Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example

Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example

Psychiatric emergencies describe profound thought, behavior, mood, or social relationship disturbances that call for urgent intervention as provided by the patient, family, or social unit to mitigate the imminent danger and its effects on the patients and other parties. The ultimate goal is to ensure the patient, surrounding people, and the medical team’s safety. Treatment for psychiatric emergencies focuses on patient stabilization, addressing the specific symptoms, and lastly trying to understand the underlying symptoms. It also calls for a consideration of vital legal aspects, especially concerning involuntary admissions. Notably, mental health practitioners should communicate consistently with the patient, surrounding family, and other healthcare team members to sustain the therapeutic alliance and emotional health. Common psychiatric emergencies include suicidal ideation or attempt, deliberate self-harm behavior, acute psychotic episodes with excited behavior and violence, alcohol and drug withdrawal symptoms, delirium tremens, depressive stupor, panic disorder with panic attacks, and dystonic reaction to psychotropic drugs. This paper discusses the legal and ethical issues related to psychiatric emergencies. (Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Texas State Laws for Involuntary Psychiatric Holds for Child and Adult Psychiatric Emergencies

Texas adopts the concept and process of involuntary commitment to address psychiatric emergencies, which involves using the legal approach to commit an individual to a mental health facility against their will or within their protests. The goal is to get an individual the needed medical treatment for the presenting mental health problem (Texas Law Help, 2023). Involuntary commitment is employed as the final resort, primarily recommended when a person cannot take care of themselves and presents with behaviors that show they are a threat to themselves and others. The magistrate or judge can order a peace officer to take a person to an inpatient mental health facility based on a filed mental warrant (Texas Law Help, 2023). Also, the peace officer can detain the individual without a court order or a warrant based on either personal observation or another individual’s reliable observation regarding recent behavior showing that there is not enough time to get a warrant before detention. Still, a psychiatrist has to assess the individual after detention and provide a medical certificate to the court serving as proof of potential harm to self or others. The court provides an order of protective custody (OPC) and holds a probing cause hearing within 3 days to determine whether the facility should continue holding the patient or release them (Texas Law Help, 2023). For minors, the parent, guardian, or managing conservator has to request admission of the patient through a request to the administrator of a facility. A psychiatrist can only discharge the patient after determining they are no longer a threat to themselves and others (Texas Law Help, 2023). The detaining facility arranges for patient pickup. Minors can only be released to their parents, guardian, or managing conservator. (Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment in Texas

Patients experiencing a psychiatric emergency can be detained or held in a mental health facility against their will for three days or 72 hours. Per Texas laws, the patient has to demonstrate potential harm to self and others, presenting with profound distress and considerable deterioration, and cannot take care of themselves or make rational and informed decisions regarding treatment (Texas Law Help, 2023). Inpatient commitment occurs when a magistrate orders mental health treatment for an individual who continues to fit Texas’ civil commitment criteria following a psychiatric hold (Texas Law Help, 2023). Conversely, outpatient commitment describes a treatment option where the magistrate issues an order to a merited individual with mental illness symptoms to comply with mental health treatment while living among other people.     

Capacity and Competency in Mental Health Contexts

Capacity determination involves assessing whether an individual can make informed medical decisions within a particular circumstance. It relates to a patient’s baseline abilities, considers only the current circumstance, and considers the severity of the potential consequences of a decision. mental health practitioners can determine capacity (Libby et al., 2023). Competency determination entails evaluating an individual’s ability to engage in legal proceedings. A hearing and evidence presentation is needed to disprove a person’s competencies. Only a judge can determine competency.(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Patient Autonomy in Psychiatric Emergencies

Patient autonomy is a central ethical and legal issue in psychiatric emergencies. A psychiatric hold means that the patient loses autonomy and cannot decide on treatment options. Several justifications exist for mental health practitioners to go against patient autonomy during psychiatric emergencies, including the very presentation of the patient in the emergency room or the magistrate’s order for a psychiatric hold (Becker & Forman, 2020). (Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)Competent patients can decline treatment, but patients presenting with psychiatric emergencies like suicide attempts and violent, psychotic, and suicidal behaviors obligate the practitioner to treat them, without which the practitioner can be charged with negligence. Generally, the practitioner should provide standard care, a legal requirement, during psychiatric emergencies (Becker & Forman, 2020). Additionally, the practitioner has the duty to warn during psychiatric emergencies to protect third parties like other patients and provide legal justification for using police officers to control a patient.    (Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Evidence-Based Suicide Risk Assessment Tool

The Columbia-Suicide Severity Rating Scale (C-SSRS) is an evidence-based suicide risk assessment tool that can be used to screen patients. It can be employed to screen children, adolescents, and adults. The tool evaluates passive and active suicidal ideation, approach, plan, and intent to act, and suicidal behavior (King et al., 2019). The tool provides robust information to help understand the risk level and plan for proper care in the least restrictive environment. The C-SSRS is short, with about 3-6 questions, and quickly filled without the need for responders to receive training.   (Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Evidence-Based Violence Risk Assessment Tool

The Behavioral Activity Rating Scale (BARS) is an evidence-based violence assessment tool that can be used to screen patients.(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example) It is a single-item tool that helps assess agitation (Carrarini et al., 2021). A score of 4 shows normal activity level, 5-7 show increased hyperactivity, and 1-3 reflect reduced activity or sedation. This tool has almost perfect interrater reliability and moderately correlates with the Clinical Global Impression of Severity and Positive and Negative Syndrome Scale scores. The tool is faster to administer and more receptive to unprecedented behavioral agitation changes.(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Conclusion

Psychiatric emergencies appear when patients experience severe levels of symptoms associated with a particular disorder. A patient has to indicate danger to self and others to warrant a psychiatric emergency. The court is involved in psychiatric emergencies and determining competency. Practitioners can adopt the C-SSRS and BARS to assess for suicide risk and violence risk, respectively. (Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

References

Becker, S. H. D., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies. Frontiers in psychiatry, 11, 127. https://doi.org/10.3389/fpsyt.2020.00127(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Carrarini, C., Russo, M., Dono, F., Barbone, F., Rispoli, M. G., Ferri, L., Di Pietro, M., Digiovanni, A., Ajdinaj, P., Speranza, R., Granzotto, A., Frazzini, V., Thomas, A., Pilotto, A., Padovani, A., Onofrj, M., Sensi, S. L., & Bonanni, L. (2021). Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.644317(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2019). Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk. Journal of clinical psychology in medical settings, 24(1), 8–20. https://doi.org/10.1007/s10880-017-9486-y(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Libby, C., Wojahn, A., & Nicolini, J. R. (2023). Competency and Capacity. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532862/(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

Texas Law Help. (2023, April 17). Involuntary commitment in Texas. https://texaslawhelp.org/article/involuntary-commitment-in-texas(Legal and Ethical Issues Related to Psychiatric Emergencies Comprehensive Nursing Paper Example)

https://www.ncbi.nlm.nih.gov/