Legal And Ethical Issues Related To Psychiatric Emergencies

Legal And Ethical Issues Related To Psychiatric Emergencies

Involuntary psychiatric holds for children and adults are governed by Florida law, which specifies who can place a patient in a holding facility and how long they can stay, as well as who can lift the emergency hold and pick up the patient after it is lifted. If certain conditions are met, psychiatric emergency hold laws allow for the involuntary commitment of people with serious mental illnesses to healthcare facilities. (According to Hedman et al. (2016), the duration of an emergency hold is frequently a few days.) This term may be shorter or longer in some states than in others. The Baker Act governs mental health services in the state of Florida, according to Florida Statutes Chapter 394. Involuntary examination, involuntary placement, and voluntary admissions are governed by Baker Act sections 394.463, 394.467, and 394.4625. According to Hedman, both children and adults are eligible for involuntary hospitalization for up to 72 hours under the Baker Act (2016). Many child advocates argue that the Baker Act was never intended to be used against children. The Baker Act requires three conditions to be met before beginning an involuntary mental health evaluation on anyone in the state. For an exam to be conducted, a person must be deemed a risk to themselves or others, and there must be reasonable grounds to believe that they are mentally ill. Minors should be treated differently under the Baker Act for the reasons outlined by (Hedman et al. (2016) because they cannot assess whether a mental exam is necessary or legally consent to any type of medical intervention.” In Florida, the Bakers Act can only be enforced by law enforcement, courts, or health experts. However, mental health professionals can only discharge patients into the care of their loved ones.

When it comes to emergency admissions for evaluation/psychiatric hold, outpatient and inpatient commitments are vastly different. In Florida, emergency hospitalizations for evaluation are the shortest civil restraint on liberty, typically lasting 72 hours. FLA. STAT. 394.463(1) requires an emergency hospitalization for evaluation when there is reason to believe that an individual’s mental disorder makes it impossible for them to decide for themselves whether an examination is required or when they decline a voluntary examination. 2020 (Treatment Advocacy Centre). In contrast to an emergency hold, which does not require judicial review, individuals are assigned to inpatient or outpatient placement based on a court finding based on convincing and unambiguous evidence. According to Florida Statute 394.467, people with mental illnesses who are unable to make their own decisions about whether or not they should be hospitalized because they are likely to disregard their health and safety if they do not receive treatment are eligible for inpatient placement. According to FLA. STAT. 394.4655, a person who exhibits such characteristics and has been involuntarily admitted to treatment facilities more than twice in the previous thirty-six months, has a history of noncompliance with treatment for mental disorders or is a recipient of mental health services from a correctional facility, can be placed in outpatient treatment by the court (Treatment Advocacy Centre, 2020).

Consultation-liaison psychiatrists frequently encounter clinical situations with legal implications, such as the issue of competency. According to Gledhill, confidence is a legal state rather than a medical state (2014). It generally refers to a person’s ability to complete a specific task or make a specific decision. According to Gledhill (2014), unless a court rules otherwise, all adults are presumed capable. While only a court can determine competency, psychiatric doctors can and should determine the client’s capacity to make an informed decision or judgment.

Therapists are responsible for keeping patient information private. As a matter of ethical and legal obligation, the code of ethics and statutes governing mental health professionals require practitioners to protect patient confidentiality (DeMarco et al., 2019). When the principle of confidentiality conflicts with other ethical values, such as not causing harm to others or the patient, there is always a problem. Similarly, in certain circumstances, mental health professionals may be required to release patients’ information without their consent. Breaking confidentiality may be necessary in some cases, such as when a psychiatrist seeks appropriate professional consultation. Although illegal, this decision is necessary for the patient’s well-being.

I would use the Patient Health Questionnaire to screen my patients for suicidal ideation (PHQ). According to Gold et al., all nine DSM-IV criteria for depression are scored from zero, which means not at all, to three, which means almost every day (2020). It also serves as a reliable and valid indicator of the severity of depression. Given that severe depression is associated with an increased risk of suicide, I believe this would be an excellent evidence-based tool for assessing suicidal risk.

I would use the Structured Professional Judgment (SPJ) assessment instrument to determine whether a patient has a history of violence. According to Messing, mental health practitioners can make final decisions on violence risk using SPJ rather than actuarial assessment techniques (2019). This, in my opinion, is the ideal tool for assessing violence risk because it provides recommendations for mental health professionals to make judgments rather than setting strict cutoffs to identify violence risk.”

References

DeMarco, J. P., Jones, G. E., & Daly, B. J. (2019). Ethical & legal issues in nursing. Peterborough, Ontario: Broadview Press.

Gledhill, K. (2014). The role of capacity in mental health laws – recent reviews and legislation. International Journal of Mental Health and Capacity Law, (20), 127. doi:10.19164/ijmhcl.v0i20.272

Gold, L. H., Frierson, R. L., & American Psychiatric Association. (2020). The American Psychiatric Association Publishing textbook of suicide risk assessment and management. Washington, DC: American Psychiatric Association Publishing

Hedman, L. (2016). State Laws on Emergency Holds: Updated Data Set. Psychiatric Services, 67(5), 578-578. doi: 10.1176/appi.ps.670505

Hedman, L., Petrila, J., Fisher, W., Swanson, J., Dingman, D., & Burris, S. (2016). State Laws on Emergency Holds for Mental Health Stabilization. Psychiatric Services, 67(5), 529 535. doi: 10.1176/appi.ps.201500205

Messing, J. (2019). Risk-Informed Intervention: Using Intimate Partner Violence Risk Assessment within an Evidence-Based Practice Framework. Social Work, 64(2), 103- 112. doi: 10.1093/sw/swz009

Treatment Advocacy Centre. (2020). State Standards for Civil Commitment, Updated: September 2020. Retrieved from https://www.treatmentadvocacycenter.org/storage/documents/state- standards/state standards for-civil-commitment.pdf

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The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors.

Regardless of the 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.