An unfortunate reality is that mental healthcare has long been stigmatized, such that millions of people who deserve care choose to shun it instead.

One of the sources of that stigma comes from the process of involuntary commitment, including a lot of rumors, myths, and misinformation about the process. All too many people fear that if they seek mental health treatment, they’ll be “put away” or locked up in a mental health facility.

If images of straitjackets and padded rooms come to mind when you think about mental healthcare, know that the reality is far from those images.

Today, we wanted to talk about involuntary commitment, to alleviate your fears and encourage you to seek the treatment you deserve.

As always, if you or someone you know is experiencing a crisis, call 988 for emergency assistance. The process for involuntary commitment is not meant for emergency services, as you’ll learn as we go through the details.

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual's experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

Dispelling the Myths

First, let’s talk about those padded rooms and straitjackets that are so common in popular culture and horror media.

Straitjackets were certainly a real device used all the way back in the late 1700s and early 1800s, but have been replaced by much more humane methods of restraint in the modern era. Though they’re still found today, they’re more often used in prisons or in stage shows or as movie props.

Padded rooms are similar. They can still be found around the world today, but they’re more colorful and soothing, meant to be a place of safety for people in acute crisis to ground themselves and work through a crisis.

Most importantly, neither one of these is going to show up when you set an appointment for mental healthcare. You aren’t going to be ambushed and chained to a bed, wheeled to a cell, and locked away.

That’s another myth to dispel. Involuntary commitment is a real process, but it’s not something that just happens to you. For one thing, it requires a court order, and if you’ve ever experienced the courts, you know that’s not likely to be a fast process.

Generally speaking, involuntary commitment is rare and reserved only for emergency cases where there is a clear danger to the individual or to the people around them. It goes above and beyond a mental health crisis, and beyond the capacity for a call to 988 or a visit to a crisis center to handle.

What is Involuntary Commitment?

Involuntary commitment is defined by Michigan state law as hospitalization with the intent to help a person who may be mentally ill and who is potentially harmful to themselves or to others, and who refuses to seek treatment on their own. It can also apply to those with impaired judgment or cognition that leaves them incapable of understanding the need for treatment.

Serious mental illness, and even imminent crisis, are not necessarily sufficient justification for involuntary commitment. They can be grounds for hospitalization, but even in those circumstances, you aren’t confined to the hospital.

Who Can Be Involuntarily Hospitalized?

Michigan state law defines who can be the subject of involuntary commitment. In addition to meeting the criteria for serious mental illness, the individual must be:

• An individual who has a mental illness and who, as a result of that mental illness, can reasonably be expected within the near future to intentionally or unintentionally seriously physically injure himself or another individual, and who has engaged in an act or acts or made significant threats that are substantially supportive of the expectation.
• An individual who has mental illness, and who as a result of that mental illness is unable to attend to those of his or her basic physical needs such as food, clothing or shelter that must be attended to in order for the individual to avoid serious harm in the near future, and who has demonstrated that inability by failing to attend to those basic physical needs.
• An individual who has a mental illness, whose judgment is so impaired that he or she is unable to understand his/her need for treatment and whose continued behavior as a result of this mental illness can reasonably be expected, on the basis of competent medical opinion, to result in significant physical harm to himself or herself or others. This individual shall receive involuntary mental health treatment initially only under the provisions of the mental health code.

These criteria are both broad and narrow. Because of that, there are some exceptions. An individual who is affected by advanced age and cognitive decline, alcoholism, epilepsy, or substance use is not necessarily a person requiring treatment. The bar is high.

Additionally, there are stricter requirements if the individual in need of treatment is a minor. In these cases, only a parent, guardian, or relevant health professional can file the petition.

If an individual is in crisis and acting out, they can be restrained and hospitalized, such as via protective custody from the police. More likely, though, they will be voluntarily hospitalized until the crisis passes.

All of this information and more can be found in the Mental Health Code of Michigan, Act 258 of 1974.

What is Required to Initiate Involuntary Commitment?

The first step is a petition to the local probate court.

A concerned individual (a family member, a member of the public, or anyone who witnesses the person’s behavior) can choose to file the petition to have the person examined. This can happen for a family member, a friend, or even a stranger. Since it’s a court proceeding with testimony, it’s unlikely to be done when it shouldn’t be.

The petition is a set of forms that a person fills out, attesting that the individual in need of treatment is acting in a manner consistent with the definition above. It is filed for free with the probate court of the county, where the person filing the petition must give testimony to the behaviors of the patient. This may be done in person or over a video meeting, and must be completed for the petition to advance.

