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.
• Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
• 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”
In 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.
Submit your Assignment. Attach copies of or links to the suicide and violence risk assessments you selected.
The laws for involuntary psychiatric holds vary by state. In general, a licensed mental health professional, such as a PMHNP, can initiate a hold if they determine that a patient presents a danger to themselves or others. The length of the hold also varies by state, with some allowing for holds of up to 72 hours, while others allow for longer periods of time. The patient can be released by a licensed mental health professional, and they can be picked up by a designated caregiver or family member.
Emergency hospitalization for evaluation/psychiatric hold is typically used when a patient presents an immediate danger to themselves or others and requires immediate attention. Inpatient commitment is when a patient is admitted to a hospital for a longer period of time for further treatment and observation. Outpatient commitment is when a patient receives treatment on an outpatient basis, typically under court-ordered supervision.
Capacity refers to a patient’s ability to make decisions for themselves, while competency refers to a patient’s ability to understand the consequences of those decisions. In the context of mental health, a patient may have capacity but lack competency, meaning they can make decisions but may not fully understand the implications of those decisions.
A legal issue related to patient autonomy in the context of treating psychiatric emergencies is the issue of involuntary commitment. The patient may not want to be hospitalized or treated, but a mental health professional may determine that it is necessary for the patient’s safety and the safety of others. An ethical issue that may arise is balancing the patient’s autonomy with their right to receive appropriate care.
One evidence-based suicide risk assessment that can be used to screen patients is the Columbia-Suicide Severity Rating Scale (C-SSRS). It is a widely used assessment tool that helps identify suicide risk by asking questions about a patient’s suicidal thoughts, behaviors, and plans.
Another evidence-based violence risk assessment that can be used to screen patients is the Brøset Violence Checklist (BVC). It is a widely used assessment tool that helps identify a patient’s risk for violence by asking questions about a patient’s past violent behavior, current behavior, and potential triggers for violence.