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

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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.

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 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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Rubric

NRNP_6675_Week8_Assignment_Rubric

Criteria

Ratings

Pts

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.

15 to >13.0 ptsExcellent 90%–100%

The response includes a thorough and well-organized explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

13 to >11.0 ptsGood 80%–89%

The response includes an accurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

11 to >10.0 ptsFair 70%–79%

The response includes a somewhat vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

10 to >0 ptsPoor 0%–69%

The response includes a vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies. Or the response is missing.

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.

15 to >13.0 ptsExcellent 90%–100%

The response includes an accurate and concise explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

13 to >11.0 ptsGood 80%–89%

The response includes a well-organized explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

11 to >10.0 ptsFair 70%–79%

The response includes a somewhat vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

10 to >0 ptsPoor 0%–69%

The response includes a vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Or the response is missing.

15 pts

This criterion is linked to a Learning Outcome • Explain the difference between capacity and competency in mental health contexts.

10 to >8.0 ptsExcellent 90%–100%

The response includes an accurate and concise explanation of the difference between capacity and competency in mental health contexts.

8 to >7.0 ptsGood 80%–89%

The response includes an accurate explanation of the difference between capacity and competency in mental health contexts.

7 to >6.0 ptsFair 70%–79%

The response includes a somewhat vague or incomplete explanation of the difference between capacity and competency in mental health contexts.

6 to >0 ptsPoor 0%–69%

The response includes a vague or inaccurate explanation of the difference between capacity and competency in mental health contexts. Or the response is missing.

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.

15 to >13.0 ptsExcellent 90%–100%

The response accurately and concisely explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

13 to >11.0 ptsGood 80%–89%

The response accurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

11 to >10.0 ptsFair 70%–79%

The response somewhat vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

10 to >0 ptsPoor 0%–69%

The response vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies. Or, response is missing.

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.

15 to >13.0 ptsExcellent 90%–100%

The response identifies and explains an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

13 to >11.0 ptsGood 80%–89%

The response identifies an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

11 to >10.0 ptsFair 70%–79%

The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.

10 to >0 ptsPoor 0%–69%

The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.

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.

15 to >13.0 ptsExcellent 90%–100%

The response identifies and explains an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

13 to >11.0 ptsGood 80%–89%

The response identifies an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

11 to >10.0 ptsFair 70%–79%

The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.

10 to >0 ptsPoor 0%–69%

The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.

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.

5 to >4.0 ptsExcellent 90%–100%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.5 ptsGood 80%–89%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 to >3.0 ptsFair 70%–79%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.

3 to >0 ptsPoor 0%–69%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.

5 pts

This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 ptsExcellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors

4 to >3.5 ptsGood 80%–89%

Contains 1-2 grammar, spelling, and punctuation errors

3.5 to >3.0 ptsFair 70%–79%

Contains 3-4 grammar, spelling, and punctuation errors

3 to >0 ptsPoor 0%–69%

Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding

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.

5 to >4.0 ptsExcellent 90%–100%

Uses correct APA format with no errors

4 to >3.5 ptsGood 80%–89%

Contains 1-2 APA format errors

3.5 to >3.0 ptsFair 70%–79%

Contains 3-4 APA format errors

3 to >0 ptsPoor 0%–69%

Contains five or more APA format errors

5 pts

Total Points: 100