Legal and Ethical Issues Related to Psychiatric Emergencies
Student’s Name
Institutional Affiliation
Course
Professor’s Name
Date
Legal and Ethical Issues Related to Psychiatric Emergencies
State Laws for Involuntary Psychiatric Holds for Child and Adult Psychiatric Emergencies
The state laws in Mississippi indicate that patients below 18 years cannot be held in psychiatric emergencies without the consent of a parent or guardian (Heldt et al., 2019). The Chancery and Youth court have the exemptions of deciding to hold an individual below 18 years in a psychiatric treatment facility. The intention is to diagnose and treat mental illness that can cause injury, self-harm, violence, and undermine the safety of other people (Heldt et al., 2019). The Chancery court applies the same requirements for adult patients. A guardian or parent is required to pick a patient after the involuntary hold. Emergency commitments will require a certificate from a healthcare provider to explain the need for an emergency (Heldt et al., 2019). An emergency order will require the signature of two physicians or a physician and a nurse practitioner.
Emergency Hospitalization for Evaluation/Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment
Emergency hospitalization for psychiatric evaluation is the process of evaluating a patient in a psychiatric treatment facility for mental concerns. Emergency hospitalization is also called pick-up or psychiatric hold for approximately 72 hours (Nordstrom et al., 2019).
Inpatient commitment is a legal process involving a court order to ensure an individual showing signs of mental illness receives appropriate care. Civil commitment is a requirement in all states (Morris, 2020). The objective of civil commitment is to safeguard individuals who are resisting care and protect members of the family who can be at risk of injurious behavior (Morris, 2020). For example, individuals can commit suicide or kill members of the family.
Outpatient civil commitment involves a court order to compel an individual who shows signs of mental illness to receive treatment. An individual in the outpatient civil commitment is required to continue staying in society (Segal, 2020). The court order is also called mandated outpatient treatment which applies to all states with little variance.
Capacity and Competency
Capacity is the ability and potential of an individual to participate in the delivery of care and making medical decisions. Healthcare workers can experience varying situations that assess their capacity (Gibson et al., 2020). Competency means the ability of a professional to participate in legal decision-making. To determine the competency of a professional it is relevant to present concrete evidence before a court of law. Healthcare workers cannot determine the competency of an individual (Gibson et al., 2020). It means the ability of a person to participate in legal decisions while making choices on their own.
Legal and Ethical Issue
The selected ethical issue is the confidentiality of information. Healthcare workers have a responsibility to maintain confidentiality when they receive information from a patient. It is vital to assure a patient that the information will not be shared with a third party without their consent (Zucker et al., 2019). A provider has the moral responsibility to avoid exposing the weaknesses of a patient to other people. Confidentiality helps patients to gain trust in the provider and the treatment process (Zucker et al., 2019).
The selected legal issue is legal gun ownership. The law prohibits individuals committed to a mental facility or treatment to own or use guns. Federal law 18 U.S.C. § 922(d) indicates that such individuals pose a risk to other members of society if they own guns (Felthous & Swanson, 2017). According to Miss. Stat. Rev. § 45-9-101 the state will deny the right to own or hold a gun to individuals who are adjudicated as mentally incompetent or have been involuntary or voluntarily committed to a mental health facility (Felthous & Swanson, 2017). A person will require a certificate from a psychiatrist that they have not suffered mental illness for the last five years (Felthous & Swanson, 2017). Psychiatrists should comply with the federal and state orders to deny a license to people with a recent history of mental illness by providing relevant and truthful information.
Evidence-Based Suicide Risk Assessment
Columbia-Suicide Severity Rating Scale (C-SSRS) is one of the rating scales to examine the risk of suicide. The questionnaire for suicide risk is developed and approved by multiple institutions (Bjureberg et al., 2021). The institutions include NIMH support and Columbia University. The questions are framed in interview format or self-report survey to measure suicide ideation or the wish to be dead (Bjureberg et al., 2021). The tool has been used in multiple situations with convincing success results that it can be applied with efficacy and accuracy in different situations.
Evidence-Based Violence Risk Assessment
Triage tool is a violence risk assessment tool that examines if there are reasonable grounds for risk of violence. The objective of the tool is to measure if an individual is at risk (Chepenik, 2017). It examines five observable characters indicating the risk of violence among patients and people around them. The five important characters include mumbling, tone, anxiety, eye contact, and pacing (Chepenik, 2017). The tool has been used successfully and accurately in the past to identify patients at risk of violence. The results of the assessment enable healthcare providers to take appropriate precautions to eliminate the risk of violence that can undermine recovery.
References
Bjureberg, J., Dahlin, M., Carlborg, A., Edberg, H., Haglund, A., & Runeson, B. (2021). Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department. Psychological Medicine, 1-9.
