Involuntary Hospital Commitment: What You Should Know

Involuntary commitment to a hospital psych ward can be a very traumatizing experience for everyone involved.

Do you know someone who has been involuntarily committed to a hospital for psychiatric treatment? What do you wish you knew?

This audio blog will discussion the 302 or involuntary treatment process and reasons for why it happens.

Involuntary psychiatric commitment or the 302 process is one of the most abrasive and traumatic experiences someone could ever experience while in the care of a mental health professional. It is a last resort some therapists must take.

What are the downsides?

A 302 helps mental health professionals ensure the safety and protection of a client, even if that client isn’t admitted. It is the process by which a clinician must weigh and balance the pros and cons of making the decision to commit a client to a hospital. The process can go terribly wrong if poor decisions are made without forethought.

Despite the many reasons for an involuntary commitment, it can be a traumatizing experience including for the therapist. Therapists have a difficult position because they strive to be supportive and caring and yet, must make drastic decisions if a client isn’t safe, healthy, or able to care for basic needs. The relationship that seems, to the client, to be a “friendship” can quickly turn in to a relationship with a major power differential. This power differential, once exercised, can cause a client to feel betrayed, hurt, or disappointed. This can then lead a client to drop out of therapy forever.

A therapist tends to move from caring, compassionate, and understanding to authoritative and in control of the client’s ultimate fate. The changing role of the therapist is what tends to keep client’s on guard throughout therapy and possibly even unable to fully trust.

A caring therapist tries their hardest to avoid involuntary commitment as it can seriously disrupt the therapeutic relationship and cause scars difficult to heal. So what is the answer? Education.

Why do therapists use involuntary commitment?

For me, involuntary commitment is the last resort after hours, days, weeks, or months of trying to support a client and ensure their health and safety. Unfortunately, some mental health professionals (especially those who are inexperienced) may rely on this method to control clients, win a power struggle, or “get rid of” clients who are very difficult and resistant. But this is not what a 302 is. Involuntary commitment should occur if the following is happening:

  1. Harm to self or others
  2. Moderate to extreme self-mutilation
  3. Threats to harm or kill self or others
  4. Emotional disturbance and thought disturbance with a history of suicide attempts or gestures
  5. Impulsivity, suicidal ideation, threats, poor anger management, SIB that is severe (cutting, burning, etc) with the intent of killing self.
  6. Violence and threats toward others.

Education about the 302 process may lead to greater autonomy and maintenance of the therapeutic relationship

A 302 will not be approved by a county delegate, police, or crisis center/hospital if grounds for the 302 are weak. In other words, a 302 is basically a team procedure that requires agreement that a 302 is necessary.

If there is agreement, the client will be admitted. If there isn’t agreement, the 302 may still occur but the hospital may refer the client elsewhere believing the client isn’t in imminent or immediate danger. The client will be released with recommendations for further outpatient care.

It is important to note that a 302 to a hospital will give a client a criminal record. This may also result in difficulty purchasing firearms. Sadly, there is a lot of misinformation about the 302 process and it’s about time we change that.

If we can educate clients and their families on the 302 process, it may propel many to be compliant with treatment, accept referrals, and maintain safety. Of course, like with anything else, there will be holes in this approach. But perhaps it is a start.

If more client’s know what happens before, during, and after a 302, they may become better advocates for themselves.


For further information on this topic, listen to my most recent audio blog here:


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