Legal and Ethical Issues Related to Psychiatric Emergencies NRNP 6675
Legal and Ethical Issues Related to Psychiatric Emergencies NRNP 6675
Legal and Ethical Issues Related To Psychiatric Emergencies Sample Paper
California State Laws For Involuntary Psychiatric Hold
In California, individuals can be helped in psychiatric facilities without consent if it is determined that one is a danger to others, themselves, or gravely disabled. Under California law, only designated professional personnel can place individuals on a 72-hour hold, known as a 5150 hold (Zakhari, 2021). The experienced personnel includes police officers, members of the mobile crisis team, and other mental health professionals authorized by the country.
There must be paperwork stating the circumstances under which the person’s condition was called to the officers’ attention and the probable cause for believing the individual is a danger to themselves or others (Sadock et al., 2015). After 72 hours, individuals may be released. They may sign in as voluntary patients and can be put under the 14 days 5250 involuntary hold.
Differences Among Emergency Hospitalization For Psychiatric Hold, Inpatient Commitment, And Outpatient Commitment
In inpatient commitment, people are committed to mental illness and being a danger to themselves and others. These need to be presented to the magistrate in the community in the form of a petition (U.S. Department of Veterans Affairs, 2019). It includes information from someone who has direct knowledge of the issue. Outpatient commitment is a civil commitment in which the court orders individuals to comply with specific outpatient treatment programs (Sadock et al., 2015). The legal authority for the outpatient commitment is the state parens patriae power, which protects disabled individuals, and police power, which involves protecting others (Buppert, 2021).
Differences between Capacity and Competency
Competence is the global assessment and legal determination of mental health status made by a judge in court (Zakhari, 2021). Capacity is determined by physicians familiar with the patient’s case based on the functional assessment and clinical determination.
Patient Autonomy in Psychiatric Emergencies
Informed consent is the process where clinicians honor the patient’s autonomy. Consequently, patients understand the benefits and risks of treatment and therefore accept or refuse the treatment (U.S. Department of Veterans Affairs, 2019). The patient’s decision-making capacity should be assessed for communication, understanding, appreciation, and reasoning unless compelling additional concerns, and the patient’s confidentiality should be maintained (Thapar et al., 2015). In psychiatric emergencies, the physicians have the power to act as state agents.
Evidence-Based Suicide Risk Assessment and Violence Risk Assessment
The patient health questionnaire (PHQ-9) is the most commonly used screening tool for depression. It also covers suicidal ideation. Therefore, it is used to assess suicidal risk among patients in the clinical setting (Blakey et al., 2019). Item nine of the assessment tool evaluates the passive thoughts of death and self-injury in the last two weeks. The Broset violence checklist (BVC) is a short-term violence prediction instrument that assesses irritability, confusion, verbal threats, boisterousness, attacks on objects, and physical threats which are either absent or present.
The BVC is an effective tool for predicting inpatient violence in the coming 24 hours. The instrument’s psychometric characteristics are excellent (Blakey et al., 2019). The results of ongoing research will provide critical information on cultural differences, the BVC’s validity in understaffed wards, clinical usage of the checklist, and its capacity to predict violence throughout the hospital stay.
References
Blakey, S. M., Wagner, H. R., Naylor, J., Brancu, M., Lane, I., Sallee, M., & Elbogen, E. B. (2019). Chronic pain, TBI, and PTSD in military veterans: a link to suicidal ideation and violent impulses? The Journal of Pain, 19(7), 797-806.
Buppert, C. (2021). Nurse practitioner\’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (Eds.). (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
U.S. Department of Veterans Affairs. (2019). VA/DoD clinical practice guidelines: Assessment and management of patients at risk for suicide (2019). Accessed 4th April 2022 from https://www.healthquality.va.gov/guidelines/MH/srb/
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
The Assignment Instructions
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 (California).
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.
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.
Learning Resources
Required Readings (click to expand/reduce)
Buppert, C. (2021). Nurse practitioner\’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Chapter 7, Negligence and Malpractice
Chapter 8, Risk Management
Chapter 16, Resolving Ethical Dilemmas
National Institute for Health and Care Excellence (2019). Brøset violence checklist. http://riskassessment.no/
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. (For review as needed)
Chapter 23, Emergency Psychiatric Medicine
Chapter 36.2, Ethics in Psychiatry
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (Eds.). (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
Chapter 19, Legal Issues in the Care and Treatment of Children With Mental Health Problems
Chapter 64, Suicidal Behavior and Self-Harm
U.S. Department of Veterans Affairs. (2019). VA/DoD clinical practice guidelines: Assessment and management of patients at risk for suicide (2019). https://www.healthquality.va.gov/guidelines/MH/srb/
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
Chapter 15, Violence and Abuse