Chepenik, L. G. (2017). The triage process for behavioral emergencies. Current Emergency and Hospital Medicine Reports, 5(4), 149-156.
Felthous, A. R., & Swanson, J. (2017). Prohibition of persons with mental illness from gun ownership under Tyler. Journal of the American Academy of Psychiatry and the Law.
Gibson, C., Ventura, C., & Collier, G. D. (2020). Emergency Medical Services resource capacity and competency amid COVID-19 in the United States: preliminary findings from a national survey. Heliyon, 6(5), e03900.
Heldt, J. P., Zito, M. F., Seroussi, A., Wilson, S. P., Schneider, P. L., Strouse, T. B., & Cheung, E. H. (2019). A medical incapacity hold policy reduces inappropriate use of involuntary psychiatric holds while protecting patients from harm. Psychosomatics, 60(1), 37-46.
Morris, N. P. (2020). Detention without data: public tracking of civil commitment. Psychiatric Services, 71(7), 741-744.
Nordstrom, K., Berlin, J. S., Nash, S. S., Shah, S. B., Schmelzer, N. A., & Worley, L. L. (2019). Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. Western Journal of Emergency Medicine, 20(5), 690.
Segal, S. P. (2020). The utility of outpatient civil commitment: Investigating the evidence. International Journal of law and Psychiatry, 70, 101565.
Zucker, N. A., Schmitt, C., DeJonckheere, M. J., Nichols, L. P., Plegue, M. A., & Chang, T. (2019). Confidentiality in the doctor-patient relationship: Perspectives of youth ages 14-24 years. The Journal of Pediatrics, 213, 196-202.
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Sample 2
Concerning Psychiatric Emergencies: Legal and Ethical Considerations
Name of the Student Institutional Affiliation of the Student Course
Name of the professor and the date
Concerning Psychiatric Emergencies: Legal and Ethical Considerations
State Laws Regarding Involuntary Psychiatric Holds for Children and Adults Suffering from Psychiatric Emergency
Patients under the age of 18 cannot be detained in a mental emergency in Mississippi, according to state law, unless they have the agreement of a parent or guardian present (Heldt et al., 2019). The Chancery and Youth courts are exempt from making a decision on whether or not to commit a minor under the age of 18 to a psychiatric treatment center. The goal is to identify and treat mental illnesses that can result in injury, self-harm, aggression, or a threat to the safety of others, such as bipolar disorder (Heldt et al., 2019). Adult patients are subject to the same criteria as children under the jurisdiction of the Chancery court. After the involuntary hold is lifted, a patient must be selected by a guardian or a parent. Emergency commitments will necessitate the submission of a certificate from a healthcare provider stating the reason for the emergency (Heldt et al., 2019). Two physicians, or a physician and a nurse practitioner, must sign an emergency order before it can be carried out or implemented.
Evaluation and psychiatric hold in an emergency department, inpatient commitment, and outpatient commitment were the most common options.
Psychiatric evaluation in an emergency hospital setting is the process of evaluating a patient at a psychiatric treatment center for mental health issues that have arisen. Emergency hospitalization, also known as pick-up or mental hold, is reserved for around 72 hours in most cases (Nordstrom et al., 2019).
As part of the legal procedure, a court order is issued to guarantee that an individual displaying indicators of mental illness receives adequate treatment. In all states, civil commitment is a legal obligation (Morris, 2020). When it comes to civil commitment, the goal is to protect persons who are refusing to receive care as well as members of the family who may be at risk of engaging in harmful behavior (Morris, 2020). Individuals can, for example, commit suicide or murder members of their own family members.
Outpatient civil commitment is the process of obtaining a court order to compel a person who exhibits indicators of mental illness to seek medical treatment. An individual enrolled in an outpatient civil commitment program is obligated to maintain his or her status in society (Segal, 2020). The court order is also referred to as mandatory outpatient therapy, and it is applicable in all 50 states with just minor variations.
Possessing the necessary capabilities and competencies
Capacity refers to an individual’s capacity and capability to engage in the delivery of care and the making of medical decisions in a variety of settings. Healthcare personnel might be put in a variety of circumstances that test their abilities (Gibson et al., 2020). In the legal field, competence refers to a professional’s ability to participate in legal decision-making. It is necessary to submit concrete evidence before a court of law in order to determine the competence of a professional. The competency of an individual cannot be determined by healthcare professionals (Gibson et al., 2020). When someone has the ability to engage in legal decisions while also making their own choices, they are said to be “self-sufficient.”
It is a legal and ethical problem.
