The psychiatric hospitalization of a youth (a person under 18 years of age) against his or her will is a treatment option that is pursued only when all less restrictive treatment options have been exhausted or deemed unsuitable.

Taking away an individual’s personal freedom, even with the good intention of providing mental health treatment, is such a serious step that the Virginia legislature has established strict requirements that must be met before a youth can be involuntarily hospitalized.

Involuntary hospitalization occurs only when a youth’s psychiatric condition causes a situation where the youth is a serious danger to self or others or is experiencing a serious deterioration in ability to care for self in a developmentally age-appropriate manner.

The process starts with the issuance of a Temporary Detention Order (TDO) and the scheduling of a Commitment Hearing.  The involuntary hospitalization of youth is done in accordance with the Code of Virginia, sections 16.1-335 through 16.1-348, as amended.

A Temporary Detention Order (TDO) is a court order issued by a Magistrate* that requires an individual to be held in a psychiatric facility for a period of up to 96 hours until a commitment hearing is held. How long the person is hospitalized before the hearing occurs depends upon when the TDO is issued and executed and whether there is an intervening weekend or legal holiday.

Magistrates are available to issue a TDO every day of the year, 24 hours a day.

*Often a person’s first contact with Virginia’s Judicial System is through the Office of the Magistrate. The magistrate provides an independent, unbiased review of complaints of conduct brought to the office by law enforcement or the public. Among a magistrate’s many duties are processes such as issuing arrest warrants, search warrants, subpoenas, and temporary detention orders. Magistrates can conduct hearings in person or by videoconference, and are available around the clock at two locations in Fairfax County:

• Fairfax Adult Detention Center
  10520 Judicial Drive
  Fairfax, VA 22030
  703-246-2178, TTY 711
• Mount Vernon Governmental Center
  2511 Parkers Lane
  Alexandria, VA 22306
  703-780-8580, TTY 711

Youth under the age of 14

A minor 14 years of age or younger can be admitted to a psychiatric hospital solely upon the application and consent of a parent. Since the youth does not need to consent or agree to the admission, a TDO is not needed to have the youth hospitalized.

Youth over the age of 14, nonobjecting

A minor 14 years of age and older who does not object to admission to a psychiatric hospital can be admitted upon the joint application and consent of the youth and a parent. Since the youth is agreeing to the hospitalization, this is considered a “voluntary” admission and therefore a TDO is not needed.

Youth over the age of 14, objecting

A minor 14 years of age and older who (1) objects to admission to a psychiatric hospital, or (2) is incapable of making an informed decision about treatment can be admitted solely upon the application and consent of a parent for up to 96 hours. Issuance of a TDO is not needed but the admission must be subsequently approved by the Juvenile and Domestic Relations District Court. However, since the psychiatric facilities within Fairfax County are not willing to admit an “objecting” or “incapable” youth 14 years of age or older solely upon the application and consent of a parent, an admission under this part of the statute is not possible.  As a result, to have the youth admitted a TDO must be issued.

A TDO is issued in response to a request by a “Petitioner” and, except in rare circumstances, only after completion of an assessment within the preceding 72 hours by a “Certified Prescreener.”  The Petitioner, defined by the law as the youth’s “parent, treating physician, or ‘any responsible person’,” is the person who is requesting and has evidence to support involuntary hospitalization of the youth. The Certified Prescreener must be a mental health clinician who is employed by the Fairfax-Falls Church Community Services Board (CSB) and is certified to conduct TDO evaluations.

The purpose of the Certified Prescreener’s assessment is to determine whether the youth meets the TDO criteria specified in the statute. Based on the results, the Certified Prescreener will then recommend or not recommend that the youth be involuntarily hospitalized under a TDO.

If a TDO is issued, the results of the assessment are documented in a Preadmission Screening report (“prescreening”) that is sent to the hospital and is admitted into evidence at the commitment hearing. The Certified Prescreener is also required to ascertain the insurance status of the youth, determine the facility where the youth will be hospitalized, and inform the petitioner and the “on-site treating physician” if hospitalization under a TDO is not being recommended.

