NRNP 6675 WEEK 8 Legal and Ethical Issues Related to Psychiatric Emergencies Paper
The Baker Act is a Florida statute dealing with the treatment of children and adults needing psychiatric services without consent. It allows forced examination and detention of individuals who, due to mental disorders, become dangerous to themselves or others (Maniaci et al., 2019). Physicians, psychiatric psychologists, mental nurses, psychological social workers, certified mental health therapists, and law enforcement officials can file voluntary holds. A general client assessment identifies the patient’s state of mind and needs. Patients are only discharged from involuntary holds if a doctor determines they no longer require involuntary treatment. This paper overviews Florida’s current psychiatric holding practices, underscoring capacity versus competence and exploring ethical and legal predicaments associated with patient autonomy. It also presents evidence-based approaches to suicide risk and violence risk assessments.
Variations in Emergency Hospitalizing for Psychiatric Hold or Evaluation
Florida has distinguished procedures in mental health facilities concerning evaluation and treatment against patients’ will, including emergency admission, involuntary inpatient commitment, and involuntary outpatient commitment. Hospitalization for assessment addresses the worst cases where persons are in severe states of mental distress, not exceeding 72 hours (Maniaci et al., 2019). It begins when there is a likelihood of harm to the patient or others or when the patient is incapacitated to make decisions.
Inpatient commitment refers to long-term treatment for people requiring extensive mental health services, extending beyond the initial 72-hour hold. The court order determines it based on the patient’s continual risk to self or others and inability to function within the community. Outpatient commitment offers structured treatment while allowing patients to remain in the community. It is appropriate for individuals requiring ongoing care but can safely be treated on an outpatient basis (Maniaci et al., 2019). These approaches ensure patients receive proper care based on their needs and risks.
Mental Health and Capacity vs. Competency
Capacity and competency in mental health contexts are relevant but different. Khan and Jain (2022) state that capacity refers to the patient’s ability to make informed treatment decisions, which providers and situation-specific assess. A patient may consent to simple procedures but not to complex healthcare decisions. Competency is a legal decision awarded by courts, dealing with the patient’s ability to manage affairs and decisions. It is considered globally and more stable than capacity, which changes situationally (Calcedo-Barba et al., 2020). Health professionals must understand these differences when dealing with patients with reduced decision-making abilities.
The Ethical and Legal Issues in Patient Autonomy
Patient autonomy is a guiding healthcare principle upholding patients’ rights to independent treatment decisions. Chase (2020) notes numerous legal issues are linked with patient self-determination, most of which are topically informed consent. This progression ensures that patients are legally equipped to make treatment decisions and have the right to refuse treatment unless suspended by the court as incompetent. Obtaining informed consent involves informing patients about procedures, alternatives, risks, and benefits affecting their choices. Respect for autonomy involves balancing responsibility for patients’ decision-making rights against the duty to prevent harm. Fields (2020) elaborates that this can be cumbersome in developing client-care relationships, especially in psychiatric emergencies. Professionals must consider such situations, not violating clients’ rights while fulfilling health protection requirements.
Evidence-Based Suicide Risk Assessment
The Columbia-Suicide Severity Rating Scale (C-SSRS) is used for suicide risk assessments. It evaluates suicidal ideation and thoughts through professional questioning. Simpson et al. (2020) state that C-SSRS identifies suicide risks by assessing idea severity and past suicidal behavior. Flores-Kanter et al. (2023) assert that it allows health practitioners to judge appropriately on required attention and intervention. C-SSRS has been critical in various patient care settings like outpatient clinics, physician’s special psychiatric care, and emergency centers.
Evidence-Based Violence Risk Assessment
The HCR-20 instrument helps professionals estimate violence propensity from historical, clinical, and risk files. Challinor et al. (2021) note that the assessment signifies a systematic professional judgment proceeding from these variables to guide examination and actions. HCR-20 enables reasonable assessment of violent behavior according to past actions, current clinical state, and possible future factors. It is practiced in forensic and therapeutic settings to aid decision-making when considering treatment plan approaches and protocols. By populating the HCR-20, therapists assess risks associated with aggressive behavior and ways to protect oneself.
Conclusion
Health professionals should understand legal and ethical frameworks regarding psychiatric emergencies. Florida’s Baker Act articulates how involuntary psychiatric holds must be handled for individuals in crisis to receive emergency treatment and evaluation. Distinct separation of emergency hospitalization from inpatient or outpatient commitment provides care levels with individual considerations. Understanding capacity and competency distinctions enable responsible patient care decisions—legal issues related to informed consent and patient autonomy deal with respecting patients’ rights in healthcare delivery. Evidence-based assessment and management tools for suicidal and violent risks, such as C-SSRS and HCR-20, enhance patient outcomes.
References
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). https://doi.org/10.1186/s12888-020-02756-0
Challinor, A., Ogundalu, A., McIntyre, J. C., Bramwell, V., & Nathan, R. (2021). The empirical evidence base for the use of the HCR-20: A narrative review of study designs and transferability of results to clinical practice. International Journal of Law and Psychiatry, p. 78, 101729. https://doi.org/10.1016/j.ijlp.2021.101729
Chase, J. (2020). The ethics of compulsory treatment of addictions under Canadian legislation. The Canadian Journal of Addiction, 11(1), 6–13. https://doi.org/10.1097/cxa.0000000000000074
Fields, B. G. (2020). Regulatory, legal, and ethical considerations of Telemedicine. Sleep Medicine Clinics, 15(3), 409–416. https://doi.org/10.1016/j.jsmc.2020.06.004
Flores-Kanter, P. E., Alesandrini, C., & Alvarado, J. M. (2023). Columbia Suicide Severity Rating scale: Evidence of construct validity in Argentinians. Behavioral Sciences, 13(3), 198. https://doi.org/10.3390/bs13030198
Khan, S., & Jain, A. (2022). Telepsychiatry. Springer EBooks, pp. 241–248. https://doi.org/10.1007/978-3-030-91975-7_30
Maniaci, M. J., Burton, M. C., Lachner, C., Vadeboncoeur, T. F., Dawson, N. L., Roy, A., Dumitrascu, A. G., Lewis, P. C., & Rummans, T. A. (2019). Patients threatening harm to others evaluated in the emergency department under the Florida involuntary hold act (Baker Act). Southern Medical Journal, 112(9), 463–468. https://doi.org/10.14423/smj.0000000000001019
Simpson, S., Goans, C., Loh, R., Ryall, k., Allana Middleton, M. C., & Dalton, A. (2020). Suicidal ideation is insensitive to suicide risk after ED discharge: Performance characteristics of the Columbia-suicide severity rating scale screener. Academic Emergency Medicine, 28(6). https://doi.org/10.1111/acem.14198
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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.
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 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.
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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- To submit your completed assignment, save your Assignment as WK8Assgn_LastName_Firstinitial
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Rubric
NRNP_6675_Week8_Assignment_Rubric
Criteria | Ratings | Pts | ||||
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This criterion is linked to a Learning Outcome 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. |
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15 pts | ||||
This criterion is linked to a Learning Outcome • Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. |
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15 pts | ||||
This criterion is linked to a Learning Outcome • Explain the difference between capacity and competency in mental health contexts. |
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10 pts | ||||
This criterion is linked to a Learning Outcome • 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. |
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15 pts | ||||
This criterion is linked to a Learning Outcome •Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified. |
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15 pts | ||||
This criterion is linked to a Learning Outcome • Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified. |
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15 pts | ||||
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
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5 pts | ||||
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
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5 pts | ||||
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
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5 pts | ||||
Total Points: 100 |