Summary. Fifteen sequences, from the afternoon before to the year after.

1. Before any crisis (the highest-leverage hour available)

  • Save 988 and the county mobile crisis number in your phone.
  • Find out whether your county has a crisis stabilization unit — and where it is.
  • Execute a psychiatric advance directive: medications accepted and refused with reasons, preferred hospital, who to notify, who decides, what helps in a crisis.
  • Execute a health care power of attorney.
  • Sign releases of information — one per likely hospital, several named recipients. Give copies out.
  • Sign a HIPAA authorization for records.
  • Make a wallet crisis card: diagnosis · medications and doses · allergies · prescriber · pharmacy · two contacts · what helps.
  • Set up automatic bill payment for rent and utilities.
  • Consider a joint account or representative payee so a three-week hospitalization is not an eviction.
  • Secure firearms elsewhere; lock or reduce excess medication.

2. The crisis call

  • Write the dated facts down first. Do not assemble them while a crisis team stands in your kitchen.
  • Call 988 or mobile crisis for a mental health crisis; 911 only for immediate physical danger.
  • If police are coming: "This is a mental health crisis — please send a CIT-trained officer if available."
  • Have ready: sleep · food · weight · hygiene · quoted statements with dates · behaviors with dates · any threat or act · diagnosis · medications · adherence · prescriber · last appointment · prior hospitalizations · substances · access to means · housing and income at risk · who is willing to help and what they can actually do.
  • Be accurate about available family support — it cuts against commitment under the O'Connor standard.

3. If no hold is placed

  • Ask how to file a petition for evaluation in your county.
  • Ask about assisted outpatient treatment eligibility and who files.
  • Keep documenting, dated, in the same categories.
  • Reduce means — firearms, medication, keys.
  • Find a family support group.

4. First hours of a hold — patient

  • Ask your status: voluntary or involuntary. Get it in writing.
  • Ask for your phone call.
  • Ask for the patient rights handout.
  • Ask for the patient advocate or ombudsman.
  • Ask when the hearing is and whether counsel is appointed. Write it down.
  • Sign releases naming who may receive information.
  • Do not convert to voluntary status without asking the advocate what you give up — in most states, the hearing.

5. First hours of a hold — family

  • Call the unit: "I am calling to provide collateral information."
  • Ask what you can bring: glasses · hearing aids · dentures · CPAP · medication list · insurance card.
  • Ask to speak with the unit social worker — more reachable than the psychiatrist, and the person who builds the discharge plan.
  • Ask when the hearing is and whether counsel is appointed.
  • Handle: employer · rent · pets · children · car · household medications.
  • Ask the patient to sign a release naming you.

6. Understanding the hold

  • Confirm the actual expiration date and time — hold periods commonly exclude weekends and holidays.
  • Understand a hold is not a commitment; no judge has ruled.
  • Note that involuntary commitment triggers the federal firearms prohibition; voluntary admission generally does not.
  • If admitted as "voluntary" while too impaired to understand the form — flag it. Signing is not consent if you cannot understand it.

7. Getting counsel

  • Confirm counsel was appointed. Get the name and number.
  • If not: ask the patient advocate · ask the social worker · call the court clerk.
  • On the call, cover only three things:
    • What is factually wrong in the petition — dates, quotes, events
    • What the alternative is — address, person, provider, appointment, medication, transportation
    • What the person wants, and what they will agree to
  • Ask about the independent evaluation — usually available, rarely requested, takes time to arrange.

8. Preparing for the hearing

  • Know what the state must prove: mental illness AND the statutory standard, by clear and convincing evidence.
  • Identify which standard is alleged: danger to self · danger to others · grave disability · deterioration.
  • Build the least restrictive alternative and bring paper.
    • Named residence, with a willing person who understands the commitment
    • Named provider and a scheduled appointment with written confirmation
    • Medication: what, filled where, paid how, delivered by whom
    • Transportation, concretely
    • Benefits status
  • Correct factual errors in the petition.
  • Assert the right to be present; resist exclusion.
  • Decide with counsel whether the person testifies.
  • Note: arguing the person is not ill rarely works. Arguing the specific statutory finding is unsupported and an alternative exists works far more often.

9. Medication over objection

  • Understand: a commitment order does not authorize medication.
  • Ask what process applies in this state — independent clinical review (the federal floor) or a court order (some states).
  • State the objection clearly and on the record.
  • Request the hearing, and an advisor or advocate.
  • Ask about alternatives: a different drug · a lower dose · oral rather than injectable.
  • Note that objecting to this medication is often more winnable than objecting to all treatment.
  • In a criminal case, medication solely to restore competency requires the four-factor Sell showing.

10. During the commitment

  • Request a treatment team meeting.
  • Request a second opinion if you disagree.
  • Put concerns in writing and ask that they be placed in the chart.
  • Push discharge planning from day one, not day nine.
  • Verify insurance is still active — lapses during hospitalization are routine.
  • Note the term is fixed; renewal requires a new petition and a new hearing.

11. The discharge plan

  • Where — a specific address
  • Who — a named person who has agreed and understands
  • Clinical follow-up — named provider, appointment within seven days, confirmed
  • Medication — what, how much, filled where, paid how, who ensures it
  • Transportation — specifically how they get there
  • Money — benefits status, applications filed, payee if needed
  • Crisis contacts — written, on paper, in a pocket
  • If full discharge is unlikely, ask about conditional release — the thing courts actually grant.

12. The first thirty days

  • First outpatient appointment within seven days
  • Enough medication in hand to bridge the gap
  • Insurance verified active
  • Benefits applications filed
  • Written crisis plan carried
  • Someone checking in, in person, more than once

13. If the person is in jail instead

  • Notify the jail in writing of the diagnosis, medications, doses, prescriber, and pharmacy.
  • Request a suicide risk screening if there is history.
  • Contact the public defender immediately — not at arraignment.
  • Ask whether the office has a social worker or mitigation specialist.
  • Ask about mental health court and diversion — eligibility is decided early.
  • Before raising competency, ask: what is the restoration wait, what is the maximum exposure, is diversion or dismissal available? The wait can exceed the sentence.
  • If transfer to a hospital is proposed, note that notice and a hearing are required.
  • Document any denial of medication or care in custody: dates, requests, responses.

14. Afterward

  • Appeal insurance denials — inpatient and residential denials are frequently reversed; parity limits apply.
  • Check inpatient vs. observation billing classification.
  • Apply for hospital financial assistance — deadlines run from billing.
  • Employment: request accommodation or medical leave in writing.
  • Firearms: ask about the state's relief-from-disabilities petition if an involuntary commitment occurred.
  • Records: ask whether the state provides sealing or expungement of commitment records.
  • Redo the advance directive with what you learned.

15. Escalation — Protection and Advocacy

  • Every state and territory has a federally funded P&A agency. Services are free.
  • They may enter facilities and obtain records that a family member cannot.
  • Call them for: abuse or neglect in a facility · denial of care in custody · unjustified institutionalization when community placement is appropriate.
  • The integration mandate argument: if the person's own treatment professionals say community placement works, and the person does not oppose it, continued institutionalization may be disability discrimination.

Related documents

Educational only, not legal advice. Commitment standards, hold periods, and patient rights vary substantially by state. In an emergency, call 988 or 911.