"Your Rights in a Psychiatric Facility"
a P&A Self-Help Publication
The purpose of this booklet is to impart practical and useful information to people who find themselves in a psychiatric facility and are attempting to get out. The Protection and Advocacy for Individuals with Mental Illness (PAIMI) program of P&A hopes this booklet helps you advocate for your basic civil rights and identify those situations when you may need an advocate or a lawyer.
P&A has chosen to use the terms "individual" and "mental illness." These terms are used in federal and state laws that protect the rights of these individuals.
P&A also wants to make clear that we acknowledge the long history of denial of basic human rights of people in psychiatric institutions and recognize that institutionalization, by its very nature, implies a deprivation of rights and loss of freedom of choice.
People who are institutionalized are "at risk" of being put in potentially dangerous situations. Hopefully, this booklet, if nothing else, will allow those individuals to achieve increased control over their own lives - control often denied them in the name of mental health services.
Under Connecticut General Statutes §17a-495, the following are definitions you should know.
Mentally Ill Person: Any person who has a mental or emotional condition that has a substantial adverse effect on his or her ability to function and who requires care and treatment. This specifically excludes a person whose sole disability is alcohol or drug dependency as defined in Connecticut General Statutes §17a-680.
Dangerous To Himself or Herself or Others: There is a substantial risk that physical harm will be inflicted by an individual upon his or her own person or upon another person.
Gravely Disabled: A person, as a result of mental or emotional impairment, is in danger of serious harm as a result of an inability or failure to provide for his or her own basic needs such as essential food, clothing, shelter or safety and that hospital treatment is necessary and available and that such person is mentally incapable of determining whether or not to accept such treatment because his/her judgment is impaired by mental illness/psychiatric disability.
Under Conn. Gen. Stat. §17a-540, the following are definitions you should know.
Informed Consent: Permission given competently and voluntarily after a patient has been informed of the reason for treatment, the nature of the proposed treatment, the advantages or disadvantages of the treatment, medically acceptable alternative treatment, the risks associated with receiving the proposed treatment and the risk of no treatment. Conn. Gen. Stat. §17a-540(h).
Direct Threat of Harm: The patient's clinical history demonstrates a pattern of serious physical injury or life-threatening injury to self or to others which is caused by the mental illness with which the patient has been diagnosed and is documented by objective medical and other factual evidence. Such evidence of past pattern of dangerous behavior shall be manifested in the patient's medical history and there shall exist a high probability that the patient will inflict substantial harm on himself or others. Connecticut General Statutes §17a-540(l).
1. Can I check myself into a hospital?
If you are 16 years or older, you may enter a hospital willingly for diagnosis, observation or treatment. You are then considered a voluntary patient.
Voluntary patients may request treatment either formally or informally. An informal request means you have requested admission for hospital treatment without submitting a written request. A formal request, called a "voluntary paper", is a written request for treatment. Individuals who ask for treatment in writing are considered "formal" patients. Connecticut General Statutes §17a-495.
2. What is an emergency patient?
If you are an emergency patient, a physician or licensed clinical psychologist has concluded that you are mentally ill and dangerous to yourself or others, or gravely disabled and in need of immediate care and treatment in a hospital. You are then admitted to a hospital on what is called a “Physician’s Emergency Certificate” or PEC”, Connecticut General Statutes §17a-502.
3. How long must I stay in the hospital under the emergency certificate?
You may be confined for up to fifteen days under an emergency certificate without an order from the probate court. You may also be kept another fifteen days on the basis of a new certificate issued within fifteen days of the original certificate, if the hospital applied to Probate Court for an involuntary commitment hearing. The hospital cannot keep you longer than a total of thirty days unless the court has committed you or you sign yourself in voluntarily. Connecticut General Statutes §17a-502
4. What happens after I am admitted under the emergency certificate?
When you are admitted and detained under the emergency certificate it is required that a psychiatrist evaluate you within forty-eight hours. If it is his/her opinion that you do not meet the standard for emergency treatment, then you must be discharged immediately. Connecticut General Statutes §17a-502
5. What if I want to leave? Can the hospital stop me?
· If you are a voluntary patient and have put in a 3-day paper, the hospital can stop you from leaving by applying for a commitment hearing where you may present your case and argue your right to leave the hospital. You will have legal counsel at this hearing. Remember to call your court appointed attorney before the commitment hearing.
