A mental health crisis can be a very difficult thing to handle. Unfortunately, when your own mind is fighting you, if there’s no one around that can give you the support you need, it’s very easy to spiral.

Some mental health crises are subtle or are very internal. You might feel locked in an endless loop of anxious thoughts. You might be suffocated by depression and find it impossible to work up the energy to even eat.

Other times, a crisis can be more outward. You might feel like the only way you could possibly get attention or help is to lash out, to cause problems, even to commit violence.

It’s in these kinds of cases where an involuntary psychiatric hold might come into play. When a mental health crisis escalates, and dedicated mental healthcare support is not available, or if it’s not enough, an involuntary hold might be necessary to help de-escalate the situation, protect yourself or others, or pave the way to future care.

How does the process work in Michigan, what kinds of rights does the individual being held have, and what do you need to know? Let’s get right to it.

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.

Experiencing a Crisis? Call 988!

Before we get into the details, a quick filter. If you’re experiencing a crisis as we speak, it’s important to seek assistance before things get out of hand. Reading blog posts about involuntary commitment is unlikely to ease your current fears.

Call 988. In Michigan, 988 connects you to MiCAL, the Michigan Crisis and Access Line. MiCAL is a dedicated resource for mental health crisis care. Staffed by trained counselors, the person who picks up can help you navigate what’s going on, dispatch a care team if necessary, or help talk you through whatever is happening. They can also help connect you to future resources local to you, which in our case means throughout the Detroit area.

988 is available 24/7/365, it’s entirely free, and it’s confidential. It exists solely to provide you with the assistance you need, so don’t hesitate to call.

Even if you aren’t sure if you’re in a crisis, or if you feel like others have it worse, or you don’t deserve the attention, call anyway. We promise, they won’t turn you away. They’ll listen, they’ll help, and they’ll assist in bringing you to a better place.

Now, back to the subject of discussion.

Holds vs Hospitalizations

If you’ve followed our blog or if you’ve looked up involuntary commitment in Michigan in the past, you’ve likely come across resources that discuss the involuntary hospitalization process.

But is there a difference between an involuntary hold and an involuntary hospitalization?

The answer is yes, though they’re both part of the same overall process.

• A hold is a short-term, low-stakes form of involuntary commitment. The individual experiencing a crisis, if they cannot or will not seek other assistance, can be held against their will for a short duration. Typically, this involves police bringing the individual to a hospital, where they are held, monitored, and treated until something else can be done.
• A hospitalization is a longer-term, higher-stakes form of involuntary commitment. The individual in crisis, if they meet specific criteria, can be held against their will for treatment for up to 60 days. Despite the name, it doesn’t necessarily mean a stay in a hospital.

If you read our resource linked above, you can learn more about the involuntary hospitalization process, the rights, rules, and restrictions surrounding it, and other details you might want to know.

In short, involuntary hospitalization requires someone to file a petition with the local probate court to request hospitalization for the individual. It can only be done to patients who, due to mental illness, may be an immediate danger to themselves or to others, who is unable to attend to their most basic needs, or whose judgment is so impaired that they cannot understand their own need for treatment.

The bar is very high, it involves a whole court process, and it takes time to initiate, process, conclude, and implement.

What is an Involuntary Hold in Michigan?

An involuntary hold is generally what happens if a person in crisis is presenting as a significant nuisance, danger, or risks causing harm to themselves or their surroundings, and the police are called. We say police because the vast majority of the time, that’s the group responsible for holds. Mobile care teams have other resources and other options to pursue, and a hold is near the end of the list of options.

While the process looks similar from the outside, being placed on involuntary psychiatric hold is not being placed under arrest. Arrest is a criminal process; an involuntary hold is a civil process. However, if an individual in crisis has committed harm, violence, or another crime in the process, an arrest can be part of the process.

The majority of the time, an individual being placed under psychiatric hold is brought to the nearest hospital emergency room. There, they can be held until a professional on staff can evaluate them and make a determination as to what they need. This could be anything from a drug detox to adjusting medications to simply weathering the current crisis in a safe place until they can adjust on their own.

Sometimes, if a crime and arrest are part of the process, the individual may be taken to jail instead. This is unfortunately not as rare as it should be. Sometimes they can be transitioned to an ER once they have sobered up or calmed down somewhat, while other times a psychiatrist can visit and evaluate them in place.

In locations where a facility is available, an individual may be taken to a mental health ward or a psychiatric hospital instead of a medical emergency room. This depends entirely on the availability of such facilities, which aren’t always nearby. If a facility is available, a hold can be initiated, but this is distinct from inpatient care or an involuntary hospitalization.