To issue the TDO, the Magistrate, based on all evidence readily available, must decide that:

1. Because of mental illness, the youth (i) presents a serious danger to himself or others to the extent that severe or irremediable injury is likely to result, as evidenced by recent acts or threats or (ii) is experiencing a serious deterioration of his ability to care for himself in a developmentally age-appropriate manner, as evidenced by delusionary thinking or by a significant impairment of functioning in hydration, nutrition, self-protection, or self-control; and
2. The youth is in need of compulsory treatment for a mental illness and is reasonably likely to benefit from the proposed treatment.

Prior to deciding whether or not to issue the TDO, the Magistrate may consider (i) any recommendation from any treating or examining physician or behavioral health professional licensed in Virginia, (ii) any past actions of the youth, (iii) any past mental health treatment of the youth, (vi) any relevant hearsay evidence, (vii) any medical records available, (viii) any affidavits submitted, if the witness is unavailable, and (viii) any other information available that the magistrate considers relevant.

Defining “serious danger” and “serious deterioration in ability to care for self” is a matter for each Magistrate and Certified Prescreener and will depend on the particular facts of each case.

After the TDO is issued, a law enforcement officer will usually bring the court order to where the youth is located, take the youth into custody, and transport the youth to the hospital. During transportation to the hospital, law enforcement officers usually place the individual in handcuffs, for safety reasons.

However, a Magistrate may authorize the youth be to be taken to the hospital by an “alternative transportation provider” if it can be demonstrated that the provider is available and willing to provide the transportation and can do so in a safe manner. Alternative transportation can be provided by a parent, family member, or friend of the youth; a representative of the CSB; or a transportation provider with trained personnel who can provide such transportation. If such transportation is authorized, the law enforcement officer will bring the court order to where the youth is located, take the youth into custody, and transfer custody to the alternative transportation provider identified in the Order for Transportation to Alternative Facility of Temporary Detention.

Every attempt will be made to have the youth admitted to a local hospital that accepts juveniles (Dominion Hospital, Inova Fairfax Hospital,). However, this is not always possible. In the event that a bed cannot be located in Fairfax County, every attempt will be made to find an available bed as close to Fairfax County as possible.

• If the youth is admitted to a hospital in Fairfax County, the commitment hearing for the youth will be held by a Fairfax County Special Justice.
• If there is not an available bed in Fairfax County and the youth is detained to a hospital in a different county, the commitment hearing will be held by a Special Justice or Judge from the jurisdiction where the hospital is located.  

The Certified Prescreener will give you the name and address of the hospital where the youth will be admitted. In the printable version of this information is a list of hospitals where the youth might be admitted. There is also space where you can record the name and address of the hospital where the youth will be admitted, if known.

The deadline to hold the commitment hearing is no later than 96 hours after the TDO is executed. If the youth is admitted to one of the hospitals in Fairfax County, the commitment hearing is held at the hospital where they were admitted. The Fairfax County Assistant Commonwealth Attorney or the Independent Evaluator will contact the identified petitioner the day before and let them know the hearing day and approximate time. If the youth is placed outside of Fairfax County, the CSB Staff will contact the petitioners and can let them know the hearing date and approximate time. Information about the date, location, and starting time of a commitment hearing can also be obtained by contacting the hospital where the youth has been admitted or by contacting the Fairfax Emergency Services at 703-573-5679; TTY 711.

It is essential that the Petitioner and any witnesses be present when the case is called. If the Petitioner and/or witnesses are not present to provide firsthand information, the TDO will be dismissed, and the youth will be released from the hospital. Rules of evidence and legal procedures apply to the commitment hearing.

Fairfax TDO Hearings are currently being held via Zoom video-conferencing, the instructions for connection follow:

How to join a Zoom meeting for a Civil Commitment Hearing...

A Zoom link will be sent by email to the identified petitioner by either the County Attorney, an Independent Evaluator or a Fairfax CSB Hearing Representative on the day of the civil commitment hearing.

It is necessary to have a smart phone (a phone with a camera) or computer with video connection capability to participate in the civil commitment hearing.

• Before logging into the Zoom link via a smart phone or computer, it is helpful to download the Zoom application beforehand through the device’s “app store.”

