guide for family caregivers

HOW FAMILIES CAN MANAGE AND PREPARE FOR CRISES
by Jonathan Stanley, J.D. and Mary Zdanowicz, J.D.

When a person is overcome by the symptoms of a mental illness and refuses
needed psychiatric care, the law will only permit treatment interventions when
there is an extreme crisis. This is normally the case even when the person is
rendered incapable of making rational treatment decisions.

The criteria that must be met in order for a person with a mental illness to be
hospitalized are very stringent. Although the language differs from state to
state, most commitment laws require that the person's condition manifest an
immediate danger of physical harm to to himself or others before being placed
in treatment. Being forced to wait until a person incapacitated by a severe
mental illness presents an actual danger most often leaves family members
and treatment providers waiting for an extreme crisis in order to take action.

It has become increasingly evident that restricting treatment interventions
to such dire circumstances is a main cause of jailings, homelessness and
suicides among those with acute psychiatric disorders. In response to this,
a growing number of states have adopted alternative commitment standards
that encompass factors such as a person's deteriorating condition, need for
treatment, inability to make informed treatment decisions, likelihood of
becoming dangerous absent treatment, and the capability of independent
functioning.

The process to initiate the placement in treatment of someone incapacitated by
a psychiatric disorder also varies from state to state. A law enforcement officer
can take a person that he or she deems to meet the state's "pick-up" standard
(which is typically the same as the one for commitment) to a psychiatric facility
for an evaluation, although a few states require that the officer first receive
authorization from a judge or magistrate beforehand.

Under some laws, physicians and possibly other medical personnel can
temporarily prohibit the release of a voluntary patient or call for an emergency
evaluation without prior court approval. Many states also have a petition
process in which an individual can request a court to order an evaluation.
Possible classes of permitted petitioners range from "any person" to "inter-
ested persons" to family members to designated mental health department
employees.

Regardless of the manner in which evaluations arise, almost every state limits
their duration. Most typically, treatment providers must decide within 72 hours
either that the person continues to meet the placement criteria and pursue a
formal commitment or to release the individual.