NRNP 6635 Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
Walden University Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
Whether one passes or fails an academic assignment such as the Walden University Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
The introduction for the Walden University Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
After the introduction, move into the main part of the Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
Psychiatric emergencies entail severe disturbances in mood, thought, behavior and social interactions among individuals suffering from or suspected of having mental health issues and require immediate interventions. These interventions may entail holding of the suspected patients in emergency rooms or departments to offer the much-needed mental health interventions based on federal and state laws (Hui et al., 2020). The purpose of this paper is to discuss the legal provisions for involuntary psychiatric holds in Maryland and the differences in inpatient and outpatient commitments. The paper also differentiates capacity and competency and holds a discussion on the differences between suicide and violence risk assessment tools.
Involuntary Psychiatric Holds Laws in Maryland
Psychiatric emergency holds laws in many states, including Maryland, allow involuntary admissions of individuals to health care facilities when they have acute mental illness under certain situations. Wh
ile state laws for involuntary hold of mental cases vary across stats, the core criterion to justify the holds is mental situations may pose a danger to the individual and other (Kim et al., 2022). In Maryland, the law allows one to be admitted involuntarily if they have a mental disorder and require inpatient treatment, presents a danger to their life and safety as well as of other and is not able or unwilling to get admitted voluntarily (Carroll, 2021). The law asserts that once certified in EH for involuntary hospital admission, the individual can only be kept in the emergency facility for not more than 30 hours. The state Department of Mental Hygiene offers admission within six hours after notification.
The law also requires that an individual who gets admitted involuntarily gets a hearing with an administrative law
judge (ALJ) within ten days of admission to determine if they still meet the criteria for involuntary admission. The individual also has a right to alter the status to a voluntary admission before the hearing session, if the psychiatrist finds that they understand and agree to the treatment (Carroll, 2021). The hearing decision by the judge can be attended by the parents, guardians of next of kin for the individual. The implication is that once released, the individual is received by the next of kin or parents or guardians. The law provides that if one meets the criteria for involuntary admission, they may be held for up to six months.
Emergency Hospitalization for Evaluation/Psychiatric Hold, Inpatient Commitment and Outpatient Commitment
Emergency hospitalization entails involuntary commitment of an individual with a mental illness which is considered as a threat to them or others to a facility based on the laws of involuntary psychiatric hold. In Maryland, this can be up to 30 hours during which the hospital should evaluate and provide therapeutic interventions. Mental health patients considered a threat to themselves or others are sent against their will to inpatient facilities. Maryland law states that the individual should be assessed as competent by two psychiatrists and cleared by a competent judge to determine their discharge status (Carroll, 2021). Outpatient commitment entails involuntary commitment to an outpatient program for individuals considered a threat to themselves and others because of their mental health status. While the person is not held in a mental health facility, he or she is obligated to receive outpatient therapy and comply with their treatment plans.
Difference Between Capacity and Competency in Mental Health Contexts
Capacity and competency are critical aspects in mental health provision for individuals and even providers. Capacity is the ability to understand, appreciate and apply the nature and implications of one’s situation and the decisions and actions needed to attain quality outcomes. A person has capacity if he or she understands the nature and effects of their decisions and actions and make logical choices about their moves and the situation. competency is the legal ability of an individual to make better decisions concerning their welfare (Kim et al., 2022). A person is considered competent when they understand the nature and consequences of their actions and decide the course of actions in their best interests in regard to the mental health interventions recommended or suggested. The implication is that competency and capacity impact the overall ability of one to make better choices.
Legal and Ethical Issues Related to Autonomy in Psychiatric Emergencies
A legal issue concerning patient autonomy in psychiatric emergencies which is applicable in the context of psychiatric emergencies in involuntary commitment of the person as a threat to self and others because of their mental heal. Involuntary commitment of the person in such facilities is a violation of the autonomy as they are deprived of their right to make decisions concerning their welfare and treatment. They are forced against their will to enter in facilities and regarded as lacking competency to make better decisions (Kim et al., 2020). An ethical issue affecting patient autonomy in this situation is the forced treatment of the person who is considered as lethal to self and others because of their mental health status. The forced treatment deprives one their right to autonomy, independence and self-determination.