To log on via smart phone:

If the Zoom app is NOT downloaded before logging on, please follow these steps:

1. After clicking on the Zoom link (will likely be highlighted in blue in the body of an email), you will see a page that says, “Ready to get started?” Click on the blue button that states, “Download from App Store.” Download the app onto your phone and wait for it to load.
2. Once the Zoom app is downloaded, click “Open” and you will be taken to a page within the Zoom app that states, “Start or join a meeting.”
3. Return to the original email and click on the Zoom link again.
4. You can indicate your identification where it says “Name” and then MANUALLY enter the meeting passcode in the line labeled as “Meeting Passcode.” The meeting passcode is: ABCDE1234!
   
   It is imperative that you type in the passcode and do NOT copy and paste the passcode from the body of the email.
5. Once you enter the passcode, click “Continue” and then indicate “OK” or “Allow” to permit Zoom accessing your camera.
6. Click the blue button at the bottom of your screen where it states, “Join With Video.”
7. Another screen will open stating “Zoom would like to access the microphone” – click “Ok” to permit Zoom accessing your microphone.
8. You will then see a screen that states, “The host will let you in soon.” Please wait on this screen until the host of the Zoom meeting allows you into the court hearing.

If the Zoom app is already downloaded, please follow these steps:

1. Clicking on the Zoom link (will likely be highlighted in blue in the body of an email) that is sent to you.
2. MANUALLY enter the meeting passcode in the box labeled as “Meeting Passcode.” The meeting passcode is: ABCDE1234! (case sensitive)
   
   It is imperative that you type in the passcode and do NOT copy and paste the passcode from the body of the email.
3. Once you enter the passcode, click “Continue” and then indicate “OK” or “Allow” to Zoom accessing your camera.
4. You will then see a screen that states, “The host will let you in soon.” Please wait on this screen until the host of the Zoom meeting allows you into the court hearing.

If a Petitioner has difficulty or does not have access to a Smart Phone or Video enabled computer...

Petitioners may present to the Fairfax Falls Church CSB Emergency Services and receive assistance logging on to the TDO hearing utilizing the CSB’s available tele-video equipment.

Please present to the CSB well in advance of your scheduled TDO court appearance to allow sufficient time to set up the tele-video equipment and log on to the TDO hearing.

Those attending the commitment hearing include: the youth, their court-appointed attorney, their court-appointed Guardian ad litem, a Special Justice, a Deputy Sheriff (who provides court security), a Qualified Evaluator, a CSB representative, the Petitioner, and any witnesses who are attending the hearing to testify.

The Special Justice is an attorney who has judicial authority to conduct the hearing and determine the final outcome of the hearing.

In Fairfax County, the Qualified Evaluator (QE) is usually a clinical psychologist who is skilled in the diagnosis and treatment of mental illness. Prior the hearing, the QE conducts an evaluation of the youth in order to provide an “expert clinical opinion” about whether the youth, because of a mental illness, (1) presents a serious danger to himself or others to the extent that severe or irremediable injury is likely to result, as evidenced by recent acts or threats or (2) is experiencing a serious deterioration of his ability to care for himself in a developmentally age-appropriate manner, as evidenced by delusionary thinking or by a significant impairment of functioning in hydration, nutrition, self-protection, or self-control. The QE will also make specific recommendations for the youth’s placement, care and treatment and offer an opinion about (i) whether the youth meets the criteria for court-ordered inpatient treatment, (ii) whether the youth is in need of compulsory (court-ordered) treatment and is likely to benefit from that treatment, (iii) whether inpatient treatment is the least restrictive alternative that meets the youth’s needs. These issues are addressed in the QE’s written report that is submitted to the Court and placed in the youth’s hospital chart at least 24 hours before the hearing.

The court-appointed attorney, at State expense, represents the youth at the hearing. According to the Code of Virginia the attorney is obligated to “articulate the wishes of the minor” and “fully represent the minor in the proceedings.” This means that if the youth wants to be discharged from the hospital, the attorney will challenge the opinion and testimony of those who think the youth should remain in the hospital. Before the hearing, the attorney obtains information by interviewing the youth, the youth’s parents, the Petitioner, the Qualified Evaluator, any witnesses and by reviewing diagnostic and treatment records. During the hearing, the attorney’s role is to present witnesses on behalf of the youth and to cross-examine opposing witnesses.

