Crisis Intervention and Involuntary Commitment of a Loved-One

An article about dealing with a loved one spiraling out of control, what to expect when police and paramedics get involved, and on obtaining an involuntary commitment order.

Every so often I get a chance to sit down and write about some of my experiences in the field as a professional interventionist. And this just happens be one of those rare moments that I actually have the time to do just that, so here we go. I’m actually on a layover in Charlotte after completing a complex dual-diagnosis intervention case in a small agricultural town just outside of Sacramento, CA.

The case was full of twists and turns, involving a deputy sheriff, a dope dealer, paranoid delusions, and one very loving and determined family. This article was inspired by that case.

So, with all of that said, if you happen to be taking the time out of your busy day to read this article, someone that you care about is probably in need of immediate substance abuse and/or mental health treatment in one form or another.

Nevertheless, even though this is no way a pleasant subject to have to talk about at any time, I am glad that you somehow ended up here with me.

When First Responders Get Involved

As a professional dual-diagnosis interventionist with almost 20 years in the field, I am happy to share my experience, insight, and hope on the subject with anyone negatively impacted by addiction and mental illness. It’s not that I necessarily want people go out and try to handle serious crisis situations on their own, but rather I want concerned loved ones to have as much information at their disposal as possible before they act, especially when they probably need to do so expeditiously.

Let me make it crystal clear right from the beginning, when it comes to filing any legal documents for any form of court-ordered treatment, if your intention is to follow the letter of the law, consult with the best legal professional you can find. However, if your ultimate intention is to help create an environment conducive for long-term recovery for your loved one, while significantly reducing the potential for resentment and mistrust, then you may want to carefully consider all of your options before you take action.

Don't Hesitate to Call 911 If Necessary

Do not get me wrong, if your loved one is in need of immediate medical and/or psychiatric attention and they are categorically refusing it, do not pass go and call 911. In that case, there is no need to wait for a court to open up, a scheduled appointment with your family physician to occur, nor a trusted counselor to arrive on the scene. In my line of work, it’s almost always better to make an error on the side of caution and then have to deal with the fallout, than having to live with the consequences of inaction out of fear.

Many people are hesitant calling 911 for a variety of reasons, which may include -

• pending legal issues
• potential negative impact on a business venture
• having to deal with nosy neighbors
• and in many cases, a fundamental lack of confidence in the system

We will be getting back to having a fundamental lack of confidence in the system shortly. But until there is a better plan in place, I strongly recommend that you go ahead and call 911 if needed, regardless of whatever your issue with the process may be.

Helping Emergency Personnel - Don't Hold Back Information

Please keep in mind that I am in no way presenting myself as a legal professional in any manner, but rather as a professional interventionist who has worked with hundreds of families in crisis all over the country, helping them effectively cut right through bureaucratic red tape and statutory indifference with a strategically loving and laser-focused plan of action.

With that caveat firmly in place, I strongly recommend that if you do end up having to call 911, be sure to provide as much case-related detail as you can so that first responders have a much information as possible even before they arrive on the scene. Try not to hold anything back, no matter how insignificant, compromising, or embarrassing you think that the detail may be. In an all-out crisis situation, everything counts, and you should be all in.

If your loved one has a propensity for violence, it’s better to let police and paramedics know that as far in advance as possible, before they potentially end up having to find that out for themselves the hard way. Of course, the same goes for both suicidal attempts and statements, overdoses of any kind, and access to weapons. Let the professionals decide if the information is pertinent or not.

Dealing With a Loved One Spiraling Out Of Control

After what may end up feeling like an eternity, but might have in fact been only a few minutes, first responders will eventually arrive on the scene. In the interim, and even though you may be emotionally drained while simultaneously in a panic, you will need to somehow reach deep within your soul to try and muster up the internal fortitude to follow the 911 dispatcher’s instructions to the best of your ability.