Evidence-based Suicide and Violence Risk Assessment Tools to Screen Patients
Evidence based suicide and violence assessment tools allow psychiatric mental health nurses (PMHNPs) to screen patients and attain effective diagnosis to prevent suicide ideation and possible commission of violence. The Columbian Suicide Severity Rating Scale (C-SSRS) is a valid and reliable assessment tool that evaluate the present and prior suicidal ideation, attempts and preparatory behaviors as well as non-suicidal self-injury (NSSI) (Posner et al., 2018; Brodsky et al., 2018). NSSI entails a deliberate self-harm conduct an individual performs without any intention to cause death or suicide. The outcomes of the C-SSRS predicts future suicidal ideation and attempts for patients in psychiatric emergency situations.
The V-RISK-10 tool is an evidence-based violence risk assessment that can screen patients with the potential of committing violent actions while in healthcare facilities. The tool is used in triage to see if a patient requires more evaluation by other tools. The V-RISK-10 identifies the need for risk management to deflate immediate and potential risk for violence (Cox et al., 2018). This tool is very critical in psychiatric emergency departments to reduce and mitigate any possible violent confrontations between mental health patients and providers.
Conclusion
Psychiatric emergencies happen in all states and practitioners must know the legal frameworks of dealing with their different components. Understanding the existing hold laws, differences in commitments, capacity and competency is core to provision of best care possible. Providers must understand the ethical and legal aspects that may interfere with their overall abilities to offer quality patient care interventions.
References
Brodsky, B. S., Spruch-Feiner, A., & Stanley, B. (2018). The Zero Suicide Model: Applying
Evidence-Based Suicide Prevention Practices to Clinical Care. Frontiers in psychiatry, 9,
Carroll, H. (2021). Know the Laws in Your State. Treatment Advocacy
Center. www.treatmentadvocacycenter.org/component/content/article/183-in-a-crisis/1596- know the-laws-in-your-state.
Cox, J., Fairfax, C. J., DeMatteo, D., Vitacco, M. J., Kopkin, M. R., Parrott, C. T., & Bownes, E.
(2018). An update and expansion on the role of the Violence Risk Appraisal Guide and Historical Clinical Risk Management‐20 in United States case law. Behavioral Sciences & the Law, 36(5), 517-531. https://doi.org/10.1002/bsl.2376
Hui, K., Cooper, R. B., & Zaheer, J. (2020). Engaging Patients and Families in the Ethics of
Involuntary Psychiatric Care. American Journal of Bioethics, 20(6), 82-84. https://doi.org/10.1080/15265161.2020.1754511
Kim, A. K., Vakkalanka, J. P., Van Heukelom, P., Tate, J., & Lee, S. (2022). Emergency
psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America. Academic Emergency Medicine, 29(2), 142-149. https://doi.org/10.1111/acem.14374
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier,
- W., Melvin, G. A., Greenhill, L., Shen, S., Mann, J. J., Nam, B., Wilcox, H. C., Hilimire, M., & DeVylder, J. E. (2018). Columbia-Suicide Severity Rating Scale. Journal of American College Health, 66(8), 713-719. https://cssrs.columbia.edu/wp-content/uploads/CSSRS_Supporting-Evidence_Book_2020-01-14.pdf
Saygili, E., & Ozturkoglu, Y. (2020). Patients’ rights and professional conduct issues in hospitals’
codes of ethics. International Journal of Human Rights in Healthcare, 13(3), 201-208. https://doi.org/10.1108/IJHRH-09-2019-0071
Sample Answer 2 for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
Psychiatric emergencies are severe mood, thought, behavioral and social disturbances that need immediate emergency interventions plan as defined by the family, patient and social care unit. These immediate interventions are critical in saving the patient and others from immediate harm to themselves and others. All states across the U.S. have laws and guidelines that offer directions on handling psychiatric emergencies and access to immediate interventions to deal with such cases. Three forms of involuntary treatment exist by civil commitment laws in 46 states and the District of Columbia. Therefore, one can only secure treatment during or following a psychiatric crisis when they understand the existing laws and standards in their states (Leo, 2019). The purpose of this paper is to explore the legal and ethical issues concerning psychiatric emergencies and identify evidence-based suicide and violence risk assessments in Illinois for patients with paraphilic disorders.
