Clients who are experiencing suicidal, violent, or otherwise disturbing thoughts are frequently concerned about the possibility of involuntary commitment to an inpatient mental health facility if they disclose these thoughts to me in therapy. Involuntary commitment under the Baker Act in Florida or Section 5150 in California can be lifesaving in certain, very narrow circumstances. It is in most cases also traumatic and can lead to a variety of unintended, negative consequences that add to the burdens of an already overwhelmed client. I am highly sensitive to all of these facts.
Both laws allow for a maximum 72 hour involuntary inpatient examination.
Summary of Involuntary Commitment Criteria
- I have to have seen the person face to face within the past 48 hours in order to request an examination
- I have good reason to believe substantial harm will result if a person does not receive an immediate inpatient examination
- The person is unwilling or unable to take actions to keep themselves and others safe
Commitment Procedure
- I sign a certification that I’ve seen the person face to face and the above criteria has been met
- I arrange for an ambulance or law enforcement to transport the person to the hospital
- If the person leaves before they can be transported, I file the certification with law enforcement who may pick them up within the 72 hours and take to the hospital
- In all cases the certification expires in 72 hours, whether the person has been examined or not, and they can no longer be involuntarily examined
What this means in real world terms is that, if I have a rational, lucid client who is having violent or harmful thoughts that they do not plan/want to act on, they will very likely not meet the criteria for the a hold. We would develop a safety plan together for managing any harmful impulses while we work to address the underlying problems. If I felt that hospitalization or residential treatment would be beneficial, I would discuss that with you.
Bottom line – any thoughts that are disturbing or upsetting to you, however troubling or bizarre or violent, I want to hear about. If you have the presence of mind to know it would be a problem if you acted on these thoughts and you’re willing to take reasonable safety precautions, it is highly doubtful I would feel that involuntary hospitalization is needed.
