The Law for Treatment of the Mentally Ill
A mentally ill individual is one who suffers from impaired judgment and sense of reality. The law defines who is considered mentally ill, the persons rights, as well as the measures that can be taken for them.
Commitment to a Psychiatric Hospital
An individual to a psychiatric hospital, must have undergone a medical examination in a hospital. If the patient is a minor, he/she must be examined by a child psychiatric expert, and only then may the question of his/her consent, or lack of consent to being hospitalized be examined.
One who requests to be committed to a psychiatric hospital of his/her own free will must sign a consent form for hospitalization and treatment. There are some special treatments for which the individual will be required to sign a separate consent form.
It is important to understand that if an individual agrees to be hospitalized, his/her release will be within 48 hours of the request, not immediately. During this period, the hospital may submit a request to the district psychiatrist to issue a compulsory hospitalization order if the psychiatrists treating the patient believes compulsory hospitalization is necessary.
Involuntary Commitment by means of a District Psychiatrist
The district psychiatrist is the one appointed to issue orders for compulsory psychiatric testing. In order to issue such an order, the psychiatrist must be convinced that the individual for whom the compulsory testing is being requested is:
- Ill and as a result of the illness, significantly impaired in terms of judgment capabilities or the ability to ascertain reality.
- Liable to endanger him/herself or others and poses an immediate physical danger.
- Has refused to be tested by a psychiatrist.
The courts have repeatedly determined that a compulsory hospitalization order may not be based solely on medical grounds; it must be based on various considerations including the patient’s liberty, treatment of the patient and the public welfare.
A compulsory testing order issued by the district psychiatrist is valid for 10 days from the day it is issued. This type of order is generally carried out by a team of hospitalizing nurses from the hospital with the assistance of police officers. The hospitalizing nurses and the police officers are permitted to use “reasonable force” for purposes of entering the location in which the individual is located and for purposes of performing the testing itself.
After the individual undergoes psychiatric testing (usually in the emergency room of a psychiatric hospital), the hospital is permitted to submit a written rationale to the district psychiatrist, requesting that an urgent hospitalization order be issued. The conditions for issuing an urgent compulsory hospitalization order are identical to the conditions for issuing a compulsory testing order.
Compulsory hospitalization according to a district psychiatrist’s order is for an initial period of only 7 days. According to the hospital’s rationale, the psychiatrist is permitted to extend the hospitalization period for an additional 7 days. At the conclusion of the 14 days, authority regarding continuation of the hospitalization is transferred to the district psychiatric board, which is then authorized, according to a hospital rationale, to continue the hospitalization by an additional 3 months. Afterwards, the board is authorized to extend the hospitalization for periods of up to 6 months. In every instance, the conditions for extending compulsory hospitalization are identical to the original conditions for compulsory testing and compulsory hospitalization.
Hospitals are permitted, according to their own discretion, to release someone who is hospitalized under civil compulsory hospitalization, or may grant the individual leaves. If the patient or his/her immediate family member opposes, approval of the district psychiatrist is required for release. The district psychiatrist’s decision may be appealed before the psychiatric board.
The law determines different and stricter instructions regarding compulsory hospitalization of minors. Only the Juvenile Court has the authority to compulsorily hospitalize a minor above the age of 15 who opposes his/her hospitalization.
Urgent Involuntary Commitment
A psychiatric hospital manager may also make a decision regarding the necessity of an urgent compulsory hospitalization in unique cases.
The period of urgent compulsory hospitalization of this type may not be more than 48 hours. At the end of this period, the patient will be released unless a hospitalization order was given during that period or the patient consents to his/her hospitalization.
Commitment of a Minor
With parent or legal guardian consent
The person responsible for a minor (parent or legal guardian who has custody of the minor) is permitted to request that the minor be hospitalized and may consent to hospitalization in the minor’s name.
If the minor is at least 15 years old and does not consent to be hospitalized, he/she may not be hospitalized despite the consent of their parent or legal guardian, except with court approval given according to the juvenile law provisions, which are:
- The minor is mentally ill and there are grounds for his/her hospitalization according to the provision in Section 9 of the Law for Treatment of the Mentally Ill.
- The minor is mentally ill or has been diagnosed as having a severe mental disturbance which is liable to endanger him/herself or pose an immediate physical danger to others or to cause severe developmental mental damage if not treated by means of hospitalization.
Hospitalization of a minor with the consent of his/her parent or legal guardian, except for hospitalization which does not include residing in the hospital, may not be for a period longer than 2 months. In order to extend this period, a motion must be presented before the district psychiatric board for children and youth. The board may, according to a rationale from the manager, extend the period of hospitalization for additional periods of no more than 3 months each, according to the treatment program, if it has been convinced that extension of the hospitalization period is necessary.
The minor’s parent or legal guardian, a welfare officer, a minor who is at least 15 years old, as well as the manager, are permitted at all times to request an additional district psychiatric board for children and youth hearing regarding the minor’s hospitalization.
