Legal and Ethical Issues Related to Psychiatric Emergencies

Legal and Ethical Issues Related to Psychiatric Emergencies

The California State laws under section 5150 of the Welfare and Institutions Code stipulate the legislations that allow adults with mental disorders to be detained involuntarily for up to 72 hours in psychiatric institutions because of threats to harm themselves or others or becoming gravely disabled. The other section is 5585 which permits involuntary hold for children with mental health issues to protect them or others from harm.  The legislations allow medical providers or the police to hold the child or adult when they feel that the victim is likely to cause harm to self or others thus forcing him or her into a psychiatric facility. Additionally, the individual with threats of suicide or self-harm can be legally held by police and taken for medical assistance. The law does not allow involuntary psychiatric hold beyond 72 hours without proper hearing thus patients should be managed properly with antipsychotic medications for recovery from the psychotic state. Conversely, patients can refuse to be held after the lapse of 72 hours or cooperate although the discretion of discharge is upon the assessment of medical providers on mental status and need for further treatment Legal and Ethical Issues Related to Psychiatric Emergencies.

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The Differences among Emergency Hospitalization

The emergency hospitalization for psychiatric hold or evaluation is the response that permits a psychiatric patient who is admitted to the facility for treatment and evaluation in a short and fixed duration. The inpatient commitment refers to the process that permits the judge to order medical treatment for individuals who continue to meet civil commitment criteria following durations of emergency evaluation. Conversely, the assisted outpatient treatment or outpatient commitment refers to the treatment alternative a judge orders the qualified individual who has manifestations of psychiatric condition to adhere to treatment plans when living in the community.

The Difference between Capacity Name and Competence

In the context of mental health, competency refers to the legal term that identifies the ability of a person to behave in their behavior or the mental ability to act or take part during legal transactions or proceedings such as medical decisions. Also, competence refers to the mental state of the person that enables him or her to be liable for the actions or decisions taken. The formal competence is decided traditionally by the judge and not medical providers such as a psychiatrist, case manager, or physician. Conversely, capacity refers to a person’s capability to provide informed consent or decisions. The capacity of the person concerns the observation of free choice, reliability or consistency, and comprehension.

Patient’s Autonomy during Treatment of Psychiatric Emergencies

Patients’ autonomy during the management of patients with psychiatric emergencies has raised major concerns as patients with mental problems sometimes have impaired judgment. Compared to psychiatric patients managed for physical illnesses, the autonomy of individuals with mental problems may vary significantly. The individual who is mentally competent with the physical disease may reject some treatments with clear intentions or best interest which is not the case for psychiatric patients. On the other hand, mentally ill individuals should be accorded compulsory treatment according to mental health legislation even when the patient can make the decision. Thus, the above is violating the patient’s autonomy but the duty of clinical care is the protection of lives and promotion of health which may override the ethical principle of autonomy.

The Evidence-Based Suicide and Violence Risk Assessments

The evidence-based suicide risk assessment tool that can be used to screen patients is the suicide behaviors questionnaire-revised (SBQ-R). The assessment tool provides the general screening tool used in the emergency department. The screening tool attempt to answer the question of whether the patient has attempted or thought about killing themself and the frequency or number of times the thoughts of killing themselves has occurred in the past. Also, the screening tool attempt to explore if the victim has shared the suicidal thoughts with other people and the likelihood of the suicide may occur in the future. On the other hand, the STAMP screening tool is the violence risk assessment tool that could be used to screen patients. The tool is an uncomplicated screening technique used in most triage areas of emergency units based on yes and no answers required by providers from one or more signs of evidence-based STAMP assessment parameters. The assessment areas include pacing, mumbling, anxiety, staring, and tone of voice. The STAMP screening can be used to determine the possibility of patients turning violent in the emergency department visits for early and proper measures to be implemented to mitigate problems Legal and Ethical Issues Related to Psychiatric Emergencies.

Week 8: Psychiatric Emergencies A psychiatric emergency is a situation that if left untreated is likely to cause harm to oneself or others. These acute disturbances of behavior may manifest as suicidal ideation or attempts, violence, agitation, drug overdose, delirium, psychosis, mania, neuroleptic malignant syndrome, or serotonin syndrome. When psychiatric emergencies arise, they can present many challenges to the PMHNP. While many approaches to emergencies are similar when dealing with children and adolescents versus adults, significant differences also exist. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency. This week, you examine psychiatric emergencies and explain the ethical and legal issues surrounding these events. You will also review evidence-based suicide and violence risk assessments that you may use to screen patients. Learning Objectives Students will: Explain salient ethical and legal issues relevant to psychiatric emergencies in psychiatric-mental health practice Select evidence-based risk assessments for psychiatric emergencies Learning Resources Required Readings (click to expand/reduce) Medication Review Review the FDA-approved use of the following medicines related to treating psychiatric emergencies: Aggression Behavioral problems Cataplexy syndrome clozapine propranolol zuclopenthixol aripiprazole asenapine chlorpromazine haloperidol iloperidone lurasidone olanzapine paliperidone quetiapine risperidone ziprasidone clomipramine imipramine sodium oxybate Catatonia Extrapyramidal side effects Mania alprazolam chlordiazepoxide clonazepam clorazepate diazepam estazolam flunitrazepam flurazepam loflazepate lorazepam midazolam oxazepam quazepam temazepam triazolam benztropine diphenhydramine trihexyphenidyl alprazolam (adjunct) aripiprazole asenapine carbamazepine chlorpromazine clonazepam (adjunct) iloperidone lamotrigine levetiracetam lithium lorazepam (adjunct) lurasidone olanzapine quetiapine risperidone sertindole valproate (divalproex) ziprasidone zotepine Assignment Legal and Ethical Issues Related to Psychiatric Emergencies:

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Legal and Ethical Issues Related to Psychiatric Emergencies Photo Credit: Getty Images The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare. In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments. To Prepare Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events. The Assignment In 2–3 pages, address the following: Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released. Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Explain the difference between capacity and competency in mental health contexts. Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source. Identify one evidence-based suicide risk assessment that you could use to screen patients. Identify one evidence-based violence risk assessment that you could use to screen patients. By Day 7 of Week 8 Submit your Assignment. Attach copies of or links to the suicide and violence risk assessments you selected Legal and Ethical Issues Related to Psychiatric Emergencies.