Psychiatric Emergencies

Problems Needing Immediate Attention

It is a psychiatric emergency if your child:

• Attempts suicide: this is a medical emergency.
• Expresses serious thoughts about attempting suicide.
• Experiences uncontrollable anxiety.
• Exhibits a bizarre behavior, severe depression, disorientation or confusion.
• Acts destructive or otherwise acts out of control and cannot be restrained.
• Hears or sees things that do not exist.

Voluntary and Involuntary Examination and Treatment

Mental Health Treatment of Children Under 14 Years of Age

A parent need not go through any legal procedures to have a child under the age of 14 examined and treated in an emergency facility or psychiatric hospital. Voluntary examination and treatment may be authorized by any parent, guardian, or a person acting in loco parentis to a child less than 14 years old. If, however, your child does not want to go to the facility, you may need some help. If it is a crisis situation and your child needs immediate help but is resisting, call the Police. Ask them for help in transporting your child to emergency psychiatric care. You will be expected to accompany your child.

Talk to your child's therapist, Community MH/MR Center staff, or other mental health professional in advance to determine what is best to do if a crisis does occur.

Voluntary Mental Health Treatment of Children 14 Years of Age and Older

Voluntary examination and treatment may be authorized by any person 14 years old or older who feels he or she is in need of treatment and understands the nature of voluntary treatment. For parents, this means that if your child is willing to seek treatment in an inpatient facility, you need not go through any legal procedures.

Before your child is accepted for treatment, he or she must be given a full explanation of the types of treatment that may be provided and the possible restraints or restrictions which may be imposed. He or she also must be given a consent form to sign. By signing the form, your child agrees to placement at a specified facility for a specific period of time. Voluntary inpatients may withdraw their consent to treatment at any time by giving written notice and must in all cases be released within 72 hours of such notice. If the hospital believes your child needs more treatment and your child is unwilling, it must apply to a court for permission to detain him or her involuntarily.

Involuntary Examination and Treatment

You may be sure that your child needs a psychiatric examination and treatment, but he or she disagrees. If your child is 14 or over and refuses treatment you will need to apply for involuntary commitment. Under the Pennsylvania Mental Health Procedures Act, a severely mentally disabled person may be subject to involuntary examination and treatment. This law specifies that a person is severely mentally disabled, when, as a result of mental illness, his capacity to exercise self-control, judgment and discretion in the conduct of his affairs and social relations or to care for his own personal needs is so lessened that he poses a clear and present danger of harm to others or to himself, and in each case that there is evidence of mental disorder, not just violence.

Clear and present danger to others is shown by establishing that during the past 30 days:

• The person has inflicted, attempted to inflict serious bodily harm on another, or
• Has made threats and has committed acts in furtherance of the threat to commit harm.

Clear and present danger to himself is shown by establishing that during the past 30 days:

• The person has acted in such a manner as to evidence that he or she would be unable, without care, to satisfy his or her need for nourishment, personal or medical care, or self-protection and safety, and that there is a reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within 30 days if treatment were not provided.
• The person has attempted suicide.
• The person has severely mutilated himself or attempted to do so.
• The person has threatened suicide or mutilation, and has acted in furtherance of the threat.

Obtaining an Involuntary Commitment (Section 302)

Should any of the above conditions be present, and your child still refuses to go to an emergency facility, a parent or any interested person who has observed the child's behavior may seek an emergency psychiatric evaluation by filing a 302 Emergency Involuntary Commitment Petition.

• You can obtain a 302 Petition Form at the nearest community MH/MR center.
• Fill out the form, citing your child's specific behaviors: what you have observed your child actually do or say. Only persons who have witnessed the child's behavior can fill out the 302 petition. There can be more than one petitioner. A staff person should help you fill out the form.
• The staff person at the psychiatric emergency service or the community MH/MR center will call the Delegate of the Office of MH/MR, who will decide whether the petition meets the legal criteria for involuntary commitment.

When filling out the 302 Petition Form, you must have firsthand knowledge, within the last 30 days, of present dangerous behavior caused by mental illness.

1. To support the contention that your child is presently dangerous:

• Do: Describe actions or facts that give evidence that the person could commit harm and that it could be fatal. For example, the person threatens, "I'm going to kill myself" and tells you she has been stockpiling drugs. Or the child threatens you with a dangerous object and has one at hand.
• Don't: Cite annoying behavior rather than dangerous behavior. For example, painting sidewalks different colors in front of the neighbors' homes is an annoying, but not dangerous behavior.

2. To support the contention that your child is mentally ill:

• Do: Be as concrete as possible. Don't say, "My son has been acting weird." Say, "For the last month my son has said that TV was talking and telling him what to do."
• Don't: Quote a diagnosis. This is not evidence. You as petitioner must cite behavior which occurred within the last 30 days, and you must have witnessed this behavior firsthand.
• Do: Show your child's perceptions are significantly different than the average person. For example, he may say the food is poisoned or that he hears voices.
• Do: Show evidence of his or her high level of upset. For example, "She hasn't slept all week."
• Do: Show evidence if your child is paranoid. For example, "He says all the neighbors are watching."
• Do: Have others who have witnessed your child's behavior firsthand give information on the 302 petition and sign one petition.

Remember to write only information about the past 30 days.

After Receiving Emergency Treatment

When your child is in crisis, your first step is to get him/her to your therapist, BSU, or the facility providing emergency services for children. A mental health professional at that location will determine whether your child is in need of inpatient hospitalization or if there are other means of dealing with the crisis.

If Your Child Does Not Need Hospitalization

After examining your child, the mental health professional may tell you that he or she does not believe that your child needs inpatient care, but that other means of dealing with the crisis exist (for example, treatment in a less restrictive setting). If this happens to you:

• Ask for an explanation for your child's behavior.
• Ask for specific recommendations for dealing with your child's behavior.
• Ask for information about other programs that are available for your child.
• If your child does not already have a therapist, get a referral to your local community MH/MR center or a private therapist.
• Insist on an immediate appointment.
• If you disagree with the professional, ask for a second opinion.

If Your Child Does Need Hospitalization

If your child is found to need psychiatric inpatient care, the mental health professional will try to arrange for your child to be placed in an appropriate child or adolescent psychiatric inpatient unit.

Extended Psychiatric Inpatient Treatment

If your child has been involuntarily committed and kept in either an emergency facility or on a hospital inpatient unit, he/she may be treated on an emergency basis for not longer than 120 hours, or five calendar days. If the treating facility, you or another interested party believes that more treatment is necessary, this party must apply to court for permission to continue treating your child. This is a petition for extended involuntary emergency treatment, and is commonly called a 303. If your child does not have an attorney, the court will appoint one. This person is an ADVOCATE FOR YOUR CHILD. If you want YOUR point of view represented, you may want to retain your own attorney. The Child Advocate will represent your child at any future hearings as well.

303 Hearings In Court

The petitioner will be asked to testify in court. Since your child will also be present in the courtroom, this can be a very difficult time for parents. Bring someone with you for support, if possible.

If you have questions about the process, contact:

Pennsylvania Protection and Advocacy: 1-800-692-7443
Parents Involved Network: 1-800-688-4226

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