Legal and Ethical Issues Related to Psychiatric Emergencies Essay

Legal and Ethical Issues Related to Psychiatric Emergencies Essay

Legal and Ethical Issues Related to Psychiatric Emergencies Essay

Several legal and ethical questions arise while responding to psychiatric emergencies in mental health. This paper explores some of the more complex areas of psychiatric care, including emergency hospitalization, competency, capacity, and patient confidentiality. In addition, it analyzes the most important suicide and violence risk assessment instruments used to recognize and control such threats in patients and others.

Arizona State Laws

Arizona laws state that an “admitting officer” is responsible for evaluating the physical and psychiatric condition of the person presented for admission to ascertain if there is a reasonable cause to render the person a danger to themselves or others. In this case, an admitting officer means a psychiatrist, physician, or mental health nurse practitioner with experience evaluating and admitting persons (LawServer, n.d.). The laws make exceptions that if the above procedures are not present, a peace officer can take the person into custody if they have a probable reason to. Anyone taken into custody through an emergency admission should not be detained for more than 24 hours, without considering the holidays and weekends following admission, unless an evaluation is filed through a court directive (LawServer, n.d.). If the decision made by the medical director in charge of evaluation is appropriate, the person can be released. A guardian of the patient can pick them up after discharge.

Emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment

Emergency hospitalization for evaluation/psychiatric refers to a circumstance in which an individual is taken against their will to a hospital due to a mental health crisis and poses an urgent danger to themselves or others. It is often a short-term measure, lasting fewer than 24 hours, during which mental health specialists assess the subject to decide whether additional intervention is required. The formal legal process of inpatient commitment entails placing a person under the care of a mental health care provider for an extended length of time, usually for treatment, observation, or stabilization. To do this, a judge must issue an order and hold a hearing at which evidence of the person’s mental illness and risk to themselves or others can be presented. Outpatient commitment permits authorities to enforce mental health care for people who may not need emergency hospitalization but pose a risk to themselves or others. Mental health professionals will monitor one’s progress following a court-ordered treatment plan that may include frequent therapy sessions, medication, and supervision.

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Capacity and Competency

When discussing a person’s mental health, “capacity” refers to their ability to make informed choices about their care, treatment options, and legal issues. The assessment evaluates the candidate’s ability to comprehend significant information, consider potential outcomes, and articulate decisions (King et al., 2022). “Competency,” on the other hand, is a legal term that establishes whether a person can stand trial or otherwise take part in a legal action (King et al., 2022). While capacity and competency refer to a person’s mental faculties, capacity is concerned with making decisions in a confined context, while competency is concerned with the person’s ability to understand and apply the law generally.

Confidentiality

Under the Health Insurance Portability and Accountability Act (HIPAA) privacy rule, treating psychiatric emergencies raises a legal concern regarding confidentiality. To safeguard the patient’s and the public’s safety, healthcare providers must balance keeping a patient’s sensitive mental health information confidential and sharing it with relevant parties like family members or law the authorities (Bani Issa et al., 2020). Finding this balance can be challenging since oversharing or hiding key facts can negatively affect care and intervention.

The ethical issue surrounding confidentiality in psychiatric emergencies revolves around patient autonomy and trust. Promoting a therapeutic connection and protecting patient autonomy necessitates strict adherence to patient confidentiality. Clinicians face ethical dilemmas when deciding whether or not to break patient confidentiality to prevent imminent danger to the patient or others. When faced with a mental emergency, healthcare personnel must keep the patient’s trust while acting ethically in information disclosure concerns.

Suicide risk assessment tool: The Ask Suicide-Screening Questions (ASQ) Tool

The Ask Suicide-Screening Questions (ASQ) tool is a quick and verified screening tool for kids and