Internment
Three circumstances apply here:
– Voluntary internment: the term presupposes
lack of difficulties, but controversy surrounds this
circumstance. Complete psychiatric assessment is
necessary, including morbidity, history, reasons for
request, social support etc Patients seeking a treatment
environment must be distinguished from
those primarily seeking attention, escaping from
social conflict or judicial processes.
– Involuntary internment: a judicial order is required,
after psychiatric or forensic medical reports.
When an emergency physician is needed,
the patient is usually co-operative. If not, the previously
described measures are taken.
– Emergency involuntary internment, in the context
of acute phase psychiatric pathology, without
previous judicial order. This may be ordered by the
physician immediately and then, within 24 hours,
reported to the judge for legal endorsement. Physician-
ordered internment involves the violation of a
fundamental constitutional right to freedom, as stipulated
in article 1732. The internment must be
confirmed by a psychiatrist or the duty physician of
a reference hospital. It is important that the physician
must provide a detailed report of the circumstances
and reasons for this measure, especially so
sedation has been used; this report contains the information
required by the judge. The legal framework
for this type of emergency internment is outlined
in article 763 of the Law 1/2000 of 7 January,
which replaces and amplifies article 211 of the Civil
Code (derogated by this law).
Article 763 says: “Internment for psychic disorder
reasons of someone incapable of making the
decision himself, although under state custody, requires
judicial authorization. This will be prior to
the internment, except if emergency reasons make
the measure necessary, when the judge shall
be informed as soon as possible and within 24
hours. In all cases, internment of minors shall only
be performed in health centres that are adequate
for their age and after report from official services
for the attention of minors”.
Emergency internment is a legal instrument allowing
a physician to provide a solution to a healthrelated
problem (“medical problem, medical solution”)
33, with subsequent judicial control, bypassing
the judge beforehand. In general, when the threat
of violent behaviour is evident, it is preferable to intern
a patient against his will than to face the legal
consequences of harm inflicted on the patient himself
or on others8. Access denied to the home of a
mental patient requires authorization by a judge,
except in cases of utmost necessity, when it must
be performed by the police force.