· If you are preparing for a civil commitment hearing, you should contact the attorney appointed by Probate Court to represent you. You can call Probate Court to get the name and telephone number of your court appointed attorney.
· If you are an informal patient you may leave anytime after you inform the hospital of your desire to be discharged. The hospital may allow you to leave or may attempt to stop you by applying to Probate Court for a commitment hearing.
6. What can I do if the hospital applies for civil commitment?
If the hospital applies to the Probate Court for a hearing to have you committed, you may choose to do the following:
· You can sign back in as a voluntary patient (revoke the 3-day paper) any time prior to the actual hearing. This action will halt civil commitment proceedings.
· If you are an involuntary patient under a 15-day paper also called a P.E.C. (Physician’s Emergency Certificate), you may ask, in writing, for the Probate Court Judge to give you a probable cause hearing. They must give you this hearing within 72 hours (3 days). At the probable cause hearing, the hospital must show that you need to stay in the hospital for the length of the fifteen days. If the hospital cannot show this, the Judge can order the hospital to release you. Probable cause hearings are only available to patients who are committed under a P.E.C.
7. What is a committed patient?
A committed patient is a patient who is under a Probate Court order to stay in the hospital and receive treatment. This decision is based upon an application from the hospital for your involuntary commitment, and sworn certificates from at least two impartial physicians selected by the Probate Court. One of the physicians must be a practicing psychiatrist. Connecticut General Statute §17a-498.
8. What roles do the two court-appointed physicians play in my commitment?
The physicians selected by the Probate Court Judge must be impartial. They are given the responsibility to examine you within ten days and submit a report to the Judge by the date of the hearing. The doctors will come to the hearing if you or your attorney request it. You must let the court know 3 days before the hearing that you wish to question them. You may be represented by your own attorney or will be appointed a free attorney by the court if you are unable to afford a lawyer. You can also present an independent evaluation provided by your own doctor or select another independent physician to provide a third opinion. Connecticut General Statutes §17a-498.
9. What will the doctors' reports contain?
The doctors' reports will contain a description of the mental illness you are alleged to have, whether or not you are dangerous to yourself or others, whether or not your illness has resulted or will result in serious disruption of your ability to live an independent life, whether or not a less confining setting is recommended and available, and
whether or not you are capable of understanding the need to accept the recommended treatment on a voluntary basis.
If the court finds by clear and convincing evidence that you are mentally ill and dangerous to yourself or others or gravely disabled, the Judge will order your commitment.
10. As a voluntary or involuntary patient, must I take the medication or treatment?
You may decide to take drugs or other psychiatric treatment. If you do not want to take the medication the hospital cannot force it on you. Your condition must be determined to be of an extremely critical nature by the head of the hospital and a qualified physician before any measures can be taken without your consent.
Public or private psychiatric hospitals can forcibly medicate involuntarily and voluntarily admitted patients under only two specific circumstances after an internal hearing or Probate Court hearing is held.
The circumstances are: (1) if the head of the hospital and two physicians decide that you are incapable of giving informed consent to the medication, are in need of psychiatric medication and will rapidly deteriorate without the medication or (2) you are a “direct threat of harm.” (See Definition Section). If either or both of these two criteria apply to you, you may be medicated against your will for up to thirty days or until discharge after an internal hospital hearing is held. You have the right to representation at both hearings. After the internal hearing you can also go directly to Probate Court for a second expedited hearing to be held within fifteen days of the internal hearing.
This process can be difficult for you to go through alone. We urge you to call an advocate or attorney at one of the agencies listed at the end of the booklet.
For additional information see the Office of Protection and Advocacy self-help booklet entitled, Your Rights and Responsibilities in Making Medication Choices - Expanded Patients Rights: Conn. Gen. Stat. §17a-543.
11. Can I be subject to psycho-surgery or shock treatment?
Ordinarily, no psycho-surgery or shock therapy may be administered without your written informed consent. Your consent is effective for a maximum of 30 days and may be revoked at any time. However, if it is determined by the head of the hospital and two qualified physicians that you have become incapable of giving informed consent, shock treatment may be administered upon order of Probate Court, but only after a hearing in which the court finds that you are incapable of informed consent and there is no other reasonable procedure which can be used. Connecticut General Statutes
12. Can I be placed in seclusion or restraints?
Under Connecticut General Statute §45a-150-154 you may not receive life threatening physical restraints. You also may not receive involuntary physical restraint except: (1) as an emergency intervention to prevent immediate or imminent injury to yourself or to others; or (2) as necessary and appropriate determined on an individual basis by your treatment team. It cannot be used as discipline or as a substitute for a less restrictive alternative.