Illinois State Laws for Involuntary Psychiatric Holds
Psychiatric emergency hold laws allow individuals with mental health disorders like paraphilic disorders to get involuntary admissions to health facilities to get immediate interventions to reduce potential harm to themselves and others. The state of Illinois is among 17 states that offer access to treatment on a needs-basis with a consideration of possible risk or danger (Kenneally, 2022). The implication is that laws in the state allow individuals to get admitted to mental health facilities against their consent or wishes under the involuntary civil commitment. There are two ways individuals with mental illness can involuntarily be admitted to a mental health facility (Posner et al., 2019). These include by a court order where a state judge forces one to be admitted to a facility, and emergency admission by certification where due to the nature of one’s mental health, and posing immediate harm himself or other. The second scenario means that one does not require a court order as long as local authorities are aware of the immediate danger, they can take the individuals to a mental health facility to get treatment.
Proof of mental illness alone is not sufficient to admit an individual; either a minor or an adult, into a mental health facility. The issuance of a mental health warrant means that a sheriff’s office can detain a patient and transport them to a health facility for evaluation and subsequent treatment. A psychiatrist must provide a medical certificate to court upon assessment. The certificate is a proof that the individual may potentially harm themselves and even other. The court then issues an order of protective custody (OPC) where the individual is held for at most 72 hours before a judge holds a probable cause hearing to determine if the facility can hold or release the patient (Kenneally, 2022). The court is then mandated to hold a mental health hearing within 14 days.
For minors, the Illinois law mandates parents, managing conservator, or guardian to request for their admission to inpatient health facility. They can do this by filing a request with the administrator of the facility. A psychiatrist can only discharge such patient upon the determination that they do not pose any harm to themselves or others. Minors can only be released to parents, guardians and the managing conservator.
Psychiatric Hold, Inpatient Commitment & Outpatient Commitment in Illinois
Patients on psychiatric hold are confined in psychiatric facilities against their will for a maximum of 72 hours. Illinois laws require the individual to either be a danger to themselves or others, suffer from severe distress, and experiencing significant deterioration as well as lacking the ability to make rational and informed decisions to submit to treatment (Santillanes et al., 2018). Inpatient commitment occurs when a judge orders an individual to get hospital treatment when they meet the state’s criteria for civic commitment after being in psychiatric hold. On its part, outpatient commitment is a treatment intervention or alternative where a judge orders a qualifying individuals with mental illness symptoms to comply with a prescribed mental health plan while they live in the community.
Capacity and Competence in Mental Health Contexts
Capacity entails the evaluation of a person’s functional abilities to make rational choices and decision. Physicians conduct assessments to determine if one lacks the capacity to make reasoned medical decision. Under such situations, they grant others or surrogates to make decisions on their behalf. On its part, competency is assessment and legal determination by a court on one’s ability to rationally execute legally recognized acts and situation (Bipeta, 2019). The court determines the level of one’s incompetence where those deemed incompetent get assigned persons to make decisions on their behalf.
