Civil Commitment to Inpatient Services
A civil commitment is the second of the two routes for admission to a state psychiatric hospital in Washington. It begins with an evaluation by a county-designated mental health professional. The mental health professional can commit a patient to a hospital for a 72-hour evaluation if he or she is dangerous to themselves or others due to a mental disorder. The related statute is Chapter 71.05 RCW. Discharge planning begins as soon as a patient is admitted.
The hospital evaluations occur in the hospitals' Center for Adult Services or, in the case of older people, in the Center for Geriatric Services (CGS) at Western State or the Geropsychiatric Unit at Eastern State.
If needed, subsequent court hearings can result in additional commitments of 14, 90 or 180 days.
The hospitals' responsibility is to evaluate and treat state residents with the most complicated mental illnesses. The goal is to stabilize the patient sufficiently that he or she can return to the community as quickly as possible.
While at the state hospitals, patients live on locked wards. All civilly committed patients have the right to earn off-ward privileges based on their treatment progress. Some of these patients have criminal histories but they are at the hospital to be treated for their illnesses, not to pay for their convictions.
After being stabilized through medications and other treatment, patients may earn incremental levels of independence and responsibility. This usually includes limited trips off their wards, sometimes with staff members; then in supervised groups or with a fellow patient. Ultimately many patients earn independent trips off the hospital campuses after learning skills such as riding buses, banking, shopping, money and time management and so on..
Each patient’s psychiatrist approves all off-ward privileges. No patients considered a danger to him or herself or to others is granted such privileges.
As noted, discharge planning for each patient begins when he or she is admitted. Plans begin with the question: "What does the patient need to recover to the point of being ready for discharge?" The treatment team, consisting of psychiatrists, psychologists, nurses, social workers and others, tackles that question, then sculpts a treatment plan with strategies and goals which work towards discharging him or her as quickly as possible.
To make the transition smooth, social workers and others work with community liaisons to find a placement most appropriate to the needs of each patient. Once an appropriate placement is identified, the patient then is discharged from the hospital or given a "less restrictive alternative" (LRA) placement in the community. An LRA placement is a time-limited placement, approved by the court, with stipulations the patient must follow in order to be fully discharged at the end of the LRA. Arrangements are made for psychiatric support in the communities before patients are discharged.