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.
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 Assessment/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.
SUBMISSION INFORMATION
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Rubric
NRNP_6675_Week8_Assignment_Rubric
REQUIRED READINGS
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 checklistLinks to an external site.. 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 guidelinesLinks to an external site.: 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”
Legal and Ethical Issues Related to Psychiatric Emergencies
Psychiatric emergencies refer to a broad range of conditions, including drug reactions, suicidal ideation or behaviors, and abuse, among others. Psychiatric-mental health nurse practitioners (PMHNPs) play a crucial role in addressing emergencies, coordinating care with other healthcare providers, and communicating effectively with family members. In this assignment, I will explore legal and ethical issues related to psychiatric emergencies, including state laws for involuntary psychiatric holds, emergency hospitalization for Assessment/psychiatric hold, inpatient commitment, and outpatient commitment, capacity, and competency in mental health contexts. Furthermore, I will explain legal and ethical issues related to patient autonomy and confidentiality, as well as identify evidence-based suicide and violence risk assessments.
State Laws for Involuntary Psychiatric Holds
In most states, involuntary psychiatric holds are governed by state laws that dictate who can hold a patient, for how long, who can release the emergency hold, and who can pick up the patient after the hold is released. In California, for instance, involuntary holds are known as 5150 holds, and they allow for the detention and Assessment of individuals who are deemed to be a danger to themselves or others due to a mental disorder. The hold is initiated by a peace officer, psychiatric professional, or qualified health care professional, and the individual can be held for up to 72 hours for Assessment and treatment. During the hold, the individual is assessed for psychiatric conditions, and if necessary, an additional 14-day hold can be obtained through a petition process.
Emergency Hospitalization for Assessment/Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment
Emergency hospitalization for Assessment/psychiatric hold refers to the detention of individuals who pose a danger to themselves or others due to a mental disorder. This detention is usually temporary and is meant to allow for Assessment and stabilization before release. Inpatient commitment, on the other hand, refers to the process of detaining individuals for an extended period, typically up to 180 days, for treatment of a mental disorder. Outpatient commitment is a less restrictive alternative that allows individuals to receive treatment while living in the community. These three processes differ in their degree of restriction and the length of time for which an individual can be held.
Capacity and Competency in Mental Health Contexts
Capacity refers to an individual’s ability to make informed decisions about their care and treatment, while competency refers to an individual’s ability to stand trial or make legal decisions. These two concepts are distinct but related, and they are crucial in mental health contexts. Mental health professionals must assess an individual’s capacity and competency before providing treatment or engaging in legal proceedings. In cases where an individual is deemed incapable or incompetent, a guardian or conservator may be appointed to make decisions on their behalf.
Legal and Ethical Issues Related to Psychiatric Emergencies
Patient Autonomy: One legal issue related to patient autonomy in treating psychiatric emergencies is the right to refuse treatment. Patients have the right to refuse treatment, even if it is recommended by healthcare providers. However, in some cases, such as when an individual poses a danger to themselves or others, healthcare providers may need to override the patient’s autonomy to protect their safety.
Confidentiality: Confidentiality is a critical ethical issue in mental health contexts, as it allows individuals to seek treatment without fear of stigma or discrimination. However, in cases where an individual poses a danger to themselves or others, mental health professionals may need to breach confidentiality to protect their safety.
Evidence-Based Suicide and Violence Risk Assessments
One evidence-based suicide risk assessment is the Columbia Suicide Severity Rating Scale (C-SSRS), which is a screening tool designed to identify individuals at risk of suicide. It assesses the severity of suicidal ideation, suicidal behavior,
