What happens if someone needs psychiatric treatment, and they are either unaware of the need, refusing treatment, or not able to make an informed decision?
All states have a method or way of having someone admitted against their will. And, this is one area that Virginia does well. Some states allow any medical doctor to sign someone in...other states extend that to licensed social workers and other licensed counselors.
In Virgina, a person must be evaluated by a representative of the community services board. Each board has an emergency services unit that is responsible for performing the evaluations. Interestingly, none are medical doctors; in fact, some who were grandfathered in have bachelor degrees. About 12 years or so ago the Commonwealth established a certification system. Now an evaluator is required to have a masters degree and go through a not difficult certification process.
Why is this system better than most? Even though these folks are aware of the potential liability in what they do, they are not driven by it. Medical doctors are always aware of the potential to be sued for their actions or lack of acting. The emergency services' worker often time acts as an advocate for the person who everyone is saying needs to be detained. Their job is to look for the least restrictive alternative to detaining someone.
Routinely emergency room doctors and psychiatrists ask for patients to be screened. Their motivations are usually wanting someone else to be the one who makes the decision as to whether or not a person will be allowed to go home.
The typical request is sort of like this, "I don't feel comfortable with discharging them."
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Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
We often hear people say the system is "broke." However, the problem is that there isn't a system.... Joseph Heller would be proud. Please note, what follows is from my, most likely, myopic viewpoint and I surely don't claim to have The Big Picture, if there is one. I am definitely at the bottom of the food chain looking up......
This is Emergency Services as its Defined on a Community Services Boards' Web Site
Emergency Services/Crisis Counseling is a State mandated program. This unit provides short-term crisis counseling and referrals to individuals on an emergency basis. Emergency and crisis response services include: telephone interventions; face-to-face assessments and evaluation (including pre-admission screening); psychiatric consultation and other clinical consultation about mental health, substance abuse, and special populations which include children, adolescents, geriatric, people with mental retardation, and individuals involved in the forensic system. Emergency Services/Crisis Counseling is staffed 24 hours a day, 7 days a week.
Everything on this website has been thoroughly examined, reviewed, evaluated, and ultimately approved by The Citizens’ Committee for the Advancement of Rational Thought and Actions in Virginia's Mental Health System….
Things Sure Aren't What They Used to be..Conditions Sure Have Changed
coming soon........
Think it's time to post the old First Amendment........ January 17, 2008
Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.
Please Read: Important!
Any events that are mentioned or described here actually happened: however, of course the names of any citizens have been changed and the circumstances of the situation have been altered and modified so that they could never be identified.
Who am I and Where am I?
No way, Jose. I have enough problems. Let me just say that I am sure my part of the state is no different than what other folks are trying to come to grips with in Virginia.
I guess I'll just say that I have some idea of what's going on....and let it go at that.
I'm sure you can separate the facts from the opinions......
PS. OK. I'll fess up...yes, I work for an emergency services unit and have for a few years. My opinions are mine and surely I am not speaking for all of the other emergency services' workers throughout the state.
And, my opinions are based on the population that we see day in and day out.
I guess I'll just say that I have some idea of what's going on....and let it go at that.
I'm sure you can separate the facts from the opinions......
PS. OK. I'll fess up...yes, I work for an emergency services unit and have for a few years. My opinions are mine and surely I am not speaking for all of the other emergency services' workers throughout the state.
And, my opinions are based on the population that we see day in and day out.
The Temporary Detention Order (TDO)
The Temporary Detention Order (TDO).
In the Commonwealth of Virginia there is a provision that allows a person to be forced into a psychiatric hospital. Basically the code says, That if because of mental illness a person is imminently dangerous to themselves or others, or if because of mental illness a person is substantially unable to care for themselves, a magistrate may issue the order.
The magistrate will have a probable cause hearing at which time the emergency services' worker and sometimes a petitioner (note: a petitioner is a reliable responsible member of the community who has seen the behavior or heard the words) will give sworn testimony to support the issuance of the TDO. Some jurisdictions require a petitioner and some allow the order to be issued based only on the testimony of the emergency services' worker.
The TDO specifies where the person is and where they are going (to which hospital). It is an order that must be carried out by sworn officers; usually a sheriff's deputy or a police officer.
In the Commonwealth of Virginia there is a provision that allows a person to be forced into a psychiatric hospital. Basically the code says, That if because of mental illness a person is imminently dangerous to themselves or others, or if because of mental illness a person is substantially unable to care for themselves, a magistrate may issue the order.
The magistrate will have a probable cause hearing at which time the emergency services' worker and sometimes a petitioner (note: a petitioner is a reliable responsible member of the community who has seen the behavior or heard the words) will give sworn testimony to support the issuance of the TDO. Some jurisdictions require a petitioner and some allow the order to be issued based only on the testimony of the emergency services' worker.
The TDO specifies where the person is and where they are going (to which hospital). It is an order that must be carried out by sworn officers; usually a sheriff's deputy or a police officer.
What are the steps required to have a TDO issued?
- A police officer, citizen, hospital worker, friend, loved one, relative, requests an evaluation for a TDO
- Information is usually required that would indicate that the person may be meeting criteria
- A face-to-face evaluation is completed
- A screening form is filled out that provides information that supports the request for the TDO...after the evaluation, if the person is not meeting criteria, they are released
- If the person is meeting the criteria a willing facility must be found
- After a hospital is found, the information is presented to the magistrate
- The person is taken to the hospital by law enforcement officers
- At the hospital the officer signs/executes the TDO and turns over the patient to the hospital
Who can request an evaulation for a TDO?
With some exceptions, almost anyone can request an evaluation. Some folks think it must be a family member...not true. Any reliable and responsible citizen may make the request; however, they must have first-hand knowledge of "recent" events that would lead the worker to feel as though the person would meet the criteria. The person requesting the evaulation should be able to describe living conditions and in general overall mental status.
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