1. Psychiatric Petitions &
The Commitment Process
Teresa Chahine MSN, PMHNP
Oakland University, School of Nursing

2. Process of Psychiatric Admissions
Adult Formal Voluntary Admission
• Admission form signed by patient
who is agreeable to seeking
inpatient psychiatric treatment.
• Patient’s must be their own legal
guardian to sign a voluntary
admission form.
• The voluntary admission form
allows the hospital to continue to
hold a patient for up to 3 days after
patient gives written notice of intent
to leave hospital if staff do not feel
patient is ready for discharge.
Adult Involuntary Admission
• The process of filing a “petition for hospitalization”
to begin court proceedings for treatment of an
individual who is refusing or cannot give formal
consent.
• A physician/psychiatric/psychologist must file a
“clinical certificate” that verifies patient’s clinical
presentation and danger to self/others.
• Both the petition and the clinical certificate are
submitted to probate court in the county the patient
is in.
• A hearing occurs within 7 to 10 days of admission
both the patient and the healthcare organization are
represented by attorneys that present the case to
the judge for decision.

3. What is a “petition for hospitalization”?
• A petition is the initial process of involuntary psychiatric treatment.
• Petitions are completed for any patient that there is concern for their health
or welfare as it relates to: suicidal/homicidal behavior, and/or inability to
care for self due to mental illness, and is ambivalent or refusing mental
health treatment.
• Ideally, patient’s family member, friend or professional staff completes the
petition. The person who completes the petition knows the patient’s
situation and has witnessed events, situations or verbalizations which
illustrate the need for psychiatric treatment.
• The petition requires the patient to remain in the hospital until the
individual is evaluated by a physician/psychiatrist/psychologist and finds
patient psychiatrically cleared to be discharged.

4. Co-morbidities:
Substance Abuse And Psychiatric Symptoms
• The law states that you cannot force treatment under the Michigan Mental Health
Code for substance abuse.
• Only people who are found guilty of a crime associated with substance abuse can
be ordered by a civil court to receive rehabilitation treatment.
• In the clinical setting, assess behavior that is potentially dangerous even in a
monitored substance abuse program:
• Is the individual exhibiting psychotic symptoms?
• Can delirium (from withdrawal) be ruled out?
• Has the individual made a serious, impulsive act of self harm while under the influence?
• Is the individual still feeling like harming themselves or harming someone else when not
under the influence?
• What type of supports and resources does the individual have in their life?
• When documenting on a petition, focus on what the individual is doing, besides
the substance abuse, that is endangering themselves or others? (i.e not eating, not
bathing, wandering, overdosing…etc)

5. Fast Facts on the Involuntary Patient
• Anyone over 18 years of age can fill out a petition on an adult patient for
whom they have concerns of harm to self or others. The petitioner must
have witnessed the behaviors and be accurate on this form because it is a
court document.
• Behaviors described on the petition should be recent, within the last 2
weeks. Historical behaviorof self harm or harm to others should only be
listed after the present dangerous behaviors are described.
• The petition is legal for 10 days only.
• The petition must be treated like writing a check; no scribbles; draw a line
through your error and initial it. Do not punch holes in the document.
• Completing a petition is not committing the patient. You are ensuring that
the patient received a psychiatric evaluation.

6. …More Facts on the Involuntary Patient
• The physician’s certificate is only good for 24 hours. A physician must re-evaluation
and a new certification is to be completed to continue to hold the patient prior to
filing the papers with probate court.
• Hearings are set within 7 days (excluding Sundays and holidays) after papers have
been filed with probate court.
• The patient will have a chance to accept treatment without a court hearing. The
psychiatrist may deem the patient able to sign a formal voluntary admission form.
The second chance is through a deferral meeting with a court appointed attorney
prior to a court hearing.
• Court orders are recommended treatment with limitations in the hearing. These
orders are usually short term 30 to 60 days. The patient may be discharge if stable
prior to maximum days indicated by a court order.
• An alternative treatment order holds the patient accountable for continued
outpatient treatment. If this treatment is not followed by the patient, re-
hospitalization will occur.

7. When is a Court Order a Court Order?
• A court order is something that occurs after the patient has been
psychiatrically hospitalized and had a probate court hearing.
• In a medical-surgical setting, nurses may come across a “court order for
examination”. This document is one that is used to “go get” or ensure that
the patient who is unwilling to come in for a psychiatric evaluation on their
own. This document only ensures that a psychiatric evaluation will be
completed. It is not an automatic admission.
• Once a patient has had a hearing and an court order has been issued, the
order may be a combination of inpatient and out patient treatment with a
time restriction or both.
• Court order treatments are a matter of public records and as such are not
privy to HIPAA or privacy acts. Individuals that have at some point in time
been court ordered for treatment will have this information appear in court
documents or by police during a routine traffic stop.

8. End