Tough choices

It's a crisis that loved ones of those living with severe mental illness are likely to deal with at some point.

The person is clearly not well - the symptoms are presenting themselves for the first time, or the person is suffering a seri ous setback - and they will not seek help.

The Mental Health Pro cedures Act lays out condi tions for a person to be involuntarily committed in Pennsylvania if that person is a serious danger to them selves or someone else. By law, this process has a system of checks, designed to balance the rights of the individual with the rights of society.


For a person to be involun tarily committed, he or she must meet one of these standards:

  • Have inflicted or at tempted to inflict serious bodily harm on others within the last 30 days.

  • Attempted or seriously considered suicide, or have sub stantially mutilated himself or herself within the past 30 days.

  • Have shown, within the past 30 days, that the person is unable to care for himself or her self "to the point that death or serious bodily injury or serious physical debilitation" would result without intervention.

    The process



    The loved one: The law says if a responsible adult - a loved one, police officer, doctor - feels a mentally ill person meets the standards, they can petition to have that person in voluntarily committed. A staffer from York/Adams Mental Health/Mental Retardation, called a delegate, reviews the petition.

    2. The delegate: If the del egate believes the person should be committed, the peti tion becomes a mental health warrant, authorizing police to take the person to the nearest emergency room.

    3. The person: Within two hours of arriving at the hospital, an emergency doctor and crisis intervention staff will meet with the person. The doctor will deter mine if the person is a danger to himself or herself and if he or she needs to be stabilized in a hospital setting.

    4. The team: If so, the person is committed under sec tion 302 of the law, which likely means he or she will be ad mitted to York Hospital, where a treatment team, including psy chiatrists and social workers, begins work.

    Once the team feels the person is stable and no longer a threat, the person will be dis charged with a treatment plan, possibly to an outpatient pro gram.

    The hearings

    303 hearing: If, after five days, the doctors feel a person is not ready to be discharged, the person has a commitment hearing, where the doctors and original petitioners testify before a hearing officer. The person is represented, usually by a public defender.

    If the hearing officer agrees with the doctor's decision, the commitment is extended for at most 20 days under section 303 of the law. Again, doctors will discharge the person as soon as they feel the person is ready.

    If the person is not dis charged, the treatment team will likely look to move the person from York Hospital to another fa cility in the community or - in more serious cases - to Wer nersville State Hospital.

    304 hearing: If 20 days pass without discharge, another hearing is held. Members of the treatment team testify to explain why a person still requires hospi talization. Under section 304 of the law, the person could then be recommitted for 90 days.

    305 hearing: After that, if a person is still not responding to treatment and fits one of the original standards, another hear ing is held. Under section 305 of the law, a person can be recom mitted for 180 days.

    People who have been in hospital settings for years still have a hearing every 180 days to re-evaluate their condition.

    Appeals: People with mental illness can appeal the mental health review officer's ruling.

    York County Court of Common Pleas Judge Penny Blackwell hears those appeals and issues a ruling. If she upholds the officer's decision, people can appeal their cases to the state Superior Court.

    - Sources: Jennifer Richard, program director for Crisis Inter vention; Steve Warren, director of York-Adams Mental Health/ Mental Retardation; Allen Miller, director of WellSpan's behavioral health program; attorney Victor Neubaum, mental health review officer.