The reality is each state is different, including rules for involuntary holds. From an ER standpoint, our psychiatric liaisons are so helpful with this, as they will see all patients I have any concerns about and staff with the psychiatrist and know the regular patients much better than I do. And if I have any concerns with their plans they are generally very receptive.

To your point, and mine as above, funding is an issue. Insured patients are much easier to place, even if it is still expensive, and uninsured patients will often board for days (if not longer, once cared for a patient who lived in the ED for more than a month) waiting placement because of financial concerns combined with a history of violent behavior.

Part of the issue, to my initial response, is that, while in a monitored setting, patients will be compliant with medications, cooperative, etc. Do you continue to hold them then? And if not, how do you ensure medication compliance (or should you even once a patient has been cleared), etc once they are discharged.