Are There Limitations on Involuntary Holds?

An involuntary hold is in some ways more flexible and less limited than an involuntary hospitalization, but in one extremely crucial way, it is much more limited.

An involuntary hospitalization requires a court order from a probate court, in response to a petition from an interested party, often family members. An involuntary hold doesn’t need a court order and can be initiated by most typically a police officer when there’s reasonable suspicion that the patient could be a danger to themselves or others.

The key limitation is on duration. A court-ordered hospitalization allows for up to 60 days of involuntary commitment, though the physician or psychologist in charge is allowed to shorten that duration per their evaluation of the patient.

In contrast, an involuntary hold is capped at a maximum of 72 hours. This three-day cap is standard for just about every state in the country, and Michigan is no different. Of course, if the crisis is treated and the attending physician determines that the patient can be released earlier than 72 hours have elapsed, they can be let go before that cap.

Why 72 hours? It’s a good duration for treatment without putting undue pressure or stress on a patient. With a 72-hour hold, an individual is unlikely to have serious damage to their lives and livelihoods (occasional job repercussions notwithstanding), and it’s enough time for many drugs to wear off, for illnesses to be identified and treated, and for other factors to be evaluated.

A shorter hold might simply not be helpful, especially when accessing appropriate care on short notice is very difficult. Conversely, a longer hold can be risky in a few different ways and often can do more harm than good.

That’s why any longer hold (hospitalization) requires a court order based on a petition. It’s not something that can be filed frivolously, nor will it be granted without reason.

Are Involuntary Holds a Good Idea?

This is where things can get tricky.

Unfortunately, there are a lot of potential drawbacks to these short-term involuntary holds. Since there’s relatively little oversight and relatively few restrictions on them, they are a form of hold that can be abused. Fortunately, this is relatively rare, but it can still occur.

More importantly, there’s a decent chance that a short-term involuntary hold won’t actually do much to help a patient.

• The fact of being pulled from their usual surroundings and stuck in a clinical environment like a hospital room can be traumatizing in and of itself.
• Expectations for privacy in a hospital setting are low, and while medical records are confidential, there is a greater risk to a patient in this situation.
• Available treatment in a 72-hour timespan can be very limited, and without avenues to add support after being released, there are no long-term resources or improvement for the patient.
• There can be a serious stigma to being hospitalized for a mental health issue, the kind of stigma that doesn’t exist for physical health concerns. This can further add to a mental health burden.

An involuntary hold tends to be most effective in situations where there is a clear path to additional treatment, when there are more resources available to provide that treatment, or in cases where substance abuse is a significant factor and the 72-hour window serves as a sort of mandatory detox with medical support.

Nevertheless, there are a significant number of psychotherapists and psychiatric nurses who dislike the idea of an involuntary hold. While an involuntary hospitalization is a more stringent process, the requirement to have both a court and a doctor sign off on it means that it’s generally only used when a patient truly needs the help.

Are You at Risk of an Involuntary Hold?

If you’re struggling with mental health and feel like you’re at risk of an involuntary hold, you might be afraid that it could happen and that there could be extensive negative repercussions. Horror stories on the news don’t help issues, and the broad lack of awareness of mental healthcare historically has made it feel like the only option.

Fortunately, you do have options, especially here in Detroit.

An involuntary hold is likely only going to be initiated if you are a clear and present danger to yourself or to others, such that the police are called to solve the situation. Usually, the only other situation where it could occur is if you go to the emergency room for treatment and the physician there determines that, if you were allowed to leave, you would be a danger to yourself or others.

That’s why we always recommend calling 988 if you feel like you’re in crisis mode. The experts at 988 are always available and can help you navigate even the most serious challenges. More importantly, if you’re in need of immediate emergency treatment, they can dispatch mobile care units with mental health training, not just call the police. That way, you can receive treatment, as well as receive assistance with seeking further care, all without the risk of being held or committed. Only in the most extreme cases is a hold warranted even after all of that.

Here at BMC-Troy, while we don’t provide emergency care, we do work with patients of all ages with all kinds of mental health struggles. From anxiety and depression and ongoing therapy to substance abuse and more severe mental health disorders, our staff is trained in a variety of different care modalities to ensure you get the help you need. If you need medication or need your medication adjusted, we can do that too.

To get started with care from BMC-Troy, you can fill out our new patient intake form here on the website. If you have any questions, give our office a call at 248.528.9000. We’re accepting new patients, and we’re more than happy to get you started on the road to recovery.