Getting someone admitted to a psychiatric hospital typically starts with one of two paths: they agree to go voluntarily, or you initiate an emergency process because they’re in immediate danger. The specific steps depend on the urgency of the situation, whether the person is willing to accept help, and the laws in your state. Here’s what to expect at each stage.
Voluntary vs. Involuntary Admission
If the person recognizes they need help and is willing to go, a voluntary admission is simpler and gives them more control. They can check themselves in, consent to treatment, and generally have the right to request discharge through a formal process. Voluntary patients retain more decision-making power over their care, and outcomes tend to be better when someone enters treatment willingly.
Involuntary admission, sometimes called civil commitment, is a legal process used when someone can’t or won’t seek help but meets specific criteria. In nearly every state, those criteria center on the person being a danger to themselves, a danger to others, or so severely impaired they cannot meet their own basic needs for food, shelter, or safety. “Danger to self” can include suicide risk, severe self-harm, or an inability to function in daily life. “Danger to others” can include threats of violence, but also situations where someone’s behavior is creating serious risk for the people around them, including dependents they’re responsible for.
The legal bar for involuntary commitment is intentionally high. You cannot have someone committed simply because they’re making decisions you disagree with, refusing medication, or behaving strangely. The danger or impairment must be imminent and serious.
What to Do in a Crisis
If someone is in immediate physical danger, such as a suicide attempt in progress or active violence, call 911. Police in all 50 states have the authority to detain a person who appears to pose an imminent danger, and 38 states explicitly authorize officers to initiate an emergency psychiatric hold.
If the situation is serious but not immediately life-threatening, you have options that may lead to a better outcome. Calling 988 (the Suicide and Crisis Lifeline) connects you with a trained counselor who will assess the situation and coordinate the appropriate level of response. Most calls are resolved through counseling alone, without dispatching anyone. When more help is needed, many areas can send a mobile crisis team rather than police. These are behavioral health professionals who can evaluate the person, de-escalate the crisis, arrange referrals, and provide transport to a facility if necessary.
Mobile crisis teams produce significantly fewer involuntary hospitalizations than police. In New Orleans, for example, only 15% of mobile crisis calls resulted in involuntary hospitalization, compared to 60% of mental health calls handled by police in the same city. The presence of officers in uniform with weapons and sirens can escalate a behavioral health crisis, so civilian-led teams are generally preferred when safety allows it. You can ask your local 988 center or search online whether your area has a mobile crisis team available.
Starting an Emergency Hold
An emergency psychiatric hold is a short involuntary detention that allows professionals to evaluate whether someone meets criteria for longer-term commitment. The most common duration is 72 hours, used in 22 states including California, Florida, New York, and Washington. But hold times vary widely. Nine states allow only 24 hours (Arizona, Delaware, Illinois, and others), while some states permit holds of five, seven, or even ten days. New Hampshire and Rhode Island allow up to ten days.
You may know these holds by their state-specific names: a “5150” in California, a “Baker Act” hold in Florida, or a “temporary detention order” in Virginia. The process for initiating one also varies. In some states, a family member can file a petition directly with a court or magistrate. In others, only a physician, mental health professional, or law enforcement officer can start the process. Your local community services board or the nearest emergency room can walk you through the specific steps for your state.
During the hold, the person has constitutional rights to be notified of why they’re being detained and to receive a hearing. They also have the right to receive treatment and, in many circumstances, to refuse certain treatments. If clinicians determine the person needs longer inpatient care beyond the initial hold, a court hearing is required before commitment can be extended.
What Happens at the Emergency Room
Whether someone arrives voluntarily or is brought in by crisis responders, the first stop is usually an emergency department. Federal law (EMTALA) requires any hospital to provide a medical screening and stabilizing treatment to anyone who comes in, regardless of insurance status or ability to pay. If the hospital lacks psychiatric capabilities, it must arrange a transfer to one that does, and the receiving hospital cannot refuse.