HIPAA: Legal and Ethical Issues in Psychiatric Emergencies
Caring for individuals with mental health issues, especially psychiatric emergencies needs a multidisciplinary team and families as well as friends. The implication is that these entities must share information about the care for effective care coordination to yield better outcomes. However, sharing of the information requires all involved to adhere to the provisions of the Health Insurance Portability and Accountability Act (HIPAA). This federal law protects the privacy of individual health information (Theodos & Sittig, 2020). The law is essential as it assists in protection of confidential mental health records for individuals with the problem. Ineffective communication hinders care process and HIPAA understands that individuals with mental illness may lack the competency and even capacity to make decisions. The law allows representatives of such individuals to request and obtain complete medical records for effective decision making.
An ethical issue also arises from the HIPAA law as it is more synonymous with privacy measure imploring providers to only make disclosures based on consent. Despite its good intention, many question its ethical viability as it obstructs or interferes with effective care coordination. Many assert that the law restricts providers from effective care delivery based on fast-changing technology (Theodos & Sittig, 2020). Consumers want seamless communication and believe that such should also happen in healthcare settings. For instance, patients feel comfortable texting their physicians directly or emailing their care team and getting what they want without using the patient portals. The implication is that these regulations raise ethical issues with providers being keen on offering better interventions by information sharing.
Suicide Risk Assessment Tool
The Columbia-Suicide Severity Rating Scale (C-SSRS) is an evidence-based suicide risk assessment tool that can be used in different care setting for psychiatric assessment. These include schools, campuses, fire departments and even the military. Multiple institutions and organizations developed the tool. These include Columbia University, National Institute of Mental Health and National Institute of Health as well as Substance Abuse and Mental Health Service Administration (SAMHSA) (Posner et al., 2019). The tool has a rating scale where individuals with suspected mental health issues are rated on their level of suicide ideation. The scale identifies specific behaviors and at least one must be among those identified by the scale to more likely lead to complete suicide.
Violence Risk Assessment Tool
Violence towards healthcare workers, especially in emergency rooms, continues to be a concern in healthcare and affects the quality of care that they can offer. Structured clinical tools can help healthcare providers to identify patients and their family members that can be potentially violent or aggressive. The Broset Violence Checklist (BVC) is a six-item instrument which evaluates the presence or absence of three aspects of patients that include confusion, irritability and boisterousness. The tool also measures patient behaviors like verbal threats, physical threats and attacking of objects which are indications of possible violence (Sarver et al., 2019). Individuals displaying any two or more of these aspects are likely to become violent with a 24-hour duration if no immediate interventions are put in place. The tool is effective in enhancing adherence to treatment interventions to reduce the possibility of violence.
Conclusion
Illinois state has laws that mandate involuntary admission of individuals into psychiatric facilities against their will if they pose danger to themselves and others. Those seeking such interventions must use the state’s legal system. Courts determine mental competency and but physicians determine mental capacity for individuals. The HIPAA regulations help protect patient privacy and health information. Ethical and legal concerns also arise from the use of HIPAA as it hinders effective care provision. The use of suicide risk assessment tools and violence risk tools is essential in offering better interventions to patients with mental health issues.
References
Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian Journal of
Psychological Medicine, 41(2): 108-112. DOI: 10.4103/IJPSYM.IJPSYM_59_19
Kenneally, P. D. (2022). Mental Health Involuntary Commitment.
Leo R. J. (2019). Competency and the capacity to make treatment decisions: A primer for
primary care physicians. Journal of clinical psychiatry, 1(5), 251–256.
DOI: 10.4088/pcc.v01n0501.
Posner et al. (2019). The Columbia–Suicide Severity Rating Scale: Initial validity and internal
consistency. American Journal of Psychiatry, 168: 126 6 –1277.
DOI: 10.1176/appi.ajp.2011.10111704.
Santillanes, G., Kearl, Y. L., Lam, C. N., & Claudius, I. A. (2017). Involuntary psychiatric holds
in preadolescent children. Western Journal of Emergency Medicine, 18(6), 1159. DOI: 10.5811/westjem.2017.8.35114
Sarver, W., L., Radziewicz, R., Coyne, G., Colon, K., Mantz, L. (2019). Implementation of the
Brøset Violence Checklist on an Acute Psychiatric Unit. Journal of American Psychiatric Nurses Association, 25(6):476-486. DOI: 10.1177/1078390318820668.
