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Involuntary Psychiatric Commitment and Minors in Georgia: A Parent's Nightmare

I get these calls often: a parent beside herself because her 14-year-old son is being held at a psychiatric evaluating facility against his will. "I've told them I want my child released but now I can hardly even talk to anyone!"

It's every parent's bad dream. Who would think that you would ever lose your say as to whether or not your own child receives treatment of any kind? After all, in any other kind of hospital you are an integral part of every decision made for your child's care, and there's never a question about whether you could leave with him unless his condition was critical, and even then you'd typically be permitted to stay with him.

Unfortunately, the laws in Georgia regarding involuntary psychiatric hospitalization (in many cases called a 1013) are scarce, confusing, and unevenly applied by the courts. The end result is a settled framework that denies your ability as a parent to demand discharge of your child from psychiatric hospitalization deemed necessary by the hospital due to their assessment that the child is an imminent threat of harm to himself or others. Yes, even if your child is a minor and even if they are relatively young.

Doesn't the law in Georgia protect my right as a parent to consent or not to my child's treatment?

It depends on your interpretation of the vague and limited statutory language dedicated to this subject and how it would seemingly conflict with established case law. Let's start with the statutes:

O.C.G.A. §31-9-2 identifies those who are eligible to consent for surgical or medical treatment. As it pertains to minors, we look to subsection (a)(3): "In the absence or unavailability of a living spouse, any parent, whether an adult or a minor, [may consent to such treatment] for his or her minor child;".

Now, the natural question is whether "medical treatment" includes mental health and specifically involuntary psychiatric hospitalization. O.C.G.A. §31-9-4 answers that question for us: "This Chapter shall be applicable to the care and treatment of patients in facilities for the mentally ill, as defined in paragraph (7) of O.C.G.A. 37-3-1.

You might've guessed it: O.C.G.A. §37-3-1 is the introductory statute to the Chapter of Georgia law involving involuntary psychiatric hospitalization, and includes definitions applicable to 1013s and what qualifies as an individual in need of involuntary inpatient care (danger to self and others, etc.).

O.C.G.A. §31-9-2 ---> O.C.G.A. §31-9-4 ---> O.C.G.A. §37-3-1 would seem to me to be giving explicit power to the parents of minors to consent (or not) to psychiatric hospitalization and/or treatment of any kind, just as a parent would presumably have the power to AMA their child from a regular hospital. And furthermore, any argument that it applies only to treatment and not hospitalization itself rings hollow to me; the statute encompasses "care and treatment," suggesting that the hospital's stewardship is conditional upon parental consent.

But, let's go down the rabbit hole a little bit deeper. O.C.G.A. §37-3-20 also addresses parental consent to treatment on a voluntary basis, seemingly setting the minimum age for admission at 12 years old and allowing for a parent or legal guardian to consent to treatment for their minor child but also giving the hospital the ability to detain the child pursuant to the guidelines for adults in O.C.G.A. §§37-3-21 and 37-3-22. These two statutes note that a person shall be discharged upon recovering from their crisis situation and also allow for request for discharge by the patient or his or her representative, either in writing or orally, with respective timelines for the hospital to act on those requests (see the caveat to those requests below).

One might also note that O.C.G.A. §37-3-90(e) provides that "Any minor admitted voluntarily shall be released at any time after written request is made by the minor's parent or legal guardian." Since the majority of these cases begin with voluntary admission by the parents (and subsequently morph into a nightmare scenario), one would expect that the instruction of the parent alone would result in discharge. Not so. Since the law also provides that the hospital may take a request for discharge and subsequently make a determination prior as to whether the individual in question is a danger to himself or others, such a finding is sadly inevitable in many (if not most) cases in my experience. The hospital then relies upon its "duty" to continue to hold the child and deny the parent's request for discharge, pursuant to the interpretation of law by the Courts below.

As indicated just above, in the end, the only interpretations that matter are the Courts', and those in Georgia have held that minors considered an imminent threat are subject to the same rules as adults. In Etheridge v. Charter Peachford, 210 Ga App 482 (1993) [overruled on other grounds], the Georgia Court of Appeals held in favor of the hospital on a false imprisonment claim in which the parents of a 12 year-old child alleged the hospital should have discharged her at their request. The Court did not reference O.C.G.A. §37-3-90(e) (see above), but did note the convoluted and confusing nature of the statutes, all while sorting them out to find that a child is to be treated just like an adult when it comes to requests for discharge, shielding the hospital where there was a finding that the child was a danger to herself or others. A subsequent 2009 Court of Appeals case only overruled Etheridge to the extent that it found the hospitals themselves are shielded from liability in good faith scenarios. Krachman v. Ridgeview Institute, 301 Ga App. 361 (2009).

What are the practical implications of Georgia's treatment of minors in the inpatient psychiatric system?

I think it's important for parents to not get too caught up in interpretations of the law, precisely because it is so convoluted, confusing, and conflicting. Sharp legal minds could easily argue that the law is clear that a child should be discharged from voluntary treatment immediately upon written request of the parent, and I think safe practice in a real scenario is to do just that.

Will it mean that your child is discharged immediately? I wouldn't bet on it. But the more you inject yourself into the situation (assertively, not aggressively), the more likely that the hospital will ultimately concede to your requests, as they have plenty of other patients in their hospitals who aren't squeaky wheels and through whom they can make a profit.

Be visible and you are more likely to be heard. Do NOT let your emotions take over as this can only compound the problem and many times can further delay discharge.

And lastly, remember that you took your child to the hospital for a reason; don't let my frustration with the corporate entities of these hospitals and their business models cloud that reality. You likely prevented something worse from happening, and sometimes a breath is all you need to keep an irreversible act from taking place. There is no shame in trying to protect your child, even if the realities of psychiatric hospitalization were nothing that you could have imagined. Simply prepare to have the conversation with them that crisis hospitalization is not real treatment, and then begin that journey with them, as a partner who's eyes are little more open now.

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