Is getting trapped in an asylum a realistic scenario? In various movies, most recently Unsane (2018), a scenario is painted in which a healthy person gets committed and trapped in an insane asylum and the caretakers there are more or less indifferent to whether she is actually sane or not.

In the movie she "voluntarily" commits herself by signing a form, so presumably she will not be afforded the protections some states give to involuntarily committed people.

Is this scenario realistic in the United States? Can a person who "voluntarily" commits themself, be turned into a medicated prisoner with no recourse for freeing themself?
It all boils down to the Duty of Care

Duty of Care

The duty of care is the responsibility of a mental health professional to protect patients and others from foreseeable harm. If a client makes statements that suggest suicidal or homicidal ideation, the clinician has the responsibility to take steps to prevent harm where reasonably practicable, and if necessary, initiate involuntary commitment.

The same goes when a person has been assessed as suffering from one or more severe mental health conditions which has a high chance of resulting in any other physical harm to the individual or others.

Voluntary Commitment

Getting committed either voluntarily or involuntarily is not straight forward.  In both the US and here in the UK, you can't just go into a hospital, sign a form and then be taken in as a mental health patient.  You can go into a hospital and ask to be committed, but you need to be assessed in order for the committal to be accepted.

Involuntary Commitment

With voluntary committal, you are free to discharge yourself by signing a discharge form and leave at any time, however, if at any time it is deemed that you would be a danger to yourself or others, the voluntary committal can change to involuntary committal.

Aside from an unscrupulous group of psychiatrists it is practically impossible to trap a mentally healthy person in a psychiatric unit against their will.  For a person to be held against their will, it needs the co-ordinated efforts of more than one psychiatrist.  Where it happens that a mentally healthy individual is held against their will, there is possible legal redress and the psychiatrists involved could have their practice licenses removed.

In the US

Voluntary Committal

As pointed out by psychiatrist, Scott Alexander, in his Slate Star Codex post, you are not guaranteed admission to a psychiatric unit on a voluntary basis just because you want it. You might be turned down if the psychiatrist thinks you aren’t sick enough to need it, or if your insurance refuses to pay for it. Insurance companies are very reluctant to pay for hospitalisations unless there is a clear risk involved.

Involuntary Committal

The laws governing this seems to differ depending on which state you are in.

For example:


In CaliforniaAccording to the Lanterman-Petris-Short Act (Section 5150 of the California Welfare and Institutions Code)


  When a person, as a result of a mental health disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace officer, professional person in charge of a facility designated by the county for evaluation and treatment, member of the attending staff, as defined by regulation, of a facility designated by the county for evaluation and treatment, designated members of a mobile crisis team, or professional person designated by the county may, upon probable cause, take, or cause to be taken, the person into custody for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment and approved by the State Department of Health Care Services.

In FloridaAccording to the Florida Mental Health Act


  A person may be placed in involuntary inpatient placement for treatment upon a finding of the court by clear and convincing evidence that:
  
  (a) He or she is mentally ill and because of his or her mental illness:
  
  1.a. He or she has refused voluntary placement for treatment after sufficient and conscientious explanation and disclosure of the purpose of placement for treatment; or
  
  b. He or she is unable to determine for himself or herself whether placement is necessary; and
  
  2.a. He or she is manifestly incapable of surviving alone or with the help of willing and responsible family or friends, including available alternative services, and, without treatment, is likely to suffer from neglect or refuse to care for himself or herself, and such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; or
  
  b. There is substantial likelihood that in the near future he or she will inflict serious bodily harm on himself or herself or another person, as evidenced by recent behavior causing, attempting, or threatening such harm; and
  
  (b) All available less restrictive treatment alternatives which would offer an opportunity for improvement of his or her condition have been judged to be inappropriate.



In the UK

The whole issue of committal, voluntary and involuntary, is governed by the Mental Health Act 1983 and the Mental Health Act 2007.

Involuntary Committal in the UK

To be involuntarily committed (also known as sectioned), it needs to be founded on the written recommendations in the prescribed form of two registered medical practitioners, including in each case a statement that in the opinion of the practitioner:


The individual is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and
The individual ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons. (See Sections 2 and 3 of the Mental Health Act 1983)


For voluntary committal in the UK

It needs to appear to the registered medical practitioner or approved clinician in charge of the treatment of the patient that an application ought to be made under Section 5(2) of the Mental Health Act 1983, for the admission of the patient to hospital, he or she may furnish to the managers a report in writing to that effect; and in any such case the patient may be detained in the hospital for a period of 72 hours from the time when the report is furnished. By which time the patient should be assessed by the two registered practitioners prescribed in Section 2 of the Act.