Admission to a psychiatric hospital

Rules

Voluntary Admission

Voluntary admission to a psychiatric hospital or unit occurs in much the same way as admission to a general hospital. Referral may be made by your GP or consultant. Unlike patients in general hospitals, you are not always completely free to leave psychiatric care when you wish.

If you are a voluntary patient who wants to leave a psychiatric centre and the consultant psychiatrist or a doctor or nurse on the staff considers that you are suffering from a mental disorder, the professional may detain you for a maximum of 24 hours. If the voluntary patient is a child and the parents or guardian want to remove them, the professional may have the child detained and placed in HSE custody (if the professional considers that the child is suffering from a mental disorder).

The consultant psychiatrist must either discharge you or arrange for an examination by another consultant psychiatrist. The second consultant must issue a certificate stating that you should be detained because of a mental disorder or must discharge you. If you are detained, then you are an involuntary patient and all the procedures relating to information, review and appeal apply in the usual way (see rights of psychiatric patients).

Involuntary Admission

Under the Mental Health Act 2001, you may be involuntarily admitted and detained in an approved psychiatric centre if you are suffering from a mental disorder. You may not be admitted purely because you are suffering from a personality disorder, are socially deviant or addicted to drugs or intoxicants.

Mental Disorder

The Act defines mental disorder as mental illness, severe dementia or significant intellectual disability where:
• Because of the illness, disability or dementia, there is a serious likelihood that you may cause immediate and serious harm to yourself or to other people or
• Because of the severity of the illness, disability or dementia, your judgement is so impaired that failure to admit you to an approved centre would be likely to lead to a serious deterioration of your condition or would prevent the administration of appropriate treatment that could only be given by such an admission and your reception, detention and treatment in an approved centre would be likely to materially benefit or alleviate your condition.

Mental illness means a state of mind which affects your thinking, perceiving, emotion or judgment and which seriously impairs your mental function to the extent that you require care or medical treatment in your own interest or in the interest of other people.

Severe dementia means a deterioration of the brain which significantly impairs your intellectual function and affects thought, comprehension and memory and which includes severe psychiatric or behavioural symptoms such as physical aggression.

Significant intellectual disability’ means a state of arrested or incomplete development of the mind which includes significant impairment of intelligence and social functioning and abnormally aggressive or seriously irresponsible conduct.

Application for involuntary admission

An application for the involuntary admission of an adult may be made to a registered medical practitioner by a spouse or relative, an authorised officer, a Garda or any other person. An authorised officer is an officer of the Health Service Executive (HSE) who is designated by the Chief Executive Officer of the HSE for the purposes of making such applications. Spouse does not include a separated spouse or a spouse against whom an application or order under the Domestic Violence Act has been made.

The following people may not make an application:
• Anyone aged under 18
• An authorised officer or Garda who is a relative of the person concerned or that person's spouse
• A member of the governing body (not including a member of the HSE) or staff of the approved centre concerned
• Anyone who has an interest in the payments to be made to the approved centre
• Any medical practitioner who provides a regular medical service to the centre
• The spouse, parent or other close relative of any of the people specifically mentioned above.

The person applying must have seen the person whose admission is sought within the 48 hours prior to making the application. If the application is being made by 'any other person', the application must include a statement of the reasons why it is being made, the connection of the applicant to the person whose admission is proposed and the circumstances in which the application is made.

Medical assessment

If it is proposed that you be involuntarily admitted to an approved centre, you must be examined by a medical practitioner (who is not a relative and is not involved with an approved centre) within 24 hours of the making of an application. The doctor must tell you the purpose of the examination unless he or she considers that such information would prejudice your mental health, well being or emotional condition.

If the doctor considers that you are suffering from a mental disorder, he or she makes a recommendation that you be involuntarily admitted to an approved centre (other than the Central Mental Hospital). This recommendation remains in force for seven days. If the application is refused and a subsequent application is made, the applicant is obliged to inform the doctor about the previous application, if aware of it.

Role of the Gardaí

If a Garda has reasonable grounds for believing that a person is suffering from a mental disorder and that, because of the disorder, there is a serious likelihood of the person causing immediate and serious harm to himself/herself or another person, the Garda may take the person into custody. If necessary, the Garda may use force to enter the premises where it is believed that the person is. The Garda must then go through the normal application procedure for involuntary detention in an approved centre. If the Garda's application is refused, the person must be released immediately. If the application is granted, the Garda must remove the person to the approved centre.

Removal to an approved centre

In general, it is the applicant who is responsible for taking the person to the centre. If this is not possible, then the doctor who made the recommendation may ask the clinical director of the centre or a consultant psychologist acting on his/her behalf to arrange for the person to be brought to the centre by the staff. If necessary, the Gardai may be asked to help. In this situation, the Gardai have the power to enter premises by force and may detain or restrain the patient if necessary.

Admission to an approved psychiatric centre

When you are received at an approved psychiatric centre, you must be examined by a consultant psychiatrist on the staff. You may be detained for a maximum of 24 hours in the centre for the purpose of carrying out this examination. If the psychiatrist is satisfied that you are suffering from a mental disorder, he/she then makes an involuntary admission order. If the psychiatrist is not satisfied that you are suffering from a mental disorder, you must be released immediately. The admission order is valid for 21 days. It authorises your reception, detention and treatment in the centre for this period.

A renewal order may extend this period by a further 3 months. This must be made by the consultant psychiatrist responsible and he/she must have examined you in the week before making the order. A further renewal order may be made by the same psychiatrist for a period of 6 months and subsequently for 12 months at a time.

There are provisions for the review of all admission orders - these are outlined in rights of psychiatric patients.

Children