Involuntary Commitment: When Is It Time To Bring In Counsel?

Restoration of Capacity

Last month, the Montana Supreme Court affirmed the district court’s involuntary commitment of a married, successful business owner in her late fifties (“Maggie”) to the Montana State Hospital because she showed evidence that she was unable to provide for her own basic needs, including refusing to take medication to treat her diagnosed bipolar disorder, showed signs of insomnia, lacked insight into her illness and her inability to protect her own health and safety.

Below is Maggie’s story. If you, or someone you know, is experiencing similar life-altering symptoms, it’s important to know that retaining counsel as early as possible in a psychiatric emergency situation is essential in preventing an unnecessary involuntary commitment.

What is an involuntary commitment? It is a legal proceeding to obtain a court order requiring a mentally ill individual to receive necessary psychiatric treatment that he needs but has not agreed to.  The process of obtaining the order is often initiated through a mental health screening and requires a determination that the person to be held is at risk of endangering himself or others. If it is determined that the individual can afford to pay for the cost of psychiatric care, they may be ordered to pay for the care from their own income and resources.

Why is it important to involve counsel early in the process? Retaining counsel can:

  • protect your rights
  • help you legally limit your financial responsibility where appropriate
  • provide valuable information regarding long-term care placement options and can review admissions agreements, and where the individual who is involuntarily committed is married, and cannot return to the home, counsel can help protect assets and income for the healthy spouse.
  • offer guidance regarding the next steps to take, whether it be a conservatorship, guardianship or a Medicaid or charity care application

Here’s Maggie’s story:

In 2018, Maggie lost twenty pounds and developed a sleep disorder. Over a period of approximately one week, she made multiple visits to the emergency room to obtain medical attention.  She was diagnosed with insomnia, prescribed a sleep regimen and sleep medicine, was otherwise healthy and had no history of self-harm or dangerous behavior. Maggie reported that she elected to stop driving due to the insomnia.

Fast forward to one week later, Maggie returned to the emergency department with her family due to continuing sleep issues and “high energy behaviors.” A licensed clinical social worker concluded that she was experiencing a manic episode and bipolar disorder and filed a report recommending her involuntary commitment.  The state filed its response the next day and Maggie was ordered to be held overnight pending the involuntary commitment hearing at a residential mental health facility.

Shortly after getting admitted, an evaluation was conducted and the examiner testified at the involuntary commitment hearing that Maggie had pressured speech, tangential thinking, poor judgment and insight, inability to consent to taking medication and that she exhibited paranoia with respect to the side effects of the medication prescribed.  The examiner testified that Maggie was advised that the appellant was a danger to herself due to her multiple emergency room visits, her refusal to take medication, and because she drank too many Pedialyte beverages in attempt to correct an imbalance in her electrolytes.  At the involuntary commitment hearing, the court found that Maggie presented a danger to herself and that her condition might decompensate without intervention and ordered her involuntarily committed to the state hospital.

On review, the supreme court admitted that this case was not as compelling as several prior cases in which an involuntary commitment was upheld.  However, the lower court’s decision was sustained, based on testimony that the woman had poor insight into her illness, lacked the ability to make decisions protective of her own health and safety, and was unwilling to take any medication that would resolve her manic symptoms.

Questions? Let Jane know.

Jane Fearn-Zimmer is a shareholder in the Elder and Disability LawTaxation, and Trusts and Estates Groups. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.

Involuntary Commitment Proceedings –Who Pays for That?

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An involuntary commitment, or civil commitment, proceeding, is a summary legal action filed in order to obtain a court order to require a mentally ill individual to receive necessary psychiatric treatment against his or her wishes, pursuant to N.J. Rule of Court §4:74-7 and N.J.S.A. §30:4-27.2.  Typically, the involuntary commitment process is initiated through a mental health screening, but the process can also be filed by a prosecutor or the Attorney General. Only individuals who are shown by clear and convincing evidence to present a danger to themselves may be involuntarily committed.

An order for involuntary commitment must be issued within 72 hours, and the hearing itself must be held in no more than 20 days.  The individual who is the subject of an involuntary commitment hearing has the right to an attorney to represent her in the commitment proceedings. The existence of involuntary commitment proceedings does not mean that an individual has been adjudicated incapacitated, nor does it mean that her rights, such as the right to bear arms, the right to drive, the right to have visitors, to receive medical treatment, and to fresh air and exercise, are removed or restricted.  The only mechanism to restrict these rights is to obtain a guardianship order from the Superior Court, which is an entirely different proceeding governed by different rules.

By law, the State of New Jersey is required to bear ninety percent of the cost of an involuntary commitment, leaving the remaining ten percent to be borne by the involuntarily committed individual. The financial evaluation process is undertaken by the county adjuster’s office. If it is determined that the individual can afford to pay for the cost of their psychiatric care, the county adjuster seeks a court order requiring the individual to pay for the cost of psychiatric care, which can impose a heavy financial burden on the former patient.

It is important to know that hospitals and the county adjuster’s office are required to follow strict regulations in collection matters arising from emergency hospital admissions and psychiatric emergency screening services.  Charity care regulations apply where a financially eligible patient becomes involuntarily committed as the result of a hospital emergency room admission. Newton Medical Center v. D.B., No. A-5101-15T4 (N.J. Super. App.Div., January 17, 2018.  The case involved an uninsured patient who was admitted to a hospital emergency room during a psychotic episode, and was involuntarily committed. After the patient’s release, the medical center billed the patient the sum of $65,000 bill for the eleven days of care, reduced the bill due to the patient’s lack of insurance, and attempted to collect on the reduced bill. At the trial level, the Court entered summary judgment in favor of the hospital.  The Appellate Division reversed the trial judge’s decision, ruling that the hospital could not recover from the former patient, because it did not contact the patient as required by the charity care regulations.

Questions? Let Jane know.

Jane Fearn-Zimmer is a shareholder in the Elder and Disability Law, Taxation, and Trusts and Estates Groups. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.