Involuntary Detention, Leaving Against Medical Advice

Name: Kootenai Health
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Understanding Patient Safety Procedures and Your Rights

At Kootenai Health, our priority is to ensure the safety and well‑being of every patient. In certain circumstances, such as during a mental health crisis or when a patient chooses to leave the hospital before recommended treatment is complete, specific legal and clinical procedures guide the care we provide. The information below explains what happens during an involuntary mental health detention, what it means to leave the hospital against medical advice (AMA), and the responsibilities of mandatory reporters under Idaho law.

Involuntary Detention

During a mental health crisis, an individual may be involuntarily detained through a mental health hold.

A person may be placed on an involuntary mental health hold when they show signs of a mental illness and are either:

At risk of harming themselves or others, or
Unable to care for basic needs.

A hold can be started by law enforcement or a qualified medical provider (a physician, nurse practitioner, or physician assistant). There are four types of holds:

Mental Health Hold: Started by law enforcement or a medical provider.
Neurocognitive Hold: For patients who are believed to have a neurocognitive disorder as defined by Idaho law and likely to injury themselves or others.
Juvenile Hold: For youth; started by law enforcement or medical staff.
Administrative Hold: For patients who were voluntarily admitted but want to leave before it is safe to do so.

What happens next:
All adults placed on a hold are evaluated by a designated examiner.

If the examiner determines the person no longer meets the criteria, they may leave or choose to stay for treatment.
If the criteria are still met, the case is sent to the prosecutor, and a second examiner evaluates the patient.
If both evaluations confirm the need for continued care, a judge will hold a hearing to decide whether the patient should be released or continue treatment at a designated medical facility.

For youth:
A juvenile hold can be ended by a physician, a parent signing the child in for treatment, or a designated examiner.

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 patients want to leave against medical advice:

Care team will discuss implications of discharge and potential problems or complications that may arise. This conversation will be documented.
The care team will contact and inform the patient’s physician of the patient’s discharge request
Physician will write AMA discharge order
The care team will ask the patient or the patient’s legal guardian to read and sign the Leaving 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 that leaving against medical advice may impact insurance coverage of care. Check with your insurance provider to verify coverage.

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 state designated agencies, such as 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

To view our policies regarding Child Protection Regulations, click here.

Please see our vaccination policy and philosophy of care here.