Involuntary Retention on Hospital Medical Floors for Patients Who Lack Decision Making Capacity: Clinical, Legal, and Regulatory Considerations. Sponsored by ACLP's Division Directors' SIG

Abstract: The legal, clinical, and regulatory aspects of holding patients against their expressed wishes is an evolving and complex topic for CL psychiatrists. In 2017, the Illinois Supreme Court ruled that “all hospitals, institutions, clinics, evaluation facilities,” are considered mental health facilities; effectively mandating involuntary psychiatric admission paperwork if patients who lack dispositional capacity express a desire to leave any medical setting. Complicating this issue are the secondary stipulations that filing is required when the impairment of decisional capacity is due to a “mental illness” as defined by the court rather than a psychiatrist. In a random survey of ACLP membership in Illinois in March 2022, 3 of 7 health systems that responded had changed process to address this mandate (but due to extreme delays in the Illinois mental health court system, none of these cases had been heard by the court).





Sponsored by the Division Directors SIG, this session will review the history, regulatory concerns, and clinical practices within CL psychiatry and will encourage lively discussion. We hope to inspire transformation of widely disparate practices throughout the united states and approach a more unified understanding of the factors surrounding involuntary admission of patients. Our presenters will also produce enduring content in the form of an associated resource for the ACLP with information about state by state regulations. If possible, the presenters will also prepare a paper with the presented information and audience discussion.





Dr Lisa Rosenthal will Chair the session, and in 5 minutes will introduce the topic background and each of the speakers.





Each speaker will have 15 minutes:





Dr Marie Tobin will present the history of involuntary admission to psychiatry and associated dispositional capacity assessments/





Dr Stephanie Cho will discuss criteria commonly required for involuntary commitment and ethical principles.





Dr Andrea DeSimone will discuss bias and discrimination in mental health law.





Dr. Kenneth Novoa will discuss inconsistencies in involuntary commitment policy across a variety of US states and how this impacts the clinical work of the C-L psychiatrist.





There will be 20-25 minutes for audience participation. The presenters have ultra-brief case descriptions to prompt discussion. Through discussion and audience interaction we hope to arrive at a consensus about the utility of this practice.