Many families have had the frustrating experience of going to the emergency room with someone who is agitated and manic, or severely depressed, and having them “pull it together” while they are being evaluated. The net result is that the crisis clinician or doctor sees someone who is in good control and is denying any thoughts of wanting to hurt themselves or anyone else. In the absence of other information, that person will be released. Then the family is right back where they started, with someone who is dangerously impulsive, behaviorally out-of-control, severely disabled, suicidal, or homicidal, and now also angry at you for having brought them to the emergency room.
Each state has specific criteria to determine when and how someone can be admitted to an inpatient facility against his will. These typically center on the person being imminently suicidal, homicidal, or so disabled as a result of his psychiatric symptoms that he cannot provide for his own basic needs (food, clothing, shelter). If someone is manic, in a mixed state, psychotic, or suicidally depressed, he will often try to keep this hidden from an evaluating clinician. Corroborating information that family and friends can provide may make all the difference in getting the appropriate care.
Another point that figures heavily into the real world of emergency rooms and crisis centers is that if a person is discharged and the crisis is still severe and ongoing, you need to call 911, the crisis center, or your area’s emergency number and start again. This is no time to be complacent. Just because one emergency room doctor thought the patient was “fine to go home,” if his behavior is telling you otherwise, don’t let up, and don’t leave him alone. The emotional toll on all involved can be huge, but getting help, at times being the squeaky wheel and insisting on it, may save a life. It is common to have more than one emergency room visit, often to the same hospital, before finally getting admitted to an inpatient unit.