Ordinarily, you may not receive medications without your consent except as an emergency intervention to prevent immediate or imminent injury to yourself or others or if the medication is an integral part of your medical, behavioral or educational plan. See page 6 of this booklet for the answer to the question “Must I Take the Medication or Treatment?”
You also may not be involuntarily placed in seclusion except as an emergency intervention to prevent immediate or imminent injury to yourself or others. Seclusion is not to be used as discipline or for convenience and not as a substitute for a less restrictive alternative.
Use of restraints or seclusion must be documented in your medical record. The documentation should include the nature of the emergency and what other steps, including verbal de-escalation, were taken to prevent the emergency. A detailed description of the restraint or seclusion and its use must also be included in your medical record.
You can ask to see your medical records after such an incident to review the documentation by the facility. If you feel it is incorrect or lacks important facts, you may develop your own statement and request that it be placed in the record too.
If you wish to have an outside agency review the use of the restraints, the back of this booklet contains advocacy resources to advise and assist you.
13. Do I give up my civil rights while I am in the hospital?
No. Individuals in any public/private hospital may not be deprived of any personal property or civil rights, including the right to vote, hold or convey property, and contract, except in accordance with due process of law, unless declared incompetent by a court. Connecticut General Statutes §17a-541
14. While I am a patient in the hospital, do I have any additional rights?
Yes. Whether you are a voluntary or involuntary patient in the hospital, you have the following rights. You may:
· Communicate by sealed mail with any individual, group, or agency.
· Be furnished with writing materials and reasonable postage.
· Receive mail unless the head of the hospital determines it is medically harmful for you to receive mail; all such correspondence will be returned unopened to sender with an explanation signed by head of hospital.
· Make and receive telephone calls and have public telephones available in an appropriate location unless the head of the hospital determines you have made threatening or obscene calls. The head of the facility may then restrict your right to make telephone calls. This restriction must be in writing and a part of your permanent clinical records.
· Receive visitors at regular hours, unless the head of the hospital determines it is medically harmful for you to receive visitors and so informs family and other visitors. They must also be notified immediately when you have recovered sufficiently to receive visitors.
· Be visited by your clergy, lawyer, or physician at any time.
· Wear your own clothes.
· Keep and use personal possessions, including toilet articles.
· Have access to individual storage space for your possessions.
These rights may be denied or limited only if the head of the hospital or his or her authorized representative decides that it would be medically harmful for you to exercise the rights and such a decision is placed in your hospital record. Connecticut General Statutes §17a-546, 548. These rights do not apply to any patient in a program or facility for the treatment of drug-dependent persons.
15. What other remedy do I have after all other grievance procedures have been tried?
You have the right to use the DMHAS grievance process. You must file a grievance within 4 to 5 days of the event. You begin this process by contacting the facilities designated grievance officer.
For violations of patient rights under Connecticut General Statutes §17a-540 et seq. you have the right to petition the Superior Court for relief, including bringing a temporary or permanent injunction against the hospital or bringing a civil action for damages. You will need an attorney to help you and should contact one of the agencies listed on the following pages.
in public or private psychiatric hospitals statewide
Office of Protection and Advocacy for
Persons with Disabilities
Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program
60B Weston Street - Hartford, CT 06120
(860) 297-4300 (Voice); (860) 297-4380; TTY
1-800-842-7303 (Toll-free, Voice/TTY CT-only)
Connecticut Legal Rights Project, Inc.
1-877-402-2299 or (860) 262-5030
Connecticut Mental Health Center
34 Park Street
New Haven, CT 06508
Connecticut Valley Hospital
P.O. Box 351
Middletown, CT 06457
Greater Bridgeport Community Mental Health Center
1635 Central Avenue
Bridgeport, CT 06610
Southeastern Mental Health Authority
401 West Thames
Norwich, CT 06360
Statewide Legal Services
(860) 344-0380 (Middletown area)
Greater Hartford Legal Assistance
80 Jefferson Street - Hartford, CT 06106
(860) 541-5000 - TTY (860) 541-5060
New Haven Legal Assistance Association
426 State Street
New Haven, CT 06510
CT Department of Public Health
410 Capitol Avenue
P.O. Box 340308
Hartford, CT 06134
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