After the 72-hour period, there is a period of probable cause, during which a patient can be kept for up to 10 additional days. Beyond that, the individual can be probated through a civil commitment.
But even if a person is civilly committed, MacLeod said, that doesn’t mean they remain at the hospital. Generally, they are stabilized, then treated through one of the state’s community mental health centers for a time ranging from three months to five years. That commitment can be renewed indefinitely, although that is usually not the case, he said.
The goal, he said, is to treat, stabilize and release patients back to the least restrictive environment.
The state hospital has just under 2,500 admissions/discharges a year, he said. Most patients are there for a brief time and tend “not to be problematic.”
“But there is a small cohort of individuals who tend to cycle in and out of this hospital, and tend to be more problematic,” he said. “They tend to be noncompliant.”
Those individuals may get on a regimen of medication and therapy, feel better, go back to the community, then stop taking their medication or, perhaps, start using illicit drugs, stop counseling and backslide, he said.
If that happens, the civil commitment can be revoked and the individual can be sent back to the hospital. But that process begins at the community mental health center level, generally in a hospital emergency room. And, MacLeod reiterated, the patient has “significant” rights and opportunities for a hearing.
“In the civil system, there is a heavy emphasis on protecting the rights of the patient,” he said. “We appreciate the frustration of other public officials, of law enforcement that then face the possible impact of that release. ... It can be, from the other lens, very confounding.”
But, he said, a patient is never discharged from the state hospital until they are stabilized. In all but the most extreme and rare cases, that process is not a long as many may believe.
“What we do know is that someone cannot stay here forever,” he said.