Involuntary psychiatric holds — detaining someone for mental health evaluation or treatment without their consent — are one of the most serious interventions in the mental health system. In New York, this process is governed by the Mental Hygiene Law, and a separate law called Kendra’s Law allows courts to order outpatient psychiatric treatment for people with serious mental illness who refuse care. This guide explains when involuntary holds occur, what rights the person has, and what options families have when someone refuses help.
Involuntary Emergency Psychiatric Holds: Section 9.39
Under New York Mental Hygiene Law Section 9.39, a hospital can admit and hold a person for psychiatric evaluation without their consent if a physician determines that the person has a mental illness and is likely to cause serious harm to themselves or others. This is commonly called an “emergency hold” or “9.39 hold.”
Who Can Initiate a 9.39 Hold
- A physician at a hospital emergency department
- A licensed psychiatrist
- In some circumstances, law enforcement can transport a person to a hospital for evaluation — but the hold itself is initiated by a physician, not police
Duration and Process
- Initial hold: up to 72 hours for evaluation
- If the hospital wants to continue holding the person, it must convert to a longer-term admission under Section 9.27 (formal involuntary admission) — which requires two physicians to certify the need
- Longer-term holds require a court hearing within a specific timeframe
Your Rights During an Involuntary Hold
- Right to know the basis for the hold: The hospital must explain why you are being held
- Right to an attorney: You have the right to legal representation. Contact Mental Hygiene Legal Service (MHLS) — (212) 779-1734 (Manhattan/Bronx); (718) 722-6323 (Brooklyn/Queens/Staten Island). MHLS provides free legal representation to people held involuntarily.
- Right to refuse non-emergency medication: You generally cannot be forcibly medicated unless a court orders it (under a “Rivers order”) or there is an immediate emergency
- Right to communicate with family or a designated person
- Right to challenge the hold through a court proceeding (writ of habeas corpus)
- Right to the least restrictive environment appropriate for your condition
Section 9.41: Police Transport for Evaluation
Under Mental Hygiene Law Section 9.41, a police officer who observes a person who appears to have a mental illness and is conducting themselves in a manner likely to result in serious harm can take that person into custody and transport them to a hospital for evaluation. The police action is transport only — the hospital physician makes the determination about whether to hold.
Kendra’s Law: Assisted Outpatient Treatment (AOT)
Kendra’s Law (Mental Hygiene Law Section 9.60) allows a court to order Assisted Outpatient Treatment (AOT) — requiring a person with serious mental illness to participate in outpatient treatment (therapy, medication, case management) as a condition of remaining in the community, without being hospitalized.
Who Can Be Subject to AOT
A person can be ordered into AOT if a court finds they meet all of the following:
- 18 years of age or older
- Suffering from a mental illness
- Unlikely to survive safely in the community without supervision
- Has a history of lack of compliance with treatment that has resulted in hospitalization, incarceration, or violent behavior in the past 36 months
- Is unlikely to voluntarily participate in treatment
- AOT is the least restrictive means of ensuring the person receives treatment
Who Can Petition for AOT
- A family member or household member
- A treating psychiatrist, psychologist, or social worker
- A hospital director or treating physician
- A probation or parole officer
- The director of a residential facility where the person resides
- A police officer who has personal knowledge of the person’s condition
What AOT Requires
An AOT order typically requires the person to: participate in outpatient psychiatric treatment, take prescribed medications, attend scheduled appointments, and cooperate with case management. AOT is not hospitalization — the person continues living in the community. If the person violates the AOT order, they can be transported to a hospital for evaluation.
Rights Under Kendra’s Law
A person subject to an AOT petition has the right to:
- An attorney (provided free by MHLS if they cannot afford one)
- A court hearing before an order is issued
- Present evidence and witnesses on their behalf
- Appeal the order
Alternatives to Involuntary Action
Before pursuing involuntary options, consider:
- NYC Well mobile crisis team: Mental health professionals who can engage the person in crisis without police — call 1-888-NYC-WELL
- NAMI NYC crisis support: (212) 684-3264 — family education and support for navigating a loved one’s mental health crisis
- Crisis Intervention Training (CIT): If you must call 911, request a CIT-trained officer or a B-HEARD response
- Community treatment engagement: Many people with serious mental illness will accept voluntary treatment with appropriate outreach — NYC Well can help connect to assertive community treatment teams
Resources
- Mental Hygiene Legal Service (MHLS): Free legal representation for people held involuntarily — Manhattan/Bronx: (212) 779-1734 | Brooklyn/Queens/SI: (718) 722-6323
- NYC Well: 1-888-NYC-WELL — crisis counseling and mobile crisis dispatch
- NAMI NYC: (212) 684-3264 | naminycmetro.org — family support and education
- Legal Aid Society: (212) 577-3300 — rights of people in psychiatric facilities
Frequently Asked Questions
Can my family member force me into a psychiatric hospital?
Not directly. A family member cannot on their own authority commit someone to a psychiatric hospital. However, a family member can petition for an AOT order (Kendra’s Law), bring a person to an emergency room for evaluation, or call 911 if they believe the person is an imminent danger. The actual hold decision is made by a physician.
How long can a hospital hold someone involuntarily?
The initial emergency hold is up to 72 hours. Further detention requires a formal involuntary admission with two physician certifications (Section 9.27), followed by a court hearing within a specified timeframe. Contact MHLS immediately if you or a loved one is being held beyond the initial 72-hour period without a proper process.
I’m worried about my family member but they have not done anything dangerous. Can they still be held?
Involuntary holds require a finding of likely serious harm to self or others — not just that the person has a mental illness or is acting strangely. For situations where a person needs help but is not an imminent danger, the better paths are NYC Well mobile crisis outreach, voluntary treatment engagement, or — over time — a Kendra’s Law AOT petition if the person has a history of treatment non-compliance resulting in hospitalization or harm.
What is a “Rivers order” and what does it mean for medication?
A Rivers order (from the case Rivers v. Katz) is a court order permitting a hospital to forcibly medicate a patient who lacks capacity to make treatment decisions. Courts issue Rivers orders after finding that the patient lacks the mental capacity to make an informed medication decision and that the proposed treatment is in their best interest. Contact MHLS immediately if a Rivers order is sought against you or a family member.