Theodos, K., & Sittig, S. (2020). Health information privacy laws in the digital age. Perspectives
in health information management, 18(2), 15-21.
Sample Answer 3 for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
Diagnosis forms an important part of the overall patient care and treatment plan, implying that appropriate strategies should be used to support diagnosis. Psychiatric mental health nurse practitioners need to be adept at diagnostic criteria and diagnoses that need to be performed in different settings. For example, the diagnosis of psychiatric emergencies is known to form part of the diagnosis environment and may entail different problems, ranging from suicidal behaviors or ideations to serious abuse. The practitioners must be aware of several dynamics, such as the need to effectively communicate with the family members and ensure appropriate care coordination and follow-ups (Buppert, 2021). Therefore, the purpose of this assignment is to explore legal and ethical issues related to psychiatric emergencies.
State Laws For Involuntary Psychiatric Holds
Massachusetts has particular laws that govern involuntary holds for both adults and children to ensure that each person is appropriately protected. In this state, several people can initiate a hold, including a psychiatric nurse practitioner, licensed independent clinical social workers, psychologists, and physicians. According to Massachusetts state laws, emergency holds are allowed up to a maximum of seventy-two hours or three days, and the person needs to be evaluated by a qualified mental health professional (Lee & Cohen, 2021). A licensed mental health professional can release the hold upon carrying out an evaluation that determines if a patient poses a danger or not. A released patient can be picked by a legal guardian or a family member. However, the facility can also connect with social and community services if there is no one to pick up the patient. For a child, a legal guardian, parent, or mental health professional can initiate a hold.
Differences Among Emergency Hospitalizations For Evaluation/Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment
In Massachusetts, emergency hospitalization for evaluation refers to an immediate and short-term intervention for people who could pose a risk or danger to others or themselves due to mental health complications. The individual has to be taken to a designated health facility to be evaluated within seventy-two hours. They are then released if they no longer pose a danger. Otherwise, a court order may be sought for longer-term treatment. Inpatient commitment is the admission of a person to a psychiatric facility for a prolonged duration, more than an emergency hold (Buppert, 2021). The duration can be up to six months, which can be extended by court orders. Outpatient commitment entails mandating a person to adhere to a specific treatment plan when living in the community rather than when in the hospital. Its duration may vary, depending on the court order. However, reviews can be carried out periodically to assess compliance and if there is a need for ongoing outpatient treatment.
Difference Between Capacity and Competency In Mental Health Contexts
Capacity and competency are used in mental health contexts in reference to patients’ ability to make decisions. They are distinct even though sometimes people use them interchangeably. Capacity is a person’s cognitive and mental ability to make particular decisions as determined by healthcare providers. It is usually time-specific and task-specific (Calcedo-Barba et al.,2020). On the other hand, competency refers to a legal determination, usually carried out by a court, concerning a person’s ability to make decisions and manage their affairs. It is broader based than capacity. It is also general and not time-specific.
Legal and Ethical Issues Related to the Topic
Legal and ethical issues are related to different topics, such as patient autonomy in the context of treating psychiatric emergencies. One legal issue is involuntary commitment. It affects patient autonomy since a patient is admitted to a hospital against their will (Morris & Kleinman, 2023). The ethical aspect is informed consent. A patient’s capacity to consent is considerably affected during a psychiatric emergency since the mental state may impair the ability to give informed consent. Therefore, the need to balance informed consent and autonomy can present a substantial ethical challenge.
