Pathways to Hospitalization for Mentally Ill Persons in South Carolina 

How it is Supposed to Work & Related Issues 

South Carolina law envisions three distinct pathways to evaluation and hospitalization for individuals who may be mentally ill. The three processes are described below, along with several related topics. 

Pathway 1: Voluntary Admission (Section 44-17-310) 

Step 1: Any person 18 years or older may apply for admission to a state hospital. 

Step 2: If the director of the state hospital determines the person is a proper subject for voluntary admission, then the patient is admitted.  

If a voluntary patient asks to be discharged, the director must discharge the patient, except that: 

• If the patient applied for admission and the discharge is requested by another person (parent or guardian), then the patient must agree to the discharge. 

• If the director of the hospital files a certificate with the probate court stating the person is mentally ill and should be hospitalized, then discharge may be postponed up to 15 days pending a judicial hearing.  

Pathway 2: Emergency Admission (Section 44-17-410)

Petitioning the Probate Court. An individual may be admitted to a public or private hospital, mental health clinic, or mental health facility for emergency admission if the following steps are followed. 

Step 1: A person must sign an affidavit under oath stating their belief that the individual in question has a mental illness and because of this condition there is the likelihood of serious harm to himself or others if not immediately hospitalized. The affidavit must specify the type of serious harm thought probable if the person is not immediately hospitalized and the factual basis for this belief. 

Step 2: A licensed physician must sign a certification in triplicate stating that the physician has examined the person and is of the opinion that the person is mentally ill and because of this condition is likely to cause harm to himself through neglect, inability to care for himself, or personal injury, or otherwise, or to others if not immediately hospitalized. The certification must contain the grounds for the opinion. This certification is only valid for 3 days. 

Step 3: Within forty-eight hours after admission, exclusive of Saturdays, Sundays, and legal holidays, the place of admission shall forward the affidavit and certification to the probate court of the county in which the person resides or, in extenuating circumstances, where the acts or conduct leading to the hospitalization occurred. The filings must include the names of two designated examiners at the treatment facility, at least one of whom must be a licensed physician. 

The Court Holds a Probable Cause Hearing. Within 48 hours of receiving the affidavit and certification (excluding weekend and holidays), the court must conduct a preliminary review to determine whether probable cause exists to continue the emergency detention.  

• If probable cause is not found, the court shall order the release of the patient. 
• If probable cause is found, the court shall document its findings, order the continued detention of the patient, and designate two examiners to evaluate the patient.  

If Probable Cause Exists, an Examination Follows. The two designated examiners must evaluate the patient and report back to the court within 7 days.  

• If the designated examiners determine the patient is not mentally ill to the extent involuntary commitment is required, the court shall dismiss the petition, and the patient must be discharged immediately.  
• If the designated examiners determine the patient is mentally ill and involuntary treatment is required, the court may order the person be detained, appoint counsel for the patient, and set a date for a full hearing within 15 days from the date of admission.  
• If before the hearing the designated examiners determine the patient is no longer mentally ill to the extent involuntary treatment is required, they shall file a supplemental report to the court. If the court receives the supplemental report at least 48 hours before the hearing, the court shall dismiss the petition, and the patient must be discharged immediately by the facility. 

Pathway 3: Involuntary Judicial Commitment (Section 44-17-510) 

Petitioning the Probate Court. Any interested person or a hospital administrator may file a written petition for involuntary commitment with the probate court. The petition must attach a certificate of a designated examiner stating that the person is mentally ill and should be hospitalized or a written statement by the petitioner that the person has refused to submit to an examination by a designated examiner. The certificate or the written statement shall state the underlying facts upon which the examiner (or petitioner if the person has refused to submit to an examination) bases his conclusions and not merely the conclusions themselves. 

