Medical and Psychiatric Holds

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 which can be law enforcement officers, psychologists, independently licensed physicians.
• Must document justification for why the hold is needed (progress note, assessment form, etc.)

"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, not 6404, should be completed.

• Can be ordered by any physician Medical Hold Order Set.

VUH specific procedures 

A physical copy of the first 6404 is required to accompany the patient when they are transported to a psychiatric facility after medical discharge. The form is typically completed by the psychiatry team.