an explanation of what’s happening, tranquilizing medications, crisis counseling, and a referral for treatment after discharge. The person may be detained further is they meet the legal criteria.*
Before a person is discharged from the hospital, it is important to develop a discharge plan with a social worker or case manager. Family members should be involved in discharge planning if the person is returning home or if they will need significant support. A good discharge plan ensures continuous, coordinated treatment and a smooth return to the community.
*A Fourteen Day Certification or 5250 will be extended if the patient, after 72 hours, is assessed as remaining gravely disabled and noncompliant in receiving voluntary treatment.
*A Thirty Day Certification or 5270 will be extended if it appears the individual will require further detainment after the 14 days. The professional of the facility will also give an evaluation as to whether the individual qualifies for a conservatorship referral. At this point, the Public Guardian may be contacted in order to petition for a Temporary Conservatorship (T-Con) for the individual. From here on, the status of the individual is within county legal jurisdiction and is further determined through a court hearing.
Getting Treatment During a Crisis
Mental health crisis response services are a vital part of any mental health service system. A well-designed crisis response system can provide backup to community providers, perform outreach by connecting first-time users to appropriate services and improve community relations by providing reassurance that the person’s needs are met in a mental health crisis.
What Makes an Effective Mental Health Crisis Service?
Mental health crisis services vary depending on where an individual lives. Becoming familiar with the available services and how to access them is an important step towards being prepared for a psychiatric crisis. The better prepared a person is when faced with a crisis situation the better the outcome. The following are pieces that together make up an effective response system.
24-hour crisis lines are often the first point of contact for a person in crisis or their loved one. Telephone crisis services provide assessment, screening, triage, preliminary counseling, and information and referral services.
Suicide Prevention Lifeline
Answered by community crisis centers available 24/7;
Sponsored by the US Department of Health and Human Services
Walk-in crisis services, such as clinics or psychiatric urgent care centers offer immediate attention. They focus on resolving the crisis in a less intensive setting than a hospital, though they may recommend hospitalization when appropriate. Walk-in clinics may serve as drop-off centers for law enforcement to reduce unnecessary arrests.
Partial Hospitalization or Day Hospitalization
Partial hospitalization provides care and monitoring for a person who may be having acute psychotic symptoms without being a danger to self or others. It allows a person to return home at night and is much less disruptive. It can also be used as a transition from inpatient hospital care before a complete return home.
Intensive Outpatient Programs (IOP)
IOP allows individuals to work, go to school and carry on their regular activities while also providing services and supports, such as a 12-step program to remain sober.