Can You Decline Psychiatric Medication in the ER?

Finding yourself in the emergency room (ER) for a mental health crisis can feel overwhelming. During these visits, medical clinicians may suggest taking psychiatric medication. But what if you don’t want to? Do you have the right to say no?

Understanding your rights around psychiatric medication in the ER is important. While healthcare clinicians want to keep you safe, you also deserve to have a say in the care you receive. 

In this article, we’ll discuss your rights, explain why a healthcare provider may suggest taking medication in an emergency, and share what steps you can take to advocate for yourself. 

Can You Decline Psychiatric Medication in the ER?

If you go to the ER for a mental health crisis, you have all the basic patient rights. One of the most important rights is the right to informed consent.

This right means that, whenever possible, healthcare providers must explain the purpose, benefits, and risks of all treatments before administering them. You then have the right to ask questions about the treatment and make choices about your care.

However, there are times when your rights may be more limited. If you are in immediate danger of hurting yourself or others, or are unable to make safe decisions because of your mental state, the emergency medical providers have the authority to give medication without consent. 

Psychiatric Medication in Emergency Settings

In the ER, healthcare providers sometimes use psychiatric medication to help stabilize a mental health crisis. These medications are not meant to “fix” everything at once. But they can help control more severe symptoms so you can begin the next steps of treatment. 

Why Medication Might Be Recommended

In emergency situations, healthcare providers use psychiatric medication in several circumstances:   

• Stabilizing symptoms: Some mental health conditions can cause intense distress, agitation, or confusion. Medication may help calm these symptoms so you feel safer and more balanced.
• Staying safe: If there is a risk of you harming yourself or others, psychiatric medication can reduce that immediate danger by stabilizing symptoms.
• Preparing for further care: Emergency treatment is usually the first step towards feeling better. Easing the most severe symptoms with psychiatric medication can make it easier for you to participate in ongoing care and longer-term treatment.

Types of Psychiatric Medications Commonly Used

The medications used in emergencies are chosen carefully and usually work quickly. Here is a breakdown of the common ones:

1. Antipsychotics and Mood Stabilizers

• When They May Be Given: To reduce hallucinations, delusions, or severe agitation
• Common Examples: Haloperidol (Haldol), Olanzapine (Zyprexa), Risperidone (Risperdal)

2. Anti-Anxiety Medications

• When They May Be Given: To calm severe anxiety, fear, or panic
• Common Examples: Lorazepam (Ativan), Diazepam (Valium), Clonazepam (Klonopin)

3. Mood Stabilizers

• When They May Be Given: To help manage extreme mood swings or mania
• Common Examples: Lithium, Valproate (Depakote), Carbamazepine (Tegretol)

When You Can Decline Medication

Even if you are having a psychiatric emergency, you may still have the right to decline medication. The healthcare provider treating you takes several factors into account.

• If you are in the ER voluntarily
• The nature and severity of your symptoms
• If you are able to make informed decisions about your risk of imminent harm 

Voluntary Patients' Rights

If you go to the ER voluntarily, you generally have the right to decline psychiatric medication. Healthcare providers should explain what the medication is for, what side effects it may have, and why they recommend taking it. After hearing this information, you can choose to take it or decline.

Exceptions to this right can happen if you are showing signs of being an immediate danger to yourself or others, or if you are unable to understand the risks and benefits because of your current mental state.

In these situations, medication may be given without your consent. Still, the goal is always to protect your safety and not to take away your choices. The medical clinician may offer an oral medication for you to take, or if an intravenous medication is needed, they may ask where you’d prefer to take the injection. 

If you do not want to take the medication. Here are several ways to communicate your refusal effectively:

• Calmly state that you do not want the medication.
• Ask about alternatives, such as waiting, trying a different approach, or adjusting the dose.
• Request that your wishes be written in your medical record.

Communicating clearly and calmly helps healthcare providers understand and respect your choices as much as possible, even in emergencies. 

Advance Directives and Psychiatric Care

One way you can prepare for future crises is by creating a psychiatric advance directive (PAD). This is a legal document that allows you to record your preferred treatments in advance. For example, you can list which medications you are willing to take, which ones you’d prefer to avoid, and who you designate as your representative if you’re unable to make decisions.

