Rights and Legal Issues - Involuntary Commitment
(Note: the following FAQs were developed by the DHHS Adult Mental Health Services based on the Maine Disability Rights Center's Involuntary Hospitalization Laws : a basic guide to laws covering involuntary admission to psychiatric hospitals
The following is a link to the Involuntary Commitment statute:
Frequently Asked Questions about Involuntary Commitment
- What is Involuntary Commitment?
- What is a "Blue Paper"?
- Who Can Request that Some One be Involuntarily Committed?
- What Happens After Some One Starts a Blue Paper?
- What Happens When the Person Gets to the Hospital?
- How Long Do Blue Papers Last?
- What Happens After the Blue Paper Admission?
- What is a "White Paper"?
- What Happens Once a Hospital Files a "White Paper" Requesting a Court Order of Hospitalization?
- Does the Person Have a Right to Choose an Independent Examiner?
- What Happens at a Court Commitment Hearing?
- Does the Person Have a Right to Appeal the District Court Decision?
- What Happens at the End of the Commitment Period?
- What is Protective Custody?
- What is Convalescent Status?
Involuntary Commitment is a legal process that results in a person with mental illness being held by court order at a psychiatric hospital (or psychiatric unit within a general hospital) against his or her will.
The form that is used to request that someone be involuntarily admitted to a psychiatric hospital on an emergency basis is commonly referred to as the "Blue Paper".
Anyone, including health care providers and law enforcement officers, may request that a person be involuntarily admitted to a psychiatric hospital on an emergency basis. They do that by filling out Part 1 of the "Blue Paper". The person making the request must state:
- His or her belief that the person has a mental illness;
- His or her belief that the person poses a likelihood of serious harm because of the mental illness; and
- Why he or she believes this.
The person making the request must also provide name and address of the proposed patient's guardian, spouse, parent, adult child, next of kin, or (if none of those exists) friend, so that the hospital can fulfill its obligation to notify that person.
The person making the request then finds a doctor or other clinical person to do a “certifying examination.” The examination is usually done by crisis staff or hospital staff.
The examiner completes Part 2 of the Blue Paper and must make an official statement that the person examined:
- Has a mental illness; and
- The illness causes a substantial risk of harm to self or others
The examiner must explain the reasons for his or her opinions and must also specify the least restrictive form of transportation that would meet the patient's clinical needs.
The person making the request for involuntary hospitalization (usually crisis or hospital staff) then locates a hospital bed and somebody to provide transportation, and asks a judge or justice of the peace to sign Part 3 of the Blue Paper, indicating that the application was completed in accordance with the law. The judge or justice of the peace doesn’t make a determination about whether the statements on the application are true or not.
When someone is taken to the hospital on a Blue Paper, the person is not automatically admitted. The head of the psychiatric hospital (or psychiatric unit) may do one of three things:
- Admit the person as an involuntary patient, so long as the certifying examination took place no more than two days before the date of admission
- Admit the person as a voluntary patient (if the person agrees)
- Not admit the person at all, if the hospital believes the person does not need involuntary hospitalization and does not need, or does not agree to, voluntary hospitalization
A doctor or psychologist must examine the patient within 24 hours of admission to the hospital. If that professional doesn't officially state that the patient has a mental illness and due to the mental illness poses a likelihood of serious harm, the person must be released. (The doctor or psychologist must be someone other than the professional who signed the Blue Paper).
A hospital may keep a person on Blue Paper admission for 3 days, not counting the day of admission. If the third day is on a weekend or legal holiday, then the hospital can make the person stay until the next business day. The patient may be discharged sooner if the hospital decides that the person may be safely discharged. The hospital may also admit a person as a voluntary patient at any time during the Blue Paper period if the person agrees.
If the hospital believes the person needs continued hospitalization beyond the blue paper period, then it may:
- Admit the person as a voluntary patient if the person agrees; or
- File for a court order of hospitalization
If the hospital does neither of these, then it must discharge the person after the Blue Paper admission period.
