Medical Holds¶

Soibhan Kelley, MD

Background¶

6401 vs. 6404
- "6401": process to detain someone who has a high likelihood of posing harm to themselves or others due to mental illness. Purpose is short-term detention until a prompt psychiatric assessment can be performed
  - One person completes this. Can be law enforcement officers, psychologists, physicians
  - Must document justification for why the hold is needed (progress note, assessment form, etc)
- "6404": 6404= Certificate of Need. Legal document used for emergency involuntary psychiatric admission
  - Pt must have mental illness or serious emotional disturbance (excluding intellectual/developmental disabilities) and pose an immediate substantial likelihood of serious harm because of this based on a face-to face assessment by a qualified psychiatric professional
    - Treatment must be necessary for symptom reduction and lack of treatment would lead to deterioration, with no less drastic alternative to inpatient hospitalization
  - Two certificates needed: the first to transport a patient to a psychiatric facility and the second for an involuntary admission
  - Two different qualified persons must each complete a form
    - Psychiatry residents can write these due to their special training licenses
No AMA Medical Hold: used when a patient does not have capacity to leave the hospital against medical advice due to a medical condition and needs to remain in the hospital
- Can be ordered by any physician Medical Hold Order Set

A physical copy of the first 6404 is required to accompany the patient when they are transported to a psychiatric facility after medical discharge. The form is completed by the psychiatry team