A psychiatric emergency is a situation that if left untreated is likely to cause harm to oneself or others. These acute disturbances of behavior may manifest as suicidal ideation or attempts, violence, agitation, drug overdose, delirium, psychosis, mania, neuroleptic malignant syndrome, or serotonin syndrome. When psychiatric emergencies arise, they can present many challenges to the PMHNP. While many approaches to emergencies are similar when dealing with children and adolescents versus adults, significant differences also exist. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency.
This week, you examine psychiatric emergencies and explain the ethical and legal issues surrounding these events. You will also review evidence-based suicide and violence risk assessments that you may use to screen patients.
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 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.
Attach copies of or links to the suicide and violence risk assessments you selected. You will lose points if you do not attach copies or links to the suicide and violence risk assessments you selected in the body of your paper or as appendices which are separate from the reference list. It is not enough to only include the references for the links in the list of references.
You will lose points if your paper has more than 3 pages (excluding the title page of the assignment, reference list, and appendices if any).
You will lose points if your paper does not follow APA style. APA style includes use of headings and page numbers. Insert page numbers in the top right corner. Make sure your assignment is double-spaced. You need to include headings to identify the content of each of the distinct topics you are asked to address. Review the syllabus for explanation of primary and secondary sources.
• Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
o Chapter 7, “Negligence and Malpractice”
o Chapter 8, “Risk Management”
o Chapter 16, “Resolving Ethical Dilemmas”
• National Institute for Health and Care Excellence (2019). Brøset violence checklist Links 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)
o Chapter 23, “Emergency Psychiatric Medicine”
o 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.
o Chapter 19, “Legal Issues in the Care and Treatment of Children With Mental Health Problems”
o Chapter 64, “Suicidal Behavior and Self-Harm”
• U.S. Department of Veterans Affairs. (2019). VA/DoD clinical practice guidelines Links to an external site.: Assessment and management of patients at risk for suicide (2019).
• Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
o Chapter 15, “Violence and Abuse”
Psychiatric emergencies are situations that require immediate attention to prevent harm to oneself or others. These can include suicidal ideation or attempts, violence, agitation, drug overdose, delirium, psychosis, mania, neuroleptic malignant syndrome, or serotonin syndrome. PMHNPs play an important role in addressing these emergencies by coordinating care with other members of the healthcare team and law enforcement officials (when needed), and communicating with family members.
State Laws for Involuntary Psychiatric Holds
The laws for involuntary psychiatric holds vary by state. In my state, involuntary psychiatric holds are also known as involuntary commitment or emergency hospitalization for evaluation. These can be ordered for both child and adult psychiatric emergencies. An involuntary psychiatric hold can be ordered by a licensed physician or PMHNP, and can last for up to 72 hours. The individual must be released if they are no longer considered a danger to themselves or others. The patient can be picked up by a family member or designated caregiver after the hold is released.
Differences among Emergency Hospitalization, Inpatient Commitment, and Outpatient Commitment
In my state, emergency hospitalization for evaluation is a short-term measure used to stabilize an individual during a psychiatric emergency. Inpatient commitment is a longer-term measure, typically lasting several days to weeks, and is used for individuals who require more intensive treatment. Outpatient commitment is a less restrictive measure, in which individuals receive treatment on an outpatient basis but are court-ordered to comply with a specific treatment plan.
Capacity and Competency
Capacity refers to an individual’s ability to understand, appreciate, and make decisions about their mental health treatment. Competency refers to an individual’s ability to stand trial or make decisions about legal matters. In the context of psychiatric emergencies, capacity is often assessed to determine if an individual is able to make decisions about their treatment and whether involuntary measures, such as involuntary commitment, are necessary.
Legal and Ethical Issues: Patient Autonomy
One legal issue related to patient autonomy in the context of psychiatric emergencies is involuntary commitment. Involuntary commitment can limit an individual’s autonomy by forcing them to receive treatment against their will. An ethical issue related to patient autonomy is balancing an individual’s right to make decisions about their treatment with their safety and the safety of others. It is important for PMHNPs to consider both the legal and ethical implications of involuntary commitment and to involve the individual in the decision-making process as much as possible.
Evidence-based Suicide Risk Assessment
One evidence-based suicide risk assessment that can be used to screen patients is the Suicide Assessment Scale (SAS). The SAS is a brief, self-report measure that assesses suicide risk in adults. It includes 11 items that assess suicidal ideation, hopelessness, and depression.
Evidence-based Violence Risk Assessment
One evidence-based violence risk assessment that can be used to screen patients is the Brøset Violence Checklist (BVC). The BVC is a structured professional judgement tool that assesses the risk of violence in adult psychiatric patients. It includes 22 items that assess demographic information, history of violence, substance abuse, and psychosocial factors.