During a mental health crisis, an individual may be involuntarily detained through a mental health hold.
Individuals may be placed on a hold by either law enforcement or a qualified medical professional (physician, nurse practitioner or physician assistant) when an individual demonstrates evidence of a mental illness and the individual meets at least one of the following criteria, as defined by Idaho Statutes.
- Imminent danger to self and or others as evidenced by threat of substantial physical harm
- Gravely disabled – unable to care for basic needs
There are four types of involuntary detentions:
- Peace Officer Hold – hold placed by law enforcement in the field
- Medical Staff Hold – hold placed by physician, nurse practitioner or physician’s assistant
- Juvenile Hold – placed by either law enforcement or medical staff
- Administrative Hold – placed by a physician, nurse practitioner or physician assistant – this is for the patient who has been admitted voluntarily to behavioral health for psychiatric assessment and treatment but wants to discharge but they are unsafe to do so as they meet one of the above criteria.
Once placed on a hold, all adult patients must be seen by a designated examiner. The designated examiner makes a determination to see if the patient still meets criteria. If they do not meet criteria, the patient is free to discharge or in some cases the patient chooses to remain for treatment.
If they meet criteria when seen by the first designated examiner, the case is filed on with the prosecutor’s office. At this point, a second designated examiner must see the patient. If this is positive, then a civil commitment hearing is set. At the hearing, the determination is made by a judge as to whether the patient is to be released, or sent to the state hospital for treatment.
Juvenile holds can be released by either a physician, by the parent signing the youth in for treatment, or by a designated examiner.
Discharge/Leaving the Hospital Against Medical Advice (AMA)
When it is clinically indicated to continue treatment and the patient or legal guardian requests discharge, the patient will be discharged against medical advice or AMA.
When discharging patients against medical advice:
- Care team will discuss implications of discharge and potential problems or complications which may arise. This conversation will be documented.
- Care team will contact and inform the patient’s physician of the patient’s discharge request
- Physician will write AMA discharge order
- Care team will ask patient or patient’s legal guardian to read and sign the Discharge Against Medical Advice form.
- The signatures on the form will be witnessed and the form will be placed in the patient’s medical record.
Please note, discharging against medical advice may impact insurance coverage of care. Check with your insurance provider to verify coverage.
Child Protective Services and Mandatory Reporters
Kootenai Health employees (including physicians, nurses, interns, daycare teachers and social workers) are mandatory reporters. The term “mandatory reporter” means these types of employees are legally required to report items for investigation to Child Protective Services if and when there is cause for concern based on Idaho State Law.
See Idaho State Code for more information:
- Idaho Code 16-1602 Definitions
- Idaho Code 16-1605 Reporting of Abuse, Abandonment, or Neglect
- Idaho Code 16-1608 Emergency Removal
Vaccination Philosophy of Care
Please see our vaccination policy and philosophy of care here.