Iowa's state laws for involuntary psychiatric holds for child and adult psychiatric emergencies

Full Answer Section

• • Duration of Emergency Hold: Under Iowa Code § 229.22(3), a person detained under an emergency hold can be held for a period not exceeding 48 hours, excluding weekends and holidays, unless a court order for further detention is obtained. During this time, the individual must be examined by a physician.
  • Application for Emergency Admission: Any interested person (e.g., family member, friend, caregiver) can file an application for emergency admission with the Clerk of Court in the county where the person is located. This application must be supported by an affidavit of a second person with firsthand knowledge or a written statement from a licensed medical provider. If a judge finds probable cause, they can order the person to be immediately transported to a hospital and examined by a physician, with a hearing set within five days.

• Who can release the emergency hold:

  • The superintendent or the attending physician of the facility where the person is being held can release the individual if they determine that the person no longer meets the criteria for emergency detention (i.e., is no longer likely to injure themselves or others due to mental illness).
  • A judge can also order the release of the individual at any point if they find that the criteria for the hold are not met. This could occur after a hearing or upon review of the person's condition.

• Who can pick up the patient after a hold is released:

  • Once the emergency hold is released, the individual is free to leave. Ideally, they would be picked up by family members, friends, or other supportive individuals they choose.
  • If the individual lacks such support or is still experiencing significant mental health challenges, the facility staff will work to connect them with appropriate aftercare services, which may include outpatient therapy, community mental health centers, or referrals to other support organizations. The individual's wishes regarding aftercare will be considered to the extent possible.

Child Psychiatric Emergencies (Under 18):

The process for involuntary psychiatric holds for minors in Iowa shares similarities with the adult process but includes additional considerations for the child's welfare and parental/guardian rights.

• Who can hold a patient and for how long:

  • Emergency Detention by Peace Officer or Healthcare Professional: Similar to adults, peace officers and qualified healthcare professionals can initiate an emergency hold for a minor if they have reasonable cause to believe the minor has a mental illness and poses an imminent risk of injury to themselves or others.
  • Parental/Guardian Application: A parent, guardian, or custodian of a minor can also apply to the court for an emergency order for the immediate detention of the minor for examination and treatment if they believe the minor has a mental illness and is likely to injure themselves or others if not immediately detained.
  • Duration of Emergency Hold: The emergency detention period for a minor is also not to exceed 48 hours, excluding weekends and holidays, unless a court order for further detention is obtained. During this time, the minor must be examined by a qualified mental health professional, which may include a psychiatrist or a licensed psychologist.

• Who can release the emergency hold:

  • The superintendent or attending physician/qualified mental health professional at the facility can release the minor if they determine that the minor no longer meets the criteria for emergency detention.
  • A judge can also order the release of the minor after a hearing or review.
  • Parents/Guardians: While parents/guardians can initiate an emergency hold, the decision to release the minor ultimately rests with the medical or judicial authorities. However, their input and recommendations will be carefully considered.

• Who can pick up the patient after a hold is released:

  • Upon release, the minor will typically be released to the custody of their parents, guardians, or custodians.
  • If there are concerns about the safety or well-being of the minor upon returning home, or if the parents/guardians are unable or unwilling to provide appropriate care, the facility staff will work with the Department of Health and Human Services (DHS) or other relevant child protective services to ensure the minor's safety and access to necessary support and aftercare. This may involve a safety plan, referral to outpatient services, or, in more serious cases, a temporary placement outside the home.

Differences Among Emergency Hospitalization, Inpatient Commitment, and Outpatient Commitment in Iowa

Iowa law outlines distinct processes for addressing mental health crises and ongoing treatment needs:

• Emergency Hospitalization for Evaluation/Psychiatric Hold (Emergency Detention): This is a short-term, involuntary detention, as described above, typically lasting up to 48 hours (excluding weekends and holidays), for the immediate evaluation and stabilization of an individual believed to be experiencing a mental health crisis and posing an imminent risk of harm to themselves or others. The primary purpose is to assess the individual's condition and determine the need for further treatment. It can be initiated by law enforcement, qualified healthcare professionals, or through a citizen's application with judicial approval based on probable cause. Release occurs when the individual is no longer deemed an imminent risk or when the statutory time limit expires without a court order for further detention.

• Inpatient Commitment (Civil Commitment): This is a more prolonged, court-ordered involuntary treatment in a psychiatric facility. It follows a more formal legal process than emergency hospitalization, requiring an application, supporting documentation (affidavits or medical statements), a hearing before a judge, and a finding by the court that the individual meets specific criteria for commitment under Iowa Code § 229.14. These criteria include having a serious mental impairment that results in a lack of sufficient judgment to make responsible decisions regarding hospitalization or treatment and meeting one of the following:

  • Likely to physically injure themselves or others.
  • Likely to inflict serious emotional injury on family or others.
  • Unable to meet basic needs (nourishment, clothing, shelter, medical care) leading to likely physical injury or death.
  • A history of non-compliance with treatment that has led to emergency hospitalization or acts of serious physical injury. An inpatient commitment order specifies the duration of the commitment, which can be for an initial period and may be extended through further court proceedings. The goal of inpatient commitment is to provide necessary treatment and stabilization in a structured setting for individuals who lack the capacity to consent to such treatment voluntarily.

• Outpatient Commitment (Assisted Outpatient Treatment - AOT): This is a court-ordered mandate for an individual with a serious mental illness to adhere to a specific outpatient treatment plan while living in the community. It is less restrictive than inpatient commitment and aims to prevent relapse and the need for future hospitalizations. Iowa Code § 229.1(20)(d) clarifies that outpatient commitment applies to individuals with a history of non-compliance with treatment that has been a significant factor in the need for emergency hospitalization or has resulted in acts causing serious physical injury. The court order typically requires the individual to participate in services such as medication management, therapy, case management, and substance abuse treatment. Outpatient commitment is intended for individuals who can safely live in the community with structured support but have a history of decompensation and negative outcomes when not consistently engaged in treatment. Failure to comply with the court-ordered outpatient treatment plan can potentially lead to a more restrictive intervention, such as emergency hospitalization or inpatient commitment, if the individual's condition deteriorates to meet those criteria.

In summary, emergency hospitalization is a brief, immediate intervention for acute crises; inpatient commitment is a longer-term, court-ordered treatment in a facility for individuals meeting specific criteria of serious mental impairment and risk; and outpatient commitment is a community-based, court-ordered treatment plan for individuals who can live in the community but need structured support to prevent relapse.

Sample Answer

Iowa State Laws for Involuntary Psychiatric Holds for Child and Adult Psychiatric Emergencies

Iowa law, specifically outlined in Iowa Code Chapter 229, governs the involuntary hospitalization (also referred to as civil commitment or emergency detention) of individuals experiencing a mental health crisis. The process differs slightly depending on whether the individual is an adult or a minor, but the overarching principles of ensuring safety and providing necessary evaluation and treatment remain consistent.

Adult Psychiatric Emergencies:

• Who can hold a patient and for how long:

  • Emergency Detention by Peace Officer: A peace officer may take a person into custody for emergency detention if the officer has reasonable cause to believe that the person has a mental illness and, because of that illness, is likely to injure themselves or others if not immediately detained. The person must be taken to the nearest available facility that provides care and treatment for persons with mental illness.
  • Emergency Detention by Healthcare Professional: A licensed physician, physician assistant, or advanced practice registered nurse who believes a person has a mental illness and is likely to injure themselves or others if not immediately detained may also order the person to be detained and transported to an appropriate facility.