The Court Appoints Counsel and Examiners. Within 3 days of the filing, the court shall appoint counsel to represent the person if counsel has not been retained and the court shall appoint two designated examiners, one of whom must be a licensed physician, to examine the person and report to the court their findings as to the person’s mental condition and need for treatment. The examination must be made at a suitable place not likely to have a harmful effect upon the person’s health. On a report of the designated examiners of refusal to submit to examination, the court shall order the person to submit to examination. If the person refuses to obey the court’s order the court may require a state or local law enforcement officer to take the person into custody for a period not exceeding twenty-four hours during which time the person must be examined by the two designated examiners. The person’s attorney must be notified before the person’s confinement. If the examiners do not execute the certification provided for in this section within twenty-four hours, the proceeding must be terminated, and the person must be released. 

• If the designated examiners determine the patient is not mentally ill to the extent involuntary commitment is required, the court shall dismiss the petition, and the patient must be discharged immediately.  
• If the 2 examiners disagree on whether the person in mentally ill to the extent involuntary treatment is required, the court may terminate the proceedings or appoint a third examiner (who must be a psychiatrist) and charge the 3 examiners to render a majority opinion within 5 days. 
• If the designated examiners determine the patient is mentally ill and involuntary treatment is required, the court shall set a date for a hearing not less than 5 nor more than 7 days from receipt of the report (excluding weekends and holidays).  

Related Issues 

Custody and Transport.The certificate required for emergency admission must authorize and require a state or local law enforcement officer, preferably in civilian clothes and preferably with crisis intervention training, to take into custody and transport the person to the hospital designated by the certification.  

No person may be taken into custody after the expiration of three days from the date of certification.  

A friend or relative may transport the individual to the mental health facility designated in the application or engage the services of an emergency medical technician, if the friend or relative has read and signed a statement on the certificate which clearly states that it is the responsibility of a state or local law enforcement officer to provide timely transportation for the patient and that the friend or relative freely chooses to assume that responsibility and liability. A friend or relative who chooses to transport the patient is not entitled to reimbursement from the State for the cost of the transportation.  

An officer or an emergency medical technician acting in accordance with this article is immune from civil liability.  

Upon entering a written agreement between the local law enforcement agency, the governing body of the local government, the emergency medical service providers, and the directors of the community mental health centers, an alternative transportation program utilizing peer supporters and case managers may be arranged for nonviolent persons requiring mental health treatment. The agreement clearly must define the responsibilities of each party and the requirements for program participation. 

An individual who has been certified for an involuntary emergency admission but not yet admitted to a facility and needs to be transported from a mental health center or an emergency department of a hospital to another facility for admission may be transported by an emergency medical technician. 

Preadmission Screening. The Department of Mental Health, in conjunction with its local mental health centers acting as the preadmission facilities, must develop and maintain a preadmission screening and evaluation service for all psychiatric emergencies at the local community level utilizing available local resources for mentally ill persons. The preadmission screening services must act as the public mental health system’s entry point in order (1) to provide to the examining physician information about accessible crisis intervention, evaluation, and referral services in the community; (2) to offer to mentally ill persons clinically appropriate alternatives to inpatient care, if any; and when necessary (3) to provide a means for involuntary commitment. 

Hospitalization if Mentally Ill. If, upon completion of the hearing and consideration of the record, the court finds upon clear and convincing evidence that the person is mentally ill, needs involuntary treatment and because of his condition: 

(1) lacks sufficient insight or capacity to make responsible decisions with respect to his treatment; or 

(2) there is a likelihood of serious harm to himself or others, the court shall order inpatient or outpatient treatment at a mental health facility, public or private, designated by the Department of Mental Health and may order outpatient treatment following inpatient treatment.  

If the court finds that the person is not mentally ill and not in need of involuntary treatment, the court shall dismiss the proceedings. 

If the court orders outpatient treatment and the respondent fails to adhere to the prescribed outpatient treatment order or program, the treatment facility shall report the failure to the court and the court upon notice to the respondent and his counsel shall order a supplemental hearing and may further order inpatient treatment in a designated facility as needed. The probate court issuing the order for outpatient treatment shall maintain jurisdiction over the person for the purpose of supplemental proceedings as set forth in this chapter and every order issued pursuant to this subsection must be so conditioned.  

An order for inpatient treatment at a mental health facility does not raise a presumption of incompetency and no rights may be denied a person unless specifically ordered by the court.