Behavioral health treatment is an important part of health care.  This post addresses the admission procedures for individuals in need of inpatient psychiatric treatment and is the first in a series focusing on issues related to mental health.

Some individuals with a mental health disorder recognize when their symptoms necessitate inpatient treatment and voluntarily admit themselves to a treatment facility.  Most times, however, individuals with a mental health disorder do not recognize the need for inpatient care and refuse to voluntarily admit themselves to a facility.  New York State law permits individuals, under appropriate circumstances, to be involuntarily admitted to a mental health facility to receive specialized care.

Under New York law, inpatient psychiatric admissions fall into one of three general categories: (i) informal; (ii) voluntary; or (iii) involuntary. 

(i) Informal admission occurs when a person requests treatment and is admitted without a formal or written application.  The patient is free to leave the facility at any time.

(ii) Voluntary admission occurs when a person who is 16 years or older applies in writing for admission.  The parent, legal guardian, custodian or next of kin also may apply for admission on a person's behalf when he/she is under the age of 18.  A voluntary patient may make a written request for discharge at any time. If the patient is under the age of 18, the request may also be made by the person who applied for the patient’s admission, by another person of equal or closer relationship, or by Mental Hygiene Legal Service, a branch of the New York State court system that provides legal services, advice and assistance to persons receiving care at inpatient facilities.

A voluntary patient who makes a written request for discharge must be released unless the director of the facility believes that the patient meets the requirements for involuntary admission (discussed below).  In this case, the director must apply to a court for authorization to retain the patient within 72 hours of when the request for discharge is made.

(iii) Generally speaking, involuntary admission occurs in one of three ways.  The first is known as “medical certification” or “2 PC” (shorthand for “two physicians certify”).  This type of admission requires two physicians to examine a person and certify that he or she needs involuntary care and treatment.  The certifications must be accompanied by an application for admission made by someone familiar with the patient (for example, a legal guardian, custodian, next of kin, treating psychiatrist, someone who lives with the person or by one of a number of government officials).

The facility may keep a patient admitted upon medical certification for up to 60 days.  If the patient, a family member or a friend of the patient, or Mental Hygiene Legal Services requests a court hearing to determine whether the patient should remain in the facility before expiration of the initial 60-day period, the director of the facility must determine whether the patient is suitable for discharge or whether the patient should remain in the facility.  If the director decides the patient should stay, the director must apply to a court for authorization to retain the patient.  The patient is notified of the application and has the right to request a court hearing on the proposed retention.

The second involuntary admission procedure is based upon certification by a director of community services or an examining physician designated by the director of community services, also known as a “DOCS” admission.  A director of community services is the government official with responsibility in each county for overseeing mental health issues.  They are authorized to designate certain physicians to make applications for involuntary admission.  

Under this procedure, the director of community services or a designated physician must certify that the patient is a harm to self or to others and that immediate inpatient treatment is warranted.  After a patient is admitted, he or she must be examined within 72 hours by a staff psychiatrist.  If the psychiatrist confirms that the patient meets the requirements for admission based upon medical certification, the patient may be maintained in the facility for up to 60 days.  The procedures for the patient’s right to a court hearing and involuntary retention beyond 60 days are the same as those for an admission upon medical certification.

The third admission procedure applies in emergency cases.  The emergency procedure is based upon the claim that the person has a mental illness which is likely to result in serious harm to self or others and for which immediate observation, care, and treatment in a facility is appropriate.

A patient admitted pursuant to this procedure must be examined within 48 hours by a staff psychiatrist of the facility.  If the psychiatrist confirms that the patient meets the emergency admission standard, the patient may be kept in the facility for up to 15 days.  The patient, a family member or friend of the patient, or Mental Hygiene Legal Service may request a court hearing at any time within the 15-day period to determine whether the patient meets the emergency admission standard.  In order to retain the patient beyond 15 days, the director of the facility must determine that the patient meets the requirements for an admission based upon medical certification.