The application that the hospital files with the District Court in order to request a court order of hospitalization is commonly referred to as a "White Paper".
Once the hospital files a "White Paper" several things happen:
- The hospital must give the person a copy of the application
- The hospital must also give the person and the guardian or next of kin notice of:
- The right to hire an attorney or have an attorney appointed
- The right to choose an examiner or have his or her attorney select an examiner
- How to contact the District Court
- Within two days of the filing of the application the Court must notify the person and the person's guardian and next of kin that the application has been received, and include the date of the hearing.
Yes. The court will appoint a professional (physician or clinical psychologist) to examine the person. The person or his or her her attorney can choose the examiner, and the court will appoint the chosen examiner if the examiner is qualified and reasonably available.
The hearing is held within 14 days of the application (unless a postponement of up to 21 days is requested by the hospital or patient for a good reason, or the court independently determines that there is good reason for a delay of up to 21 days).
The hearing is conducted in an informal but orderly manner. The hearing may occur in a courthouse or at the hospital or other setting that is not likely to have a harmful effect on the mental health of the patient. Usually, the commitment hearing occurs at the hospital, with the judge participating from the courthouse by a video link. The person has the right to appear at the hearing, to testify, to have witnesses testify and to cross-examine the hospital's witnesses.
The hospital must prove, by evidence of the person's recent behaviors, that the person poses a likelihood of serious harm and that inpatient hospitalization is the best available means for treatment. The hospital must include expert psychiatric testimony about the hospital’s treatment plan in its evidence.
The court must decide, based on "clear and convincing evidence" that:
- The person has a mental illness.
- The person's recent actions and behavior demonstrate that the person poses a likelihood of serious harm.
- Adequate community resources for treatment of the person’s mental illness are unavailable.
- Hospitalization the best available means for treatment
- The individual treatment plan offered by the hospital is satisfactory.
If the court concludes that all of these statements are true, it may commit the person to the hospital as an involuntary patient for a period up to 4 months.
If the court concludes that the first four statements are true, but is not satisfied with the treatment plan, the court may continue the hearing for 10 days to let the hospital revise and submit its treatment plan.
If the court concludes that ANY of the first four statements is not ture, the application must be dismissed and the person must be discharged from the hospital.
Yes. The person may appeal an order of commitment to the Superior Court. The appeal must be filed within 21 days of the District Court's order.
The hospital may apply for recommitment for a period of up to 12 months if it believes that the person needs continued involuntary hospitalization. The reapplication must be filed 21 days before the commitment period ends.
The hospital must discharge the person from the hospital at the end of the commitment period unless it has started recommitment procedures, unless the person is suitable for and has accepted voluntary admission, or unless criteria for blue paper admission are met.
A hospital is not required to hospitalize a person for the entire period of commitment. In fact, it must discharge a person from involuntary commitment whenever the hospital determines that conditions have changed and that the person no longer meets involuntary commitment criteria.
Protective custody is the term for when a law enforcement officer takes a person into custody in order to take that person to a doctor or psychologist for an evaluation for possible involuntary psychiatric hospitalization. The law enforcement officer must use the least restrictive form of transportation that meets the security needs of the situation when taking the person to the evaluation.
In order to take a person into protective custody, the law enforcement officer must have reasonable grounds, based on "probable cause" to believe that the person:
- May have a mental illness And
- Presents a threat of imminent and substantial physical harm to himself or herself, or to other persons, due to mental illness
Link to Convalescent Status statute
Maine statute allows hospitals to release patients on convalescent status. People on convalescent status technically remain patients of the hospital.
Convalescent status is considered a means to assist transition from hospitalization to community tenure. It is rarely used because the community mental health system now has the capacity to provide transition services to individuals leaving the hospital. When it is used, it is done in accordance with hospital policy.
Unless a “blue paper” are started, a person who was a voluntary patient at the time convalescent status started may only be returned voluntarily.
A person who was an involuntary patient may be returned voluntarily or involuntarily, based on requirements in the statute.