# An adult with severe schizophrenia is brought to the ED after attempting to set a fire while expressing command hallucinations. He refuses voluntary admission. Which statement best reflects the legal and ethical basis for involuntary psychiatric commitment?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375127&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: SIPC

## Question

An adult with severe schizophrenia is brought to the ED after attempting to set a fire while expressing command hallucinations. He refuses voluntary admission. Which statement best reflects the legal and ethical basis for involuntary psychiatric commitment?

## Option

1. Family request alone is sufficient for involuntary commitment
2. Imminent danger to self or others or grave disability is required, and care must be provided in the least restrictive setting **✔ Correct answer**
3. Any person with active hallucinations should be involuntarily committed for at least 30 days
4. The client may sign out against medical advice at any time during a 72-hour hold

**Correct answer: 2**

## Explanation

Involuntary psychiatric commitment requires legal criteria: imminent danger to self, danger to others, or grave disability (cannot meet basic needs due to mental illness). The principle of LEAST RESTRICTIVE setting applies — outpatient, partial hospitalization, voluntary admission, then involuntary. State 72-hour holds (often called 5150 in California or similar) allow evaluation; the client cannot leave AMA during the hold. Family request alone is insufficient — clinical and legal criteria must be met. Active hallucinations alone do NOT mandate commitment; danger or grave disability is required.

## In-depth explanation

Patient retains rights even when committed: humane care, communication (with limits), grievance process, treatment refusal except in emergencies. Commitment is not a punishment.

## Clinical scenario

Public safety officer brought him in. No medical issues. Family also concerned about safety.

## Key concepts

- **grave disability** — Inability to provide for basic needs (food, clothing, shelter, safety) due to mental illness.
- **least restrictive** — Principle that mental health intervention should use the minimum restriction needed.
- **72-hour hold** — Emergency civil commitment for evaluation; specific name varies by state.

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