With the minor’s consent only
A minor who is at least 15 years old may request to be hospitalized of his own free will and consent to being hospitalized the same way any patient requests to be hospitalized. However; if the minor’s parent or legal guardian does not consent to the hospitalization, the minor may only be hospitalized with court approval according.
Rights in The Hospital
A patient committed in a hospital may:
- Send and receive closed letters and other mail parcels;
- Receive guests at times and under conditions determined by the hospital;
- Have a relationship with people outside the hospital;
- Keep personal items to a reasonable extent and wear personal clothing according to the conditions determined by the hospital.
A hospital may limit these patient rights if required for medical reasons. In all cases, the patient’s right to send closed letters or maintain a relationship with his/her lawyer, guardian, the district psychiatrist, and the district psychiatric board may not be limited.
The hospitalization of a patient may not harm the patient’s rights to manage his/her assets, unless the hospital is of the opinion that the patient is not capable of handling his/her own affairs; the hospital must explain the decision in writing and the patient may submit an appeal of the decision to the district psychiatric board.
Receiving details of obligations and rights
A patient must receive a form detailing his/her rights and obligations, as well as an oral explanation of the topic from the receiving doctor. If the medical condition of the patient makes it impossible for him/her to understand the form, the hospital must indicate this in writing in the patient’s medical file and must explain the rights to the patient when his/her medical condition allows. In addition, the hospital must hang a copy of the patient’s rights and obligations form in a prominent location in every psychiatric department.
Receiving medical information
A hospitalized individual is entitled to receive medical information regarding his/her condition. However, one of the common patient complaints is that they are prevented from reviewing the medical file. Quite often, only with the intervention of a lawyer or other external body is a patient able to review the medical records. Sometimes, a hospital only allows a lawyer or another doctor acting on the patient’s behalf to review the information, subject to the requirement that the content will not be transmitted to the patient. There is a legal dispute between human rights organizations and the Ministry of Health regarding the conditions for denying or limiting a patient’s right to review his/her own medical information. It must be emphasized that the Patient’s Rights Law and all of the rights and arrangements detailed in it, apply to the mentally ill, as well.
Transfer between hospitals
A patient may not be transferred from one hospital to another except with the consent of both the patient and both hospital managers; in the absence of this consent, the district psychiatrist of the district in which the hospital to which the patient is being requested to move may decide. This decision may be appealed before the district psychiatric board. Nonetheless, under special circumstances and with consideration of the need for hospitalization, the head of mental health services is permitted to order the transfer of a patient from one hospital to another.
Use of forcible measures (isolation or restraint)
Forcible measures may only be performed if required for medical treatment of the patient or in order to prevent danger to him/herself or others.
The order to use forcible measures must be given in writing by a doctor and is limited to a maximum period of 4 hours. In case of emergency and in the absence of a doctor, a nurse may give this order. The supervising nurse must examine the patient at least once every half hour. Based on an examination, a doctor may extend the restraining order for additional periods of no more than 4 hours each time.
Electric shock treatment
Electric shock treatment may only be given with the decision of 3 doctors in the hospital. Electric shock treatment may not be performed on a patient with consent unless he/she consented in advance and in writing.
Submission of an appeal
For every decision of compulsory hospitalization or compulsory clinical treatment (including refusal to issue an order), an appeal may be submitted, which will be heard by the district psychiatric board. Any individual may submit such an appeal. This body has a type of judicial authority, as the law provides it with broad authorities to make decisions regarding compulsory hospitalization.
An appeal must be submitted in writing and include detailed rationale. The board must deliberate on the appeal of a hospitalization order within 5 days of its submission. For appeals of compulsory clinical treatment orders, the board must deliberate within 10 days of the submission.
Every psychiatric board is composed of 3 members: a jurist who also serves as the board’s chairman, and two psychiatrists. The discussion with the individual brought before the board includes both a psychiatric test, and the opportunity for the patient to argue factual claims and legal claims.
The board must allow the patient, the patient’s relatives and their lawyers to argue their claims before the board. Additionally, the board has the authority to permit additional people to argue claims, if it deems them relevant.
The patient has the right to be present during all court proceedings. If the board determines that the presence of the patient during the proceedings, is liable to damage his/her physical or mental welfare, the board may deliberate that portion of the proceedings in the patient’s absence, as long as the rationale for doing so is recorded.
According to the Ministry of Health’s procedures, the patient must be given an abstract and rationale of the board decision in writing within 5 days of the proceedings’ conclusion, except for instances where it is impossible to give the patient the decision on professional grounds. In this case, a copy of the decision must be given to the patient’s proxy.
Submission of a Court Appeal
The patient, a relative, or a governmental representative may appeal every psychiatric board decision before the district court. This type of appeal must be submitted within 45 days of the board’s decision and it is argued before an individual district judge.
The court ruling regarding the appeal may approve the board decision, return it to the board or issue an alternative decision.