Understanding Involuntary Holds In The State of New York
When someone is going through a mental health crisis in New York, they might be placed on an involuntary hold. This means they are admitted to a hospital or treatment center even if they don’t want to go—because doctors or a judge believe they may hurt themselves, hurt others, or can’t take care of basic needs due to their mental illness.
Involuntary holds are meant to help the person stay safe and get treatment. These decisions are made under a set of rules called the Mental Hygiene Law (MHL).
This guide explains how these holds work, the different types, what families can do, and how to support someone going through the process.
When Can Someone Be Held Involuntarily?
A commitment—whether inpatient or outpatient—requires that the person:
Is diagnosed with a mental illness
Poses a substantial risk of physical harm to self or others
Lacks the capacity or willingness to voluntarily receive necessary treatment
This can include people who are suicidal, violent, severely confused, or unable to care for themselves.
Types Of Involuntary Admissions In New York
A. Emergency Inpatient Admission (MHL § 9.39)
This happens when someone is taken to a hospital during a crisis. It’s usually started by:
Peace officers or ER doctors, CPEP staff, qualified psychiatrists, or Directors of Community Services (DCS) using official forms (OMH 474A/476A)
Likely to result in serious harm includes inability to meet basic needs, refusal of care, or suicidal/homicidal behavior
Once detained, they receive written notification of status and rights, and must be examined by a psychiatrist within 6 hours. Retention in the psychiatric emergency program (CPEP) is capped at 72 hours, unless extended via formal MHL § 9.27 procedures
B. Extended Inpatient Hold (§9.27)
After initial 72-hour evaluation, if continued involuntary care is needed:
An application is filed by qualified clinical personnel or family members (e.g., psychiatrist, DCS, relative)
Two medical certificates are required to proceed.
The process includes a legal review, patient notification, and hearing rights through the Mental Hygiene Legal Service
C. Assisted Outpatient Treatment – Kendra’s Law (§9.60)
This is for people who aren’t in a hospital but still need treatment. A judge can order someone to follow a treatment plan in the community. This might include therapy, medication, or support services.
To qualify for AOT, the person must:
Be 18 or older with a serious mental illness
Have a history of hospital stays, arrests, or violent behavior due to stopping treatment
Be likely to get worse without help
Be likely to follow the plan if ordered by a court
AOT usually lasts up to one year but can be extended.
What Happens During a Hold
Stage 1: Emergency Evaluation
The person is brought to a hospital or CPEP
They are told why they’re there and what their rights are
A doctor evaluates them to see if a short-term hold is needed
Stage 2: Ongoing Evaluation
If they are not released, a second doctor must agree they still need care
The person can be held for up to 72 hours before further steps are taken
Stage 3: Long-Term Hold or Outpatient Order
If more time is needed, doctors can apply for a longer involuntary stay (via § 9.27)
Or, a judge can order outpatient treatment under Kendra’s Law
Rights of Individuals
During any involuntary process, individuals retain:
Right to receive explanations of status and proceedings;
Right to legal representation at hearings
Right to hearings and due process at each stage
Rights concerning medication refusal, subject to judicial or medical review mechanisms
Outcomes
Possible results include:
Release: if no longer meeting danger or disability criteria.
Voluntary admission: with patient consent.
Involuntary inpatient commitment: following hearings under section 9.27
Assisted outpatient treatment: under Kendra’s Law.
Discharge planning is mandatory under the new 2025 revisions
Long-term impacts may include treatment compliance, reduced hospitalizations, and fewer arrests for AOT participants
Family & Caregiver Guidance
Initiate or support petitions during emergency or certification phases.
Document incidents, medical history, and refusal behaviors.
Share info with clinical evaluators.
Hire a lawyer or advocate: Legal guidance can be important, especially for court-ordered outpatient treatment.
Plan for discharge: New York now requires hospitals to create a support plan before a person is released.
Consider starting a petition: In some cases, you may be able to start the process by speaking to a doctor or local mental health official.
Practical Tips
Know the timelines: Remember that emergency holds last up to 72 hours, and longer stays need more paperwork and review.
Stay involved: The more informed and cooperative you are, the more support you can provide during and after the hold.
Ask questions: Don’t be afraid to ask doctors or staff about the person’s condition and next steps.
Consult patient advocates or legal service early in the process.
Connect to services: Look for local support groups, case managers, or outpatient clinics that can help after discharge.
Conclusion
New York's involuntary commitment framework aims to balance individual rights with public safety and clinical care. Recent legislative changes have broadened the criteria relating to the inability to meet essential needs. Further changes have also improved discharge panning.