The secrecy of information has been chosen as the preferred ethical concern. When a healthcare worker receives information from a patient, he or she has a responsibility to keep that information confidential. Assuring patients that their information will not be shared with a third party without their consent is critical (Zucker et al., 2019). A healthcare provider has a moral obligation to protect a patient’s vulnerabilities from being revealed to other persons. Confidentiality assists patients in developing confidence in their healthcare professional and the treatment process (Zucker et al., 2019).
The legal problem that has been chosen is that of legal gun ownership. Individuals committed to a mental institution or treatment program are not permitted to own or use firearms. According to federal law, 18 U.S.C. 922(d), such individuals represent a threat to other members of society if they own firearms (Felthous & Swanson, 2017). Individuals who have been adjudicated as mentally incompetent or who have been involuntarily or voluntarily committed to a mental health facility will be denied the ability to own or possess a firearm, according to Miss. Stat. Rev. 45-9-101 of the Mississippi Code (Felthous & Swanson, 2017). A psychiatrist’s certification stating that the individual has not suffered from a mental illness in the previous five years will be required (Felthous & Swanson, 2017). Individuals with a recent history of mental illness should be denied a license by psychiatric professionals who comply with federal and state requirements to do so by giving relevant and factual information.
Suicide Risk Assessment Using Evidence-Based Methods
The Columbia-Suicide Severity Rating Scale (C-SSRS) is one of several rating measures used to assess the likelihood of committing suicide. The questionnaire for assessing suicide risk has been created and authorized by a number of different institutes (Bjureberg et al., 2021). Columbia University and the National Institute of Mental Health are among the institutes providing assistance. In order to assess suicidal ideation or the desire to die, the questions are presented in an interview format or as a self-report survey (Bjureberg et al., 2021). The tool has been employed in a variety of settings with convincing success results, demonstrating that it can be used effectively and accurately in a variety of situations.
Assessing the Risk of Violent Behavior Using Scientific Evidence
A triage tool is a tool for assessing the danger of violence. It determines whether there are reasonable grounds to believe that there is a risk of violence. The tool’s primary goal is to determine whether or not a person is at risk of harm (Chepenik, 2017). In this study, five observable characteristics are examined to determine the likelihood of violence among patients and others around them. Mumbling, tone, anxiousness, eye contact, and pacing are the five most crucial characters in the play (Chepenik, 2017). In the past, the technique has been used successfully and accurately to identify patients who were at danger of becoming violent. The findings of the assessment allow healthcare providers to take the necessary steps to reduce the likelihood of violence, which can be detrimental to a patient’s recovery.
References
The authors, J. Bjureberg, M. Dahlin, A. Carlborg, H. Edberg, A. Haglund, and B. Bjorn Runeson, have published a paper in which they discuss their research (2021). Using the Columbia-Suicide Severity Rating Scale Screen Version, a psychiatric emergency department can screen for suicide risk in the first few minutes of a patient’s visit. Journal of Psychological Medicine, 1-9.
Chepenik, L. G., et al (2017). The procedure for dealing with behavioral emergencies. Current Emergency and Hospital Medicine Reports, vol. 5, no. 4, pp. 149-156 (April 2010).
Felthous, A. R., and Swanson, J. (in press) (2017). Persons suffering from mental illness are prohibited from owning firearms under Tyler. A journal published by the American Academy of Psychiatry and the Law (American Academy of Psychiatry and the Law).
The authors (Gibson et al.) and Ventura et al. (Ventura et al.) have published a paper titled (2020). Initial findings from a national survey on emergency medical services capacity and competency during COVID-19 in the United States are promising. Heliyon, vol. 6, no. 5, e03900.
J. P. Heldt and colleagues, Zito, M. F., Seroussi, A., Wilson, S. P., Schneider, P. L., Strouse, T. B., et al (2019). It is possible to limit the incorrect use of involuntary psychiatric holds while protecting patients from harm by implementing a medical incapacity hold policy. Psychosomatics, vol. 60, no. 1, pp. 37-46.
Morris, N. P., et al (2020). Detention without data collection: civil commitments are tracked in the public domain. 741-744 in Psychiatric Services, vol. 71, no. 7.
Nordstrom, K., Berlin, J. S., Nash, S. S., Shah, S. B., Schmelzer, N. A., & Worley, L. L. (2019). Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. Western Journal of Emergency Medicine, volume 20, number 5, page 690.
Segal, S. P. (2020). The evidence for the usefulness of outpatient civil commitment is being investigated. The International Journal of Law and Psychiatry, volume 70, number 101565, has been published.
Zucker, N. A., Schmitt, C., DeJonckheere, M. J., Nichols, L. P., Plegue, M. A., & Chang, T. (2019). Confidentiality in the doctor-patient relationship: Perspectives of youth ages 14-24 years. The Journal of Pediatrics, 213, 196-202.
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