If the judge agrees, they can issue a court order. That order can then be brought to the local police, who will then locate the individual and bring them to the relevant psychiatric facility, hospital, or crisis care center. The order to bring the person to a facility is only valid for 10 days, after which a new one would be needed if the police cannot locate the individual in question.

In some cases, the court order isn’t necessary. For example, if the individual in question is acting out in a way that police are called to handle, and police believe they meet the criteria of a person in need of treatment, they can be put into protective custody and brought to a hospital for evaluation.

An individual can also consent to evaluation and potential hospitalization, though at that point it somewhat stretches the definition of involuntary commitment.

What Happens After the Petition?

If the petition is granted and the individual is brought to a care facility, they will be seen by professionals. At least two doctors, one of whom must be a psychiatrist, must meet with the patient and see them for themselves.

This pair of doctors is the ones who make the evaluation as to whether or not the individual needs treatment. If they don’t agree, the patient is free to go, though if they are in crisis, they can be held for immediate or emergency care as necessary.

If the patient is determined to need treatment, they will certify the petition and forward it to the court. The courts will set a hearing date within a week, the patient is appointed an attorney, and they will generally be held at the hospital until the hearing date.

If the court orders treatment, it can order up to 60 days of treatment in the initial order. The hospital makes the final decision on how long they will stay up to that 60-day mark, after which they could petition the court for further treatment.

Further Questions about Involuntary Commitment

There’s always more to know, so let’s cover some of the other details you might want to know about involuntary commitment.

Is Hospitalization the Only Option?

Fortunately, for both individuals and for our stressed healthcare system, no.

Depending on the individual’s needs, the doctors or the court can recommend outpatient treatment instead. Assisted Outpatient Treatment is essentially court-ordered therapy.

Is Being Committed the Same as Being Declared Incompetent?

No.

Being declared incompetent is a serious legal declaration where a court has determined that the individual is unable to make sound decisions for themselves. While it can be related to the same sort of issues that lead to involuntary commitment, the two are not the same, nor does one naturally always follow the other.

Involuntary commitment will not remove your rights or freedoms. You will not lose your right to a driver’s license or your personal freedom outside of your hospitalization.

What Are Your Rights During Involuntary Hospitalization?

A patient who is involuntarily admitted to psychiatric care still has rights under state law.

• They can make at least two phone calls.
• They have a right to a copy of the petition or application saying they require treatment, and to copies of the reports from the examining doctors who attested to it.
• They have the right to a physical and mental examination within 24 hours of being admitted, and at least once a year afterwards.
• They have the right to a written statement explaining they will be seen by a psychiatrist within 24 hours of admission.
• They have the right to a written statement explaining their rights.
• They have a right to a full court hearing.
• They have a right to an attorney representing them in court.
• They have a right to be present at the hearing.
• They have a right to a jury trial, where applicable.
• They have a right to an independent clinical examination.
• They have a right to have their family notified of their admission to the hospital.
• They have a right to meet with legal counsel, a member of the treatment team, and a designated community mental health worker.
• They have the right to designate someone to meet with them for the purpose of discussing the treatment plan, the nature of the hospitalization, and the potential consequences of an involuntary hospitalization.

Additionally, if brought in by police via protective custody, they have the right to be examined within two hours unless there’s a valid medical reason for a delay.

If an individual is hospitalized prior to the court hearing that issues an order for admission, they have a right to refuse medication unless a physician determines it’s necessary to prevent harm to themselves or others. Notably, accepting medication does not imply consent to admission.

Who Can You Contact to Discuss Involuntary Commitment in More Detail?

There are probably questions you have that we haven’t answered here, just by the nature of a finite resource online. Who can you talk to for more information?

Generally, the best resources will be a local crisis center. Here in the greater Detroit area, the best resource is the Detroit-Wayne Integrated Health Network. Calling or reaching out to them can answer your questions and explore your options.

Though the overall process of involuntary commitment, and the rights and requirements surrounding it, are the same across all of Michigan, the specific contact information and other details will depend on location. You’ll need to find out the local probate court where the individual in need of treatment can be found.

Here at BMC-Troy, we are not a crisis care facility or a hospital, but we are providers of cutting-edge therapy, including medication management and talk therapy including CBT, EMDR, and several other therapeutic modalities. If you or someone you know is experiencing a crisis, call 988 for immediate, emergency assistance. However, if you are in need of more general mental healthcare, including confidential assessments, therapy, or information about support groups in the area, you can contact us at 248.528.9000. You can also fill out our new patient form directly on our website here.