Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies
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.
- Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
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.
Expert Answer and Explanation
Mental health issues can cause the patient to cause harm to themselves and to others, and this is why it is important for the peace officers and the guardians to present a person exhibiting symptoms of mental health, to a facility for emergency hold. A court, after hearing the reason for emergency hold or commitment, can decide to either have the patient released or be treated. For psychiatrists, working with patients with mental health problems can be a challenge, and it can present ethical and legal concerns (Thapar et al., 2015). It is important to examine these concerns, and evaluate Texas’ laws on involuntary psychiatric hold and commitment.
Law for Involuntary Psychiatric Holds for Child and Adult Emergencies
Texas, and indeed, most states have laws which govern the involuntary psychiatric holds for children and adults. The hold in Texas takes a maximum of 72 hours, and for a psychiatric facility to detain a patient, an adult has to apply for the hold. The Critical incidence Response Team (CIRT) officer plays key role in this process. The CIRT’s role in this case is to execute the affidavit by swearing out when applying for the detention. However, the physician can equally play a crucial role in this case. The regulation pertaining to this issue is found in section 574.025 of the Health and Safety Code. Under this regulation, the medical certificate is used to determine the probable cause hearing, and if no one objects to it, the court can make a ruling that justifies the detention (TexasLawhelp.Org, 2020). This law does not apply in the case of a minor.
Differences among Emergency Hospitalization for Evaluation/Psychiatric Hold, Inpatient Commitment and Outpatient Commitment
There are differences in the way Texas handles issues such as inpatient and outpatient commitments and emergency hospitalization for psychiatric hold. The main difference between the inpatient and outpatient commitments is that the former is effected if the psychiatric facility, after determining that a person has mental illness, and they can harm themselves or other people around them, present evidence to the court which orders the individual to be held for treatment. This applies to people who have guardians such as parents or siblings. Conversely, the latter is used where one does not have a guardian, and they lack the competency needed to make rational decisions. Unlike these two, emergency hold can be temporary, and it cannot exceed 72 hours TexasLawhelp.Org, 2020).
Difference between Capacity and Competency in Mental Health Domain
Capacity and competency are some of the terms which apply when a judge or a psychiatrist is determining whether one can rationally think, and make rational decisions. Capacity, based on one’s mental status, is the state in which one can make and convey their personal decisions in a rational manner. When assessing the client’s capacity, a psychiatrist may assess the patient using the tools of assessment, and the information provided by the client’s kin. While a psychiatrist is responsible for determining capacity, the judge determines the competency (Zakhari, 2021). Competency, in this case, means being in a state of cognitive and mental wellbeing so that one is able to act judiciously, and in a legal manner.
Legal and Ethical Issues related to the Treatment of Psychiatric Emergencies (Patient Autonomy)
Ethical and legal issues may occur when a provider is working with patients with mental health challenges. The patient autonomy is the ethical issue that can arise during the treatment of cases of emergencies involving mental health problems. While providers have the ethical mandate to treat patients with mental health, having the patient make decisions on matters pertaining to their own health can be a challenge especially if the patient lacks the capacity to rationally make decisions. In this case, the psychiatrist may face a decision-making challenge (Sadock, Sadock, & Ruiz, 2015). The breach of HIPAA privacy rule is a legal concern which psychiatrist may have to deal with. The disclosure, according to this rule, should be reasonable, and those handling patient’s data should disclose the information that can only help accomplish a particular task.
Evidence-Based Suicide Risk Assessment for Screening Patients
The assessment tool that can be used to screen a patient with suicide ideations is the Patient Health Questionnaire-9 (PHQ-9). The tool assesses mental health status by assessing whether certain issues bother the client. For instance, it assesses whether the patient feels tired, has lost interest in things they previously enjoyed, or they experience sleeplessness. Current evidence support the use of the instrument in assessing depression and suicide risks (Levis, Benedetti, & Thombs, 2019).
Evidence-Based Violence Risk Assessment for Screening Patient
Lantta (2016) presents an evidence-based framework for assessing the risk of violence. This framework is based on a research that utilizes the mixed method approach. The Dynamic Appraisal of Situational Aggression is used as the model for screening the risk of violence. The results of the study indicate the benefits of the involvement of the patient.
In conclusion, Texas has laws which regulate the handling of the psychiatric emergency cases. The maximum time required for involuntary detention in such a case is 72 hours, and the court can make a ruling concerning the legality of the emergency hold. In the state, holding a patient, and inpatient and outpatient commitments differ in terms of the way they are conducted.
Lantta, T. (2016). Evidence-Based Violence Risk Assessment in Psychiatric Inpatient Care: An Implementation Study. Turun Yliopisto University of Turku. Doi: 10.13140/RG.2.2.35513.60003.
Levis, B., Benedetti, A., & Thombs, B.D. (2019). Accuracy of Patient Health Questionnaire-9 for screening to detect Major Depression: Individual Participant Meta-Analysis. The BMI Journal, 365. Doi: https://doi.org/10.1136/bmj.l1476.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
TexasLawhelp.Org. (2020). Involuntary Commitment in Texas. https://texaslawhelp.org/article/involuntary-commitment-texas.
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.
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
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