Contraindications for Civil Admission DMH Hospital

Updated February 2017

Contraindications for Civil Admission to a DMH Hospital

Final decisions for admission are made by the Department of Human Services’ (DHS) Division of Mental Health (DMH) hospital medical director or designee after close case review and consultation with the referring physician.

Populations with Special Nursing Needs

1. Patients unable to perform activities of daily living (feeding, grooming and using the restroom). Examples include requiring:

  • Skilled nursing care; and
  • Requiring use of special equipment (lifts/chairs, etc.) during showering or at other times.

Using a rolling walker or cane to ambulate is a relative contraindication, while using a wheelchair is not a contraindication.

2. Patients requiring any IVs, catheters or tubes. Examples include:

  • Foley catheterization;
  • Feeding tubes or N/G tubes;
  • Central lines;
  • Insulin pump or pain pumps; and
  • Peripheral lines/ports or requiring IV injections.

Self-catheterization is generally not a contraindication.

3. Patients requiring specialized post-surgical or post-procedural care and follow up. Examples include:

  • Medically significant bleeding;
  • Open and/or draining wounds that require dressing changes, such as wet-dry dressings; and
  • Communicable diseases requiring isolation, such as airborne precautions.

4. Patients with active MRSA or VRE infections.

Populations with Special Medical Needs

  • Patients requiring dialysis;
  • Patients requiring oxygen;
  • Patients requiring EKG monitoring/telemetry;
  • Patients requiring nebulizer treatment;
  • Patients with sleep apnea requiring use of CPAP;
  • Patients who are pregnant;
  • Patients with a primary diagnosis of dementia and whose mental illness is a secondary to that condition;
  • Patients with Moderate, Severe or Profound Intellectual Disabilities – Mild Intellectual Disability is not a contraindication;
  • Patients on medications not on DHS formulary. Note: Patients may be able to provide medications prescribed by their outpatient provider for use in the hospital upon order of a DMH physician;
  • Patients on experimental medications or enrolled in a research program/protocol;
  • Patients on medical marijuana; and
  • Patients requiring PT/OT or other specialized rehabilitative services.

Populations at "High Risk" or Co-Morbid Conditions

  • Patients suffering recent major physical trauma with significant complications;
  • Patients with acute onset of neurological problems, including new onset seizures or an unstable/uncontrolled seizure disorder;
  • Patients with newly diagnosed cancer that requires acute evaluation or treatment, or an established cancer with recurrence that requires oncology services assessment and treatment. Patients with cancer that is “stable” or in remission may be admitted;
  • Patients with a medical condition potentially requiring immediate or emergency surgery;
  • Patients with acute drug or alcohol intoxication;
  • Patients at risk of medically significant complications due to drug or alcohol withdrawal (e.g., seizures, DTs) or who require IV fluid or medications. Patients with PCP intoxication will require 48 hours of observation without use of FLRs or PRNs prior to acceptance;
  • Patients with delirium or altered level of consciousness;
  • Patients with new onset of psychosis or altered mental status, where a workup has not been done;
  • Patients with toxic levels of medication or who are at risk to become toxic (e.g., acetaminophen);
  • Patients with methadone dependency requiring detoxification, unless in an accredited methadone program. Patients established at a methadone clinic may be admitted and will receive prescribed methadone treatment without further detoxification or reduction; and
  • Patients with acute or chronic conditions that are poorly controlled and require extensive medical monitoring (e.g., telemetry, continuous pulse ox) or treatment (e.g., IV fluids, oxygen):
    • Uncontrolled Diabetes Mellitus
    • Uncontrolled Hypertension
    • Uncontrolled COPD or Asthma
    • Uncontrolled CHF
    • Pain management with IV medication.