While each state has its own rules about how these documents work, they can be a powerful tool to make sure your voice is heard when you are unable to verbalize your wishes.

When Medication Might Be Given Without Consent

While your patient's rights are very important in the ER, there are certain situations where healthcare providers may give psychiatric medication without getting consent. Healthcare workers do not make this decision lightly, and it only happens on rare occasions.

Emergency Exceptions

In most cases, healthcare workers only consider giving psychiatric medication without consent when: 

• There is imminent danger to yourself or others. If healthcare providers believe you might seriously harm yourself or another person, they may act quickly to prevent that harm.
• You lack decision-making capacity. This means you are not able to understand the information being given to you, or cannot make safe choices because of your symptoms.
• A court order is in place. Sometimes a judge can require treatment if it is considered necessary for your health and safety.

The Process for Involuntary Medication

Even when a psychiatric medication is given without consent, there are legal requirements and safeguards healthcare professionals must follow. Often, the decision is made with more than one medical provider. This process ensures that medication is only given without consent when absolutely necessary.

During this process, you still have the right to:

• Be informed about what medication is being given and why.
• Ask for an advocate, such as a trusted family member, friend, or patient rights representative.
• Challenge the decision through legal channels.

Advocating for Yourself

Even if you are having a psychiatric emergency, you can still take steps to advocate for yourself. It’s good to share your preferences, concerns, and ask questions. However, it’s important to understand how to communicate effectively.

Communicating with Healthcare Providers

When discussing medication or treatment in the ER, clear communication is key. Being calm, clear, and respectful helps healthcare providers understand your perspective, which can increase the likelihood that they’ll consider your wishes. 

Here are tips on how to voice your wishes or concerns: 

• Express your concerns openly: Let the staff know if you’re worried about side effects or past experiences with psychiatric medications.
• Ask questions: For example, “What is this medication for?” “How long will it take to work?” “Are there other options?”
• Request alternatives: If you feel uncomfortable with a recommended medication, you can ask about different approaches or lower doses.

Having an Advocate

You don’t have to navigate a psychiatric crisis in the ER alone. Having someone you trust as an advocate can help make sure your voice is heard and that your rights are respected. 

An advocate may include:

• Family members or friends who know you well and can speak on your behalf if needed.
• Patient advocates who work in hospitals to support people in understanding their rights and treatment options.
• Legal representation if there are questions about involuntary treatment or court orders.

After the Emergency

Once the immediate crisis is over, it’s important to take time to review what happened and plan for the future. 

Schedule a follow-up appointment with your mental health provider to review what happened and how you felt about the treatment. Talk to them about the medications you were given and why they gave them to you.

Reviewing what happened and gaining an understanding of the reasons behind emergency interventions can help you feel more informed and more in control of your healthcare plan.

Consider creating or updating a PAC to outline your treatment preferences. Identify people you want as your advocates who can help if another emergency occurs. 

Work with your mental health provider to develop a crisis plan, including warning signs of an oncoming psychiatric emergency and steps you can take to reduce the likelihood of needing emergency treatment. 

The Bottom Line

Understanding your rights around psychiatric medication in the emergency room can make a difficult situation feel more manageable. 

While there are times when medical providers may give medication without your consent, these situations are limited and tied to immediate safety concerns. 

Knowing when you can refuse, how to communicate clearly, and how to prepare documents like psychiatric advance directives empowers you to stay involved in your care. 

Sources

Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies. Frontiers in Psychiatry, 11, 527503. https://doi.org/10.3389/fpsyt.2020.00127

Jalgaonkar, Sharmila V.; et al. Drug use pattern for emergency psychiatric conditions in a tertiary care hospital: A prospective observational study. Perspectives in Clinical Research 12(4):p 203-208, Oct–Dec 2021. | DOI: 10.4103/picr.PICR_158_19

https://pubmed.ncbi.nlm.nih.gov/34760648/

National Alliance On Mental Illness. (2020). Psychiatric Advance Directives. Retrieved September 9, 2024 from https://www.nami.org/advocacy/policy-priorities/responding-to-crises/psychiatric-advance-directives/

Pirotte BD, Benson S. Refusal of Care. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560886/

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