Borderline Personality Disorder: The Ins and Outs of Voluntary and Involuntary Psychiatric Hospitalizations

Most people have a Hollywood perspective of psychiatric hospitalizations. It is commonly assumed that emotionally-struggling individuals are admitted to get psychological treatment and are only released once they are cured, or at least more socially functional. This is not true.

Since brief stays at a psychiatric hospital are often part of the treatment plan for people struggling with borderline personality disorder, it is important to understand when and how to facilitate an admission to such a facility. Some common questions about psychiatric hospitalizations include: What psychological or physical symptoms are required to qualify someone for an admission? What is the difference between an involuntary commitment and a voluntary admission? Can a patient sign out of the hospital at anytime?

Criteria for psychiatric hospitalization have changed over the years. The main purpose is to keep individuals safe while their most severe symptoms are being treated with medication. Most psychiatric facilities throughout the United States require admitted patients to be a “danger to themselves or others.” Only when potential patients meets this criterion are they able to be considered for an inpatient stay.

How is someone a danger to himself or herself? Usually suicidal thoughts, ideas or gestures are required to be present to meet this definition, but this criterion also includes those individual who are so severely dysfunctional that their inadequate self-care is putting them in grave danger. For example, an insulin-dependent diabetic who is no longer voluntarily administering insulin shots, as a result of being psychotic or severely depressed, qualifies for an admission.

There are two types of hospitalizations: a voluntary admission and an involuntary commitment (or sometimes called “a hold.”) Most patients in a psychiatric facility agree they need extra support and help and have signed themselves into the hospital. They are there voluntarily. Since they are in the hospital by choice, they also can leave the hospital at any point. Most hospital psychiatrists and staff members, however, will strongly discourage terminating treatment prematurely, but patients cannot be forced to stay as long as they do not meet criteria for an involuntary commitment.

The second type of hospitalization is an involuntary commitment. It occurs infrequently and usually happens when an individual is too ill to get help. For instance, a person can become so severely depressed that suicide seems to be the only answer to the pain. Or, a psychotic individual’s extremely irrational behavior is putting himself (or herself) and others in danger. In such cases, an involuntary commitment is necessary.

It is important to understand that an involuntary commitment is a legal process that commits an individual to the psychiatric hospital for a specific amount of time. In the state of Michigan, the hold lasts for 72 hours. During this period of time, the patient no longer needs to agree to treatment, but rather is required to submit to treatment. Once the commitment time is completed, the patient will be re-evaluated. If this person is still a danger to herself (or himself), then the case will go before a judge to petition for an extension of the commitment. This rarely happens. Once proper medical treatment is started, most patients realize they need help and voluntarily sign themselves into the hospital for psychiatric care before the legal hold is completed.

Each country or state has its own procedures regarding involuntary commitments. If this type of hospitalization becomes necessary, contact your local Emergency Room or nearest psychiatric hospital for help and instructions.

A psychiatric hospitalization can be a very helpful step in the process of getting better. Sometimes it is a  necessary “wake-up” call, warning that one’s life is out of control. Other times it can provide the necessary security and safety when someone is working on painful issues and is feeling suicidal.

Helpful Links:
Michigan guidelines: http://www.kalcounty.com/courts/probate/mental-health.htm
Virginia-Youth admissions: http://www.fairfaxcounty.gov/csb/reports/brochures/involuntary-psychiatric-hospitalization-youth.pdf
Virginia-Adult admissions: http://www.fairfaxcounty.gov/csb/reports/brochures/involuntary-psychiatric-hospitalization-adults.pdf
Washington State guidelines: http://www.kingcounty.gov/healthservices/MentalHealth/Services/Hospitialization.aspx
Maine guidelines: http://www.maine.gov/dhhs/mh/rights-legal/involuntary/faq/home.html

The next article will be a list of several great resources on Borderline Personality Disorder.