Medical and Psychiatric Holds

Background 

• 6401 vs. 6404
  • "6401": process to detain someone who has a high likelihood of posing harm to themselves or others due to mental illness. Purpose is short-term detention until a prompt psychiatric assessment can be performed
  • One person completes this. Can be law enforcement officers, psychologists, independentlylicensed physicians
  • Must document justification for why the hold is needed (progress note, assessment form, etc)
• "6404": 6404= Certificate of Need. Legal document used for emergency involuntary psychiatric admission
  • Patient must have mental illness or serious emotional disturbance (excluding intellectual/developmental disabilities) and pose an immediate substantial likelihood of serious harm because of this based on a face-to face assessment by a qualified psychiatric professional
  • Treatment must be necessary for symptom reduction and lack of treatment would lead to deterioration, with no less drastic alternative to inpatient hospitalization
  • Two certificates needed: the first to transport a patient to a psychiatric facility and the second for an involuntary admission
  • Two different qualified persons must each complete a form
    • Psychiatry residents can write these due to their special training licenses
    • Attending physicians may also complete these forms
    • Residents functioning under a training license are not able to complete 6404 holds
  • No AMA Medical Hold: used when a patient does not have capacity to leave the hospital against medical advice due to a medical condition and needs to remain in the hospital. A 6401, nor 6404 should be completed.
    • Can be ordered by any physician Medical Hold Order Set