Evidence-Based Suicide Risk Assessment That Can Be Used to Screen Patients
Assessment of suicide risk can be vital in preventing suicidal attempts or actions. Therefore, various Evidence-Based Suicide risk assessment tools exist that can be used to screen patients. The Beck Scale for Suicide Ideation has been used for a long time in the assessment of suicidal ideation intensity (Cha et al.,2023). It has a self-report questionnaire and can be used to monitor variations in suicidal thoughts and to assess the efficacy of interventions over time.
Evidence-Based Violence Risk Assessment That Can be Used to Screen patients
Violence risk assessment is also important. Hence, different EB tools exist. One of them is the Historical, Clinical, Risk Management-20 (HCR-20). This is a tool used in assessing the risk of violence and covers factors such as risk management, current clinical presentation, and a person’s history (Douglas & Shaffer, 2020). It has a total of 20 items placed under three different domains. This tool is usually administered through clinical records review and structured interviews.
Link: https://arizonaforensics.com/wp-content/uploads/2014/06/HCR-20.pdf
Conclusion
This assignment has explored legal and ethical issues connected to psychiatric emergencies. It is worth noting that the laws governing psychiatric emergencies vary from state to state. Therefore, practitioners should adhere to the jurisdiction’s guidelines when dealing with patients during psychiatric emergencies.
References
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Calcedo-Barba, A., Fructuoso, A., Martinez-Raga, J., Paz, S., Sánchez de Carmona, M., & Vicens, E. (2020). A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare. BMC Psychiatry, 20, 1-14. Doi: 10.1186/s12888-020-02756-0
Cha, M., Al-Chalabi, N., Qian, J., Chaudhary, Z., Graff, A., Gerretsen, P., … & Deluca, V. (2023). Concordance between the Columbia-Suicide Severity Rating Scale and Beck Scale for Suicide Ideation in assessing suicide behaviour in young adults with schizophrenia spectrum disorders. Psychiatry Research, 319, 114965. https://doi.org/10.1016/j.psychres.2022.114965
Douglas, K. S., & Shaffer, C. S. (2020). The science of and practice with the HCR-20 V3 (historical-clinical-risk management-20, version 3). In Handbook of violence risk assessment (pp. 253-293). Routledge.
Lee, G., & Cohen, D. (2021). Incidences of involuntary psychiatric detentions in 25 US states. Psychiatric Services, 72(1), 61-68. https://doi.org/10.1176/appi.ps.201900477
Morris, N. P., & Kleinman, R. A. (2023). Taking an evidence-based approach to involuntary psychiatric hospitalization. Psychiatric Services, 74(4), 431-433. https://doi.org/10.1176/appi.ps.20220296
Sample Answer 4 for Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
The United States contains several states with their own set of laws that guide the hospitalization of all mental health patients with a capacity to harm those in their surroundings in both temporal and involuntary manners (Canady, 2018). The legitimacy and value of the choice of treatment intervention however relyon several factors like statutory criteria, and how they are applied; accessibility to care concerning the selected intervention; and accuracy to the emergency hold procedure. The purpose of this paper is to conduct a comprehensive assessment of the psychiatric emergency laws of the state of Maryland for both children and adults.
State Laws for Involuntary Psychiatric Holds
The Maryland state, the laws allow healthcare workers such as physician, a psychologist, a county health officer among others to “file an emergency evaluation petition for involuntary hospitalization even without getting the approval of the judge” (Durns et al., 2021, p. 4). The petitioner must have substantial reason to believe that the person is mentally ill and display potential danger to themselves or others. Morris (2018) posits that amongst the provision of this law is the clause that permits authorities to issues involuntary commitment order within 72 hours whilst hearing should occur within 20 days after the former as regards adults. For children below the age of 18 years, the civil commitment hearing must be scheduled within 14 days, from the date of admission of the individual. The patient will be held for this period, however, when the psychiatrist fails to meet the hold criteria, the judge immediately releases the patient. A family member or emergency contact can come and pick the patient once the release order has been approved.