The Guardian ad litem is an attorney who, at State expense, represents what is, in the Guardian ad litem’s professional judgment, in the best interest of the youth. Before the hearing, the Guardian ad litem obtains information by interviewing the youth and reviewing the petition, the Prescreening and the Qualified Evaluator’s report, and ascertains the views of the youth, the youth’s consenting parent(s), the Qualified Evaluator, and the attending psychiatrist. The Guardian ad litem also makes a recommendation about what disposition should be put into effect.

The Petitioner is the person who requested that the youth be involuntarily hospitalized and is an essential part of the TDO process. Petitioners are often family members or friends but can be other mental health professionals or concerned individuals. The primary role of the Petitioner is to present testimony about why the TDO was requested or bring witnesses who can provide such testimony. According to the Code of Virginia, the Petitioner shall be given the opportunity to present evidence and cross examine witnesses at the hearing.

The testimony of the Petitioner or witnesses at the hearing is a practical necessity. If the Petitioner and/or witness are not present to provide first-hand evidence about the youth’s behavior – especially those behaviors and verbal threats that have resulted in, or could result in, physical harm - there is the strong possibility that the TDO will be dismissed at the hearing due to insufficient evidence. When that happens, the youth will be free to leave the hospital.

As the petitioner, you will be asked to complete and sign a “Petition for Certification for Involuntary Admission for Treatment” court form. On this form you will be required to provide specific information about why you are asking to have a TDO issued. The form will be notarized by the CSB Emergency Service staff and be sent to the Court.

Petitioners are permitted to hire an attorney, at their own expense, to represent them at the hearing. While not required, this is very useful as the attorney is able to elicit testimony which is admissible at the hearing, provide legal advice and suggestions, and respond to legal issues that may be raised at the hearing.

As the Petitioner, you are strongly encouraged to bring other witnesses to the hearing so they can provide supporting testimony. You and your witnesses should be available to the Qualified Evaluator prior to the hearing to provide information about why you sought the TDO. You are also encouraged to bring to the hearing any relevant physical evidence (for example, weapons, photographs, audio recordings, letters, documents, etc.) that supports your testimony. Do not hesitate to ask questions of the Special Justice, the Qualified Evaluator, and the Attorney if you do not understand something that is occurring at the hearing.

The testimony of the petitioner should provide first-hand information about what the youth has done or said that makes him/her a serious danger self or others (as demonstrated by recent acts or threats), or that indicates the youth is exhibiting a serious deterioration in their ability to care for self in an age-appropriate manner.  When you testify, it is important to focus on the youth’s recent behavior that you have personally witnessed and on recent statements or verbal threats that you have directly heard. What is considered “recent” varies among the Special Justices, but may encompass anything from the past few days to the past few weeks.

When testifying, try to be as direct and precise as possible and provide as many details as you can. You will probably not be able to simply express your opinion that the youth is a serious danger to self or others or is experiencing a serious deterioration in ability to care for self. The individual’s attorney will likely object to such testimony since only an “expert witness” may offer an “opinion.”  Rather, testimony should focus on facts and specific examples of the youth’s recent behavior and verbal threats about which you have personal and direct knowledge. This includes recent statements made by the youth directly to you or that you have personally heard the youth make to others and any documents recently written by the youth that you have obtained. Remember to include evidence related to the youth’s refusal to seek or cooperate with voluntary psychiatric treatment.

If you are the Petitioner and do not have firsthand evidence, then it is absolutely essential that you bring witnesses who do have such information. While there are exceptions, Virginia law essentially does not allow the Petitioner or witnesses to testify about what someone else told them or about behavior they have not personally seen or heard. Such evidence is rarely admissible because it is considered “hearsay” under the rules of evidence.

