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Psychiatric Commitment, Emergency Medicine

Danielle B. Kushner and Rohn S. Friedman Reviewed 06/2017
 


Basics

Description

  • Psychiatric “civil commitment”: The state-sanctioned involuntary hospitalization ofmentally disordered individual

  • Voluntary psychiatry hospitalization: Voluntary psychiatric admission...

Diagnosis

Signs and Symptoms

History

  • Recent change in behavior or thinking

  • Psychotic symptoms

    • Hallucinations

    • Delusions

    • Disorganized thought

  • Panic, anxiety, or agitation

  • Depressed mood

  • Neurovegetative symptoms ...

Treatment

Pre-Hospital

  • Patient or concerned family may call the ED and describe an emergency circumstance

  • Depending on state, police, social worker, psychologist, or psychiatrist can send patient to ED ...

Follow-Up

Disposition

Admission Criteria

  • Danger to self

  • Danger to others

  • Severely disabled and unable to care for self/protect self in community

  • Follow commitment process for your state

Discharge Criteria

  • Pa...

Follow-Up

Followup Recommendations

Patient instructed to return to ED if feels unsafe, has increasing suicidal/homicidal thoughts, or other symptoms worsen 

Pearls and Pitfalls

  • Psychiatric civil commitment involves involuntary hospitalization due to mental illness and 1 of the following:

    • Substantial risk of harm to self

    • Substantial risk of harm to others

    • Ina...

Additional Reading

  • Gutheil  TG, Appelbaum  PS. Clinical Handbook of Psychiatry and the Law. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.

  • Melton  GB, Petrila  J, Poythress  NG, e...

Codes

ICD9

  • 298.9 Unspecified psychosis

  • 300.9 Unspecified nonpsychotic mental disorder

  • V62.84 Suicidal ideation

  • V62.85 Homicidal ideation

ICD10

  • F29 Unsp psychosis not due to a substance or known physiol cond

  • ...

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