Evaluation/Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment
The state of Maryland also allows civil holds as regards involuntary hospitlaizations to occur distinctively between both inpatient and outpatient commitments (Becker & Forman, 2020). According to the inpatient commitment laws in this state, the judge has the prerogative to make an order for a forceful patient hospitalization even when a patient has not contravened any of the civil commitment criteria and the elapsing of the emergency evaluation period. On the contrary, the outpatient civil commitment permits the same judge to order for the forceful hospitalization of mentally ill patients whose symptomatology is in tandem with the civil criteria whilst they are within the bounds of the community setup. Commonalities exist in the detainment time, the hearing and release orders in the two instances.
Difference Between Capacity and Competency
In mental health sphere, capacity is associated with the ability of a patient to undertake decisions that are regarded as sound as well as offer informed consent upon request. Therefore, the patient has the correct information such as the mental status, treatment interventions as well as their relevance and precise diagnosis of their condition (Perlin et al., 2018). On the other hand, competency is associated with the ability that a person has with regards to independent acting and participation in decision-making on matters associated with their health.
Legal and Ethical Issues
The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed into law in the year 1986 by the United States Congress (Terp et al., 2019). It was considered part of the Consolidated Omnibus Reconciliation Act (COBRA) mainly handling Medicare issues. The main legal and ethical issue associated with EMTALA is the inability to uphold and respect the patients’ autonomy and confidentiality, especially when it comes to payment issues.
Evidence-Based Suicide Risk Assessment and Violence Risk Assessment
Psychiatric emergencies see the adoption of various diagnostic tools for purposes of determining the levels of severity of the mental health illness in a patient. Tools such as Evidence-based Screening tools like Patient Health Questionnaire 2 (PHQ2) play important roles in the diagnosis of the severity of suicidal ideation. On the other hand, the risk for violence can be diagnosed using Brøset Violence Checklist and Violence Risk Screening-10 can be used to assess for risks of violence among others (Chunduri et al., 2019).
Conclusion
Psychiatric emergencies call for involuntary hospitalization of mentally ill individuals for evaluation and treatment. The laws governing psychiatric emergencies however vary from state to state. However, the entire process is mainly aimed at protecting community members from harm that can be caused by the mentally ill individual.
References
Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies. Frontiers in psychiatry, 11, 127. https://doi.org/10.3389/fpsyt.2020.00127
Canady, V. A. (2018). TAC says many states fail to make the grade on involuntary treatment laws. Mental Health Weekly, 28(37), 1-3. https://doi.org/10.1016/j.ijlp.2021.101695
Chunduri, S., Browne, S., Pollio, D. E., Hong, B. A., Roy, W., Roaten, K., … & North, C. S. (2019). Suicide risk assessment and management in the psychiatry emergency service: psychiatric provider experience and perceptions. Archives of suicide research, 23(1), 1-14. https://doi.org/10.1080/13811118.2017.1414648
Durns, T. A., O’Connell, P. H., Shvartsur, A., Grey, J. S., & Kious, B. M. (2021). Effects of temporary psychiatric holds on length of stay and readmission risk among persons admitted for psychotic disorders. International Journal of Law and Psychiatry, 76, 101695. https://doi.org/10.1016/j.ijlp.2021.101695
Morris, N. P. (2018). Legal hearings during psychiatry residency. J Am Acad Psychiatry Law, 46, 351-358. https://doi.org/10.29158/JAAPL.003770-18.
Perlin, M., Dorfman, D., & Weinstein, N. (2018). On Desolation Row: The Blurring of the Borders between Civil and Criminal Mental Disability Law, and What It Means to All of Us. Articles & Chapters. https://digitalcommons.nyls.edu/fac_articles_chapters/1356
Terp, S., Wang, B., Burner, E., Connor, D., Seabury, S. A., & Menchine, M. (2019). Civil monetary penalties resulting from violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies, 2002 to 2018. Academic Emergency Medicine, 26(5), 470-478. https://doi.org/10.1111/acem.13710.