CLRP

Psychiatric Inpatient Hospital Issues

Challenging Physician’s Emergency Certificates and Involuntary Commitment

You may be sent to the hospital by a medical doctor who thinks you need immediate treatment. The doctor must examine you and sign an emergency certificate, In order to send you to the hospital; the doctor must certify three things:

1. You are mentally ill. This means you have a mental or emotional condition which substantially limits your ability to function;

and

2. Either
a. You are dangerous to yourself or others. This means that there is a substantial risk that you will physically harm yourself or someone else;

or b. You are “gravely disabled.” This means that you are in danger of serious harm because you cannot provide for your basic needs such as food, clothing, shelter or safety because of mental illness.

and
3. You need immediate treatment for mental illness (C.G.S. §17a-502).

The police may take you to a general hospital for examination and emergency certification if they believe you are mentally ill and meet the other requirements (C.G.S. §17a-503 (a)). A psychologist may alo request that the police pick you up and take you to a hospital for an examination. Anyone else who thinks you need immediate treatment, such as your family or friends, may apply to the probate court. The probate judge may then order the police to bring you before the judge to determine whether you should be examined by a doctor (C.G.S. §17a-503 (b)).

After admission on a P.E.C.:

  • A psychiatrist must evaluate patient within forty-eight hours.
  • If patient does not meet standard for emergency treatment, patient must be discharged immediately
  • Patient may be confined for up to fifteen days under an emergency certificate without an order from the probate court
  • Patient may also be kept another fifteen days on the basis of a new certificate issued within fifteen days of the original certificate, if the hospital applied to Probate Court for an involuntary commitment hearing
  • Hospital cannot keep patient longer than a total of thirty days unless committed by court or patient has signed in voluntarily

Regarding the Civil Commitment Hearing:


  • Any person detained on an emergency basis must be promptly informed of his right to (1) consult an attorney; (2) have an attorney appointed if he is indigent; and (3) have a hearing.

  • Hearing must be held within 72 hours of receipt of the person's written request, excluding weekends and holidays.

  • The patient (and his/her appointed lawyer) have the right to ask questions of any witnesses at the hearing, including any doctors (C.G.S. §17a-498 (a)). If the patient wants to question the doctors who examined you, they must come to the hearing, but the patient has to let the judge know in writing at least three days before the hearing that the patient wants to question them (C.G.S. §17a-498(c)). Before the hearing, the patient has the right to look at any psychiatric records about them, including any hospital records (C.G.S. §17a-498(b)).

Restraint and Seclusion

Regulation of the use of restraint and seclusion in facilities such as psychiatric hospitals, schools, group home for persons with cognitive disabilities and hospitals which serve children has increased since 1999. In general, the use of restraint and seclusion is not permitted except in emergency situations and its use must be limited to the shortest amount of time necessary to resolve the emergency. There are federal regulations, state laws, agency and hospital policies that govern the use of restraint and seclusion, and vary based upon the setting.

The Connecticut Patients’ Bill of Rights governing mental health services in inpatient and outpatient settings, enacted in 1971, restricts the use of involuntary seclusion and restraint to situations where “there is an imminent physical danger to the patient or others and a physician so orders.” However, the use of restraints as a “therapeutic practice” continued to be widely accepted.

In 1998, a series of restraint-related deaths in psychiatric facilities drew attention to the risks of restraint and seclusion, as did a five part series in the Hartford Courant published in October of 1998 entitled “Deadly Restraints.” This series helped accelerate work on the federal level by the Medicaid and Medicare programs to regulate the use of restraint and seclusion. It also spurred the creation of a State Task Force on Restraint and Seclusion to review state policies.

The DMHAS policies governing the use of restraint and seclusion issued in 2002 (link) establish specific rules for de-escalation to avoid the use of restraint and seclusion, the clinical requirements for ordering the use of restraints or seclusion, ongoing documentation of the continued need for restraint or seclusion, notification of advocates and family members, and de-briefing of both persons who have been restrained and the staff involved in the restraint.

The use of restraints at DMHAS facilities has declined. However, there continue to be situations where the DMHAS policies and procedures regarding restraints or seclusion, including documentation, are not followed.