The medical screening process includes a full medical and psychiatric history, vital signs, a physical exam with focus on the neurological system, and a mental status examination testing orientation and cognition. This “medical clearance” step exists because many physical conditions, from infections to drug interactions, can mimic psychiatric symptoms. Doctors want to rule out a medical cause before transferring someone to a psychiatric unit. Routine drug testing is not recommended unless clinically indicated.
The psychiatric evaluation that follows covers current symptoms, prior hospitalizations, history of self-harm or suicidal behavior, medication history, and substance use. Based on this assessment, the treatment team determines whether inpatient admission is warranted or whether a less intensive option, like a crisis stabilization unit or outpatient program, is more appropriate.
Admitting a Minor
The rules change when the person you’re concerned about is under 18. Laws vary by state, but a common framework works like this: a parent can consent to admit a child younger than 14 for inpatient psychiatric treatment. For teens 14 and older, most states require the minor’s agreement in addition to parental consent. This is a joint application, meaning both the parent and the teenager must agree.
Once admitted, a qualified evaluator must personally examine the minor within 48 hours and confirm that hospitalization is appropriate. The minor must receive a clear, age-appropriate explanation of the treatment. Teens 14 and older must also be informed of their rights, including the right to object. If a teen objects to continued treatment at any point, the facility must notify the parent and begin discharge within 48 hours unless a court authorizes continued care. As a child approaches their 14th birthday while already admitted, the facility is required to inform them that their continued stay now requires their consent.
What to Bring and What’s Prohibited
Psychiatric units restrict items that could be used for self-harm or to harm others. Expect the facility to confiscate shoelaces, belts, drawstrings, and any cords or rope. Electronics that can send, receive, or record information, including phones, tablets, and cameras, are typically not allowed. Glass items, metal objects (including items with metal bindings like some binders or headphones), and sharp objects of any kind will be taken. Medications, supplements, alcohol-containing products like hand sanitizer, and tobacco products including e-cigarettes are also prohibited.
What you should pack: comfortable clothes without drawstrings or hoods (elastic-waist pants, slip-on shoes), underwear and socks for several days, a list of current medications and dosages, insurance information, and identification. Some facilities allow soft-cover books, paper, and pencils. Call the facility ahead of time to confirm their specific policies, as rules vary. Avoid bringing valuables since storage may not be secure.
Navigating Insurance and Costs
The emergency evaluation itself is covered under EMTALA regardless of insurance. Beyond that, coverage depends on your plan. Most private insurance and Medicaid cover inpatient psychiatric care, though the length of stay approved and the specific facilities in-network will vary. If the person is uninsured, the hospital’s social worker can help identify options, which may include state-funded psychiatric beds, sliding-scale community facilities, or Medicaid enrollment if the person qualifies.
One practical challenge: psychiatric bed shortages are common, and it’s not unusual for someone to wait in an emergency department for hours or even days while a bed is located. The ER social worker or case manager handles this search. If you’re pursuing a voluntary admission outside of an emergency, calling facilities directly to ask about availability and insurance acceptance can speed up the process considerably.
If the Person Doesn’t Want Help
This is the hardest situation and the one most people searching this topic are facing. If someone you love is clearly struggling but doesn’t meet the legal threshold for involuntary commitment, your options are more limited but not nonexistent. You can call 988 to talk through the situation with a counselor and get guidance specific to your circumstances. You can contact your county’s community mental health center or crisis services to ask about outreach options. Some areas offer assertive community treatment teams that will visit the person where they are.
You can also speak with the person during a calm moment, express your specific concerns without judgment, and offer to go with them to an evaluation. Framing it as getting help for how they’re feeling rather than something being “wrong” with them can reduce resistance. If you believe they do meet involuntary criteria, filing a petition with your local magistrate, probate court, or community services board starts the legal process for an evaluation, even without the person’s cooperation.