Even If you have never actually experienced this type of excruciatingly gut-wrenching situation before for yourself, just try to imagine for a moment watching a loved one spiral completely out of control to the point at which they actually overdose right in front of you, or perhaps even threaten to kill themselves as a means by which to get away from all of the evil spirits hiding in their home. No matter how emotionally strong or well-grounded you may be, these types of situations can be a tipping point for anyone.

Nevertheless, once first responders arrive on the scene, let them do their jobs with as much collateral information and as little interference as possible. They will go right to work trying to take control of the situation on the ground, establishing some sense of order out of the chaos, and of course, working to ensure that your loved one is safe and out of harm’s way, at least for the moment.

Then, after all of their assessments have been completed, with all of those diastolic-like vitals and criteria-based questions checked and done, they will ultimately share their findings with you and make specific recommendations.

More than likely, with an obscenely apparent overabundance of both physical and circumstantial evidence, and without any real surprises, paramedics will recommend that your loved one at least agree to be observed by medical professionals in a hospital setting. And unfortunately,  that’s the moment when things seem to go statutorily sideways for a lot of families in crisis.

Before paramedics arrived, your loved one may have been cold and unresponsive after an apparent heroin overdose, or even appeared to be on the verge of jumping in front of a moving vehicle to “end it all.” Then after a dose of Narcan, some fluids, and a general fear of hospitals in general, they simply refused further care, and/or denied any intention, plan, or even thought of self-harm.

This is the moment when one of your greatest fears about calling 911 may end up being realized. No, not that your loved one was injured in a scuffle with a deputy, nor that they were going to be arrested for some old long-forgotten-about outstanding warrant from a neighboring county, but rather that your loved one is refusing further care and first responders do not feel that they are in fact currently presenting as an imminent danger to self or others.

Speechless and dumbfounded, you simply find yourself in disbelief that your loved one was able to talk themselves out of another situation! And perhaps equally as perturbing, that the whole system just seems to be broken.

Obtaining a Court Order for Involuntary Commitment

The cold hard truth is that whether your loved one is high on crystal meth and currently craving a whole bunch more, or down in the dumps about being monitored by aliens working for the Federal Government, if first responders do not feel as though your loved one meets your state-specific criteria for initiating an involuntary substance abuse & mental health assessment order, you can try your best to convince them otherwise, but more than likely, they are just not going to take any action that may in any way appear to be violating your loved one’s civil rights.

It’s important to keep in mind that although each state has its own variation of statutes that pertain to initiating an involuntary commitment, they all seem to basically agree that a person must currently present as a danger to themselves and/or others, while at the same time, refusing recommended care. This brings us to a statutorily confounding situation that I have witnessed on countless occasions.

At the end of the day, if your loved one refuses to accept help, and first responders find no statutory criteria for an involuntary commitment for a substance abuse and/or mental health assessment order to hold them with, your loved one will be free to go. And unfortunately, more than likely, go right back to engaging in the same concerning behaviors that caused all of your concern from the start.

Nevertheless, usually before police and paramedics end up leaving the scene, if it is clear that the person in question was truly in need of additional help, but their statutory hands were proverbially tied, they will encourage concerned family to file a petition/pleading for an involuntary substance abuse and/or mental health assessment in the local county court.

When the Law Intervenes

In this case, once again, a concerned family member will need to provide all collateral information and first-hand observations that demonstrate that an individual is in imminent danger of harm to self and/or others, and they have in fact refused help to a local magistrate. The magistrate will then decide whether or not that individual has met the state-specific criteria for an involuntary substance abuse and/or mental health assessment order.

If the magistrate does in fact sign your petition/pleading for an involuntary substance abuse and/or mental health assessment, depending upon the specific jurisdiction of the case, it is then sent to local law enforcement to be executed. And although this will not ensure the safety of a loved at that moment, it is definitely an avenue to explore in the near future, that is unless your loved one is only waiting for everyone to leave so that they can go back to what they were doing before you ended up trying to reach out for help.

Once again, this article should in no way preclude you from calling 911 during a substance abuse and/or mental health crisis, but rather to prepare you for the fact that additional action may be needed in the event that first responders cannot act based upon state statutes.