At the start of the hearing, the participants will be asked to identify themselves and will be sworn in if they are going to provide testimony.  The Special Justice will then advise the youth of his or her legal rights. The Special Justice will then listen to the testimony of the petitioner, the witnesses, the Qualified Evaluator, and the Guardian ad litem. The youth is not required to testify but may choose to do so. The Petitioner and the youth’s attorney may “cross-examine” (ask questions of) any of the witnesses. After all the testimony has been completed, the youth’s attorney will be given an opportunity to state what disposition he/she thinks should be reached. A final decision about the disposition is then made by the Special Justice.

The possible outcomes of the hearing process include the following:

Voluntary Admission – At the start of the hearing, the Special Justice will inform the youth of their right to be voluntarily admitted for inpatient treatment. Then, if the youth is capable of consenting to the voluntary admission and the youth’s parents consent to the voluntary admission, the Special Justice will allow the youth to voluntarily remain in the hospital. When deciding whether or not the youth is capable of consenting to a voluntary admission, the Special Justice may consider evidence regarding the youth’s past compliance or noncompliance with treatment. If the youth is allowed to be voluntarily admitted, the Court cannot “commit” the youth to inpatient treatment nor order the youth to participate in Mandatory Outpatient Treatment. According to the Code of Virginia, a voluntary admission of a youth cannot exceed 90 days unless authorized by appropriate hospital medical personnel.

Commitment to Inpatient Treatment – When the Special Justice orders a commitment to inpatient treatment, the youth is under a court order to be involuntarily admitted to a hospital and is required to remain in the hospital for a maximum period of 90 days, unless discharged sooner. To be committed, the Special Justice must find, by clear and convincing evidence, that

1. Because of mental illness, the youth (i) presents a serious danger to himself or others to the extent that severe or irremediable injury is likely to result, as evidenced by recent acts or threats or (ii) is experiencing a serious deterioration of his ability to care for himself in a developmentally age-appropriate manner, as evidenced by delusionary thinking or by a significant impairment of functioning in hydration, nutrition, self-protection, or self-control; and
2. The youth is in need of compulsory treatment for a mental illness and is reasonably likely to benefit from the proposed treatment; and
3. The Special Justice shall consider entering an order for mandatory treatment if it is found that inpatient treatment is not the least restrictive treatment.

According to the Code of Virginia, a minor committed to inpatient treatment shall be discharged from the facility when he no longer meets the commitment criteria as determined by appropriate hospital medical staff review. Further involvement of the Court is not required. Within 10 days of the order committing the youth, the youth can appeal the decision to the Circuit Court.

Mandatory Outpatient Treatment (MOT) – The Special Justice can order the youth to participate in a period of outpatient treatment. This is referred to as Mandatory Outpatient Treatment (MOT). The duration of the MOT is determined by the Special Justice but cannot exceed 90 days. To order MOT, the Special Justice must find, by clear and convincing evidence, that the youth meets the criteria for commitment to inpatient treatment and that:

1. The youth is in need of compulsory treatment for a mental illness and is reasonably likely to benefit from the proposed treatment; and Less restrictive alternatives to involuntary inpatient treatment that would offer an opportunity for improvement of his condition have been investigated and are determined to be appropriate; and
2. The youth, if 14 years of age or older, and his parents (i) have sufficient capacity to understand the stipulations of the youth’s treatment, (ii) have expressed an interest in the youth’s living in the community and have agreed to abide by the youth’s treatment plan, and (iii) are deemed to have the capacity to comply with the treatment plan and understand and adhere to conditions and requirements of the treatment and services; and
3. The ordered treatment can be delivered on an outpatient basis by the community services board or a designated provider.

In Fairfax County, a minor who has been placed in MOT must be seen at the Emergency Service of the Merrifield Center (Sharon Bulova Center for Community Health 8221 Willow Oaks Corporate Drive, Fairfax, VA 22031) after the hearing to review the court order and start the treatment process.

According to the Code of Virginia, when a youth is ordered to participate in MOT, their compliance with treatment must be monitored by the CSB that serves the jurisdiction where the youth resides. Failure of the youth to adhere to the terms of the MOT could result in a revocation of the MOT and an order for commitment to inpatient treatment. Before the MOT expires, it can be continued for a period not to exceed 90 days or it can be rescinded.

Within 10 days of the order placing the youth on MOT, the youth may appeal the decision to the Circuit Court.

Dismissal of the Petition – The Code of Virginia has certain requirements regarding the format and service of the TDO and other necessary documents such as the Petition. If these requirements are not met, the Special Justice may dismiss the petition for involuntary hospitalization. The Petition can also be dismissed if the Special Justice decides that the evidence does not meet the clear and convincing burden of proof to order an involuntary inpatient treatment or order the youth to participate in Mandatory Outpatient Treatment. When the petition is dismissed, the youth is free to leave the hospital and is under no legal obligation to receive any type of psychiatric treatment. Dismissal of the petition does not prevent the youth from staying in the hospital voluntarily, if they agree to remain in the hospital, are deemed capable of making that decision, and are accepted for admission.

According to the Code of Virginia, if the parent or parents with whom the minor resides are not willing to approve the proposed commitment, the commitment to inpatient treatment can be ordered only if the Special Justice determines (i) that the youth meets the commitment criteria, and (ii) that such treatment is necessary to protect the youth’s life, health, safety or normal development. The Special Justice may also issue a court order directing either or both of the youth’s parents to comply with reasonable conditions relating to the youth’s treatment if it is determined that such an order is in the best interests of the youth.

What happens after the hearing is determined by two factors: the disposition reached at the hearing and which hospital the youth had been admitted to under the TDO.

A minor committed voluntarily or involuntarily into the hospital will remain in inpatient psychiatric treatment, typically at the hospital where the inpatient admission was granted. A minor who has been ordered into MOT will be released from the hospital to begin their court-ordered treatment. A youth whose Petition was dismissed will be free to leave and discharged from the hospital.

During the detention period, the cost of all treatment provided while the youth is hospitalized under the TDO is the responsibility of the parent or legal guardian. When the youth is covered by private health insurance or Medicaid, the hospital will seek reimbursement from the third-party payor. In cases where the youth is not covered by a third-party payor and is demonstrably unable to pay the cost of treatment, the hospital can ask for reimbursement from the Commonwealth of Virginia’s indigent patient fund.

After the commitment hearing, the cost of all treatment is also the responsibility of the parent or legal guardian whether the youth is committed or remains in the hospital voluntarily. When the youth is covered by insurance, he/she is admitted to a facility that accepts their insurance, and the hospital will seek reimbursement from the third-party payor. Uninsured youth are usually referred for hospitalization at the Commonwealth Center for Children and Adolescents in Staunton, Virginia, where the cost of treatment is determined by the parent or legal guardian’s income level and ability to pay. Concerns about the cost of treatment and payment should be addressed to a hospital social worker.

The CSB determines the hospital where the youth who has been committed to inpatient treatment will be admitted. The youth may be able to remain at the hospital where they had been admitted under the TDO or may need to be transferred to another facility. The hospital where the youth is admitted is based on health insurance coverage, bed availability, and whether or not a particular hospital will accept the youth for admission. Every effort will be made to have the youth hospitalized at a local psychiatric facility in Fairfax County.

During the detention period, the cost of all treatment provided while the individual is hospitalized under the TDO is the responsibility of the individual. When the individual is covered by private health insurance, Medicare, or Medicaid, the hospital can seek reimbursement from these insurance carriers. In cases where the individual is not covered by insurance and is demonstrably unable to pay the cost of treatment, the hospital can ask for reimbursement from the Commonwealth of Virginia’s indigent patient fund.

After the commitment hearing, the cost of all treatment is the responsibility of the individual, even when he or she is committed or hospitalized as a voluntary admission. When the individual is covered by insurance, he/she is admitted to a facility that accepts his/her insurance and the hospital will seek reimbursement from the insurance carrier. Uninsured minors are usually referred for hospitalization to the Commonwealth Center for Children and Adolescents, a state facility, where the cost of treatment is determined by the individual’s income level and ability to pay. If space is not available there, the individual may be admitted to a private facility using a state fund that covers the cost of the hospitalization. Concerns about the cost of treatment and the payment for treatment should be directed to a hospital social worker.