Involuntary Hospitalization and Involuntary Treatment in Psychiatry - Adults, Ministry of Health
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Involuntary Hospitalization and Involuntary Treatment in Psychiatry - Adults


The text displayed is based upon the Treatment of the Mentally Ill Law, 1991 and the law's regulations, which are binding. In the event of a contradiction between that which is written below and the law, the text of the law and of the regulations made under its provisions shall be binding.

Psychiatric hospitalization can occur by a number of pathways. The most common is hospitalization and treatment by consent. However, there are situations in which hospitalization and/or treatment can be involuntary.
Every year, there are approximately 20,000 hospital admissions (a person can be hospitalized more than once in a year), approximately 15,000 of which are admissions to hospitalization by consent, and approximately 5,000 are involuntary admissions to hospital.

The information below details situations in which involuntary hospitalization is performed, the parties who are authorized to order involuntary hospitalization, and what can be done when in the opinion of the hospitalized person, the order was wrongfully given.

The parties who are authorized to order involuntary hospitalization
  1. The District Psychiatrist 
  2. Court
  3. The Director of a psychiatric hospital
The conditions will be detailed for each of these parties separately below.

Involuntary hospitalization by order of the District Psychiatrist

The District Psychiatrist is authorized to issue an involuntary hospitalization order. There are two types of order that the District Psychiatrist can issue, and specific conditions are required for each order:
a. Involuntary examination/hospitalization order – urgent
b. Involuntary examination/hospitalization order – non-urgent

Conditions for issuing an immediate hospitalization order and/or an immediate clinic treatment order 
Each and every one of the following conditions must be fulfilled in order for the District Psychiatrist to be able to issue an involuntary examination/hospitalization or clinic treatment order (in the text below, "involuntary hospitalization" will appear, but this is intended to also include "involuntary treatment").
  • The person is in a psychotic state
  • As a result of the psychotic state, there is a danger to the person himself (suicidal) or to those around him (assault), on an immediate basis
  • The person refused to be examined/be hospitalized voluntarily

The process for immediate involuntary hospitalization
  1. The issue of an immediate involuntary hospitalization order – When the District Psychiatrist is convinced that the above-mentioned conditions are satisfied, he issues an immediate involuntary hospitalization order. The name of the psychiatric hospital, or of the general hospital in which there is a psychiatric department, to which the person is to be brought is written in the order.
  2. Bringing the person to hospital – The order is conveyed to a company for executing involuntary orders – there are a number of companies that won a tender, whose role it is to bring the person in respect of whom the examination/hospitalization order was issued to hospital. The company must reach the person within 60 minutes.
  3. Psychiatric examination – The person will undergo a psychiatric examination by an examining psychiatrist who has been authorized by the District Psychiatrist, who will decide whether hospitalization is needed.
  4. Hospitalization – The person will be explained the need for him to be hospitalized, and he will be offered hospitalization by consent. If he refuses, an involuntary hospitalization order will be given.

Conditions for issuing non-immediate hospitalization
  • The person is in a psychotic state
  • As a result of the psychotic state, there is a danger to the person himself (suicidal) or to those around him (assault), on a non-immediate basis
  • The person causes severe psychological suffering to his fellows in a manner that is injurious to the conduct of a normal way of life
  • The person refused to be examined/be hospitalized voluntarily

The process for non-immediate involuntary hospitalization
  1. The issue of a non-immediate involuntary hospitalization order – When the District Psychiatrist is convinced that the above-mentioned conditions are satisfied, he issues a non-immediate involuntary hospitalization order. The name of the psychiatric hospital, or of the general hospital in which there is a psychiatric department, to which the person is to be brought is written in the order.
  2. Bringing the person to hospital – The order is conveyed to a company for executing involuntary orders – there are a number of companies that won a tender, whose role is to bring the person in respect of whom the hospitalization order was issued to hospital. The company must reach the person within 24 hours.
  3. Psychiatric examination – The person will undergo a psychiatric examination by a psychiatrist who has been authorized by the District Psychiatrist, who will decide whether hospitalization is needed.
  4. Hospitalization – The person will be explained the need for him to be hospitalized, and he will be offered hospitalization by consent. If he refuses, an involuntary hospitalization order will be given.


Duration of the involuntary hospitalization
A hospitalization order is given for 7 days. During the hospitalization the staff of the psychiatric hospital or the staff of the psychiatric department can apply to the District Psychiatrist to extend the hospitalization order for an additional 7 days.
In the event that the hospital staff are of the opinion that the person must be hospitalized for more than 14 days, the staff is required to apply to the District Psychiatric Committee (which is composed of two psychiatrists and a legal expert), which is authorized to approve or reject the application.

Appeal against the involuntary hospitalization decision
An appeal against the decision of the District Psychiatrist to involuntarily hospitalize the hospitalized person can be lodged with the District Psychiatric Committee, which must discuss the appeal within 5 days. The person himself, a family member on his behalf or a lawyer representing him can lodge the appeal,
The decision of the District Psychiatric Committee can be appealed to the District Court.

It is important to note- that any person who is involuntarily hospitalized or who receives involuntary treatment is entitled to legal representation by the State.
When a person arrives for involuntary hospitalization, the hospital must offer him the right to legal representation (see the forms in the Treatment of the Mentally Ill Regulations (Legal Representation in Involuntary Treatment), 2006). 

Leave of absence from involuntary hospitalization, and the ending of involuntary hospitalization
The staff of the psychiatric hospital or the staff of the psychiatry department in a general hospital can allow leave of absence during an involuntary hospitalization when the hospitalization is by order of the Director or of the District Psychiatrist (if the hospitalization is by court order, approval of the District Psychiatric Committee is required for leave of absence). 
The staff, based on the hospitalized person's condition, makes a decision as to the time for ending the involuntary hospitalization. A situation is also possible in which during hospitalization the hospitalized person is convinced to consent to the hospitalization, and the hospitalization is transformed from involuntary to hospitalization by consent.

Appeal of the family against a decision for release from involuntary hospitalization
If the release of an involuntarily hospitalized patient becomes known to the family and they object to the release, the family can apply to the District Psychiatrist, and his decision can be appealed against to the District Psychiatric Committee, requesting that the person be retained in hospitalization. The District Committee will consider the request and make a decision.



Submissions and complaints to the Legal Psychiatry Department in the Department of Health
A complaint may be lodged regarding the following matters:
  • A decision for involuntary hospitalization – If the person in respect of whom an involuntary hospitalization order was issued considers the order to be unjustified, he can apply to the Legal Psychiatry Department. The Department will refer the applicant directly, or by his request will refer the application to the District Psychiatric Committee.
  • The manner in which a person was brought to involuntary hospitalization – There are sometimes complaints made by the person about the use of excessive force, hurtful language and the like while being brought to hospitalization. The Legal Psychiatry Department will examine the complaints, and will inform the hospitalized person regarding the results of the examination. If needed, action will be taken against the company/companies that execute involuntary orders.
  • The treatment provided during hospitalization – A psychiatrically hospitalized person can apply to the Legal Psychiatry Department complaining of the treatment given to him in hospital. The Department will convey the complaint for examination to the Director of the hospital or the head of the psychiatry department. It is recommended that the hospitalized person apply directly to the treating staff or the head of department.
  • Conditions that accompany the hospitalization – When a psychiatrically hospitalized person feels that the conditions beyond his medical treatment are unsuitable or injurious (i.e. the complaint is not about the treatment itself but rather about the conditions of the treatment), he can apply to the Legal Psychiatry Department, which will clarify the complaint with the hospital.
  • Duration of the hospitalization – When an involuntarily hospitalized person feels that the hospitalization has improved his condition and that he does not need further hospitalization treatment, and the staff is not releasing him, he can apply to the Legal Psychiatry Department, which will refer him to the District Psychiatric Committee.

It is possibly to apply in the following ways
Telephone: 08-6241010, *5400
Fax: 02-5655969
Post: The Legal Psychiatry Department, Mental Health Division, Ministry of Health, 39 Yirmiyahu St., P.O.B. 1176, Jerusalem, zip code 9101002

Involuntary hospitalization by order of the Director of a psychiatric hospital

 
The Director of a psychiatric hospital or the head of a psychiatry department in a general hospital has the authority to involuntarily hospitalize a person for up to 48 hours under the following conditions:
  1. The person is in a psychotic state
  2. As a result of the psychotic state, there is a danger to the person himself (suicidal) or to those around him (assault)
  3. The person refused to be voluntarily hospitalized
  4. The person is located in the hospital (e.g. when a person came for an examination, or he is already hospitalized voluntarily and wishes to be released and the staff believe that hospitalization is required due to the above conditions)
If during the 48 hours after the issue of order the hospital staff are convinced that continued hospitalization is required and the person refuses hospitalization, the staff can apply to the District Psychiatrist requesting the issue of an involuntary hospitalization order.

Court order for hospitalization / observation

 
When a person is defined as a suspect for having committed an offence, or he is under arrest by the police, or an indictment has been served against him, he can claim that it is his mental state that brought him to his actions, or that his current mental state does not permit him the proper conduct of a trial.

In this situation, the person or his lawyer can apply to the judge requesting the issue of an involuntary psychiatric examination order or an involuntary observation under hospitalization order. Also, the police can, in case of a suspect or arrested person, apply to court with a similar request. In case of an indictment, the court can also, of its own volition, order a psychiatric examination or psychiatric observation.

The judge can issue an order for involuntary psychiatric examination or observation under hospitalization, with the aim of assessing the person's condition. The observation is carried out in a psychiatric hospital (usually). The duration of observation under hospitalization is usually between 3 days and 3 weeks.

Psychiatric hospitalization
In accordance with the assessment of the medical staff of the psychiatric hospital, the judge will make a decision as to whether the person's mental condition is such that requires involuntary hospitalization, or what the person's condition was at the time of committing the offence.

Appeal
Appeal against the judge's decision will be made in the accepted legal courts of law.

End of the psychiatric hospitalization, or leaving the hospital for leave of absence
In a situation where a person is involuntarily hospitalized in a psychiatric hospital by court order, only the District Psychiatric Committee (which is composed of two psychiatrists and one legal expert) can decide upon the end of the hospitalization and release the person to his home, or approve leave of absence from the hospital. The decision will be made based upon examination and assessment of the person's mental state.

Submissions and complaints
It is possible to apply to the Department of Legal Psychiatry in the Ministry of Health with complaints about issues connected to the treatment given during the hospitalization and/or the conditions accompanying the hospitalization.

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Submissions and Complaints

 

You may contact the Legal Psychiatry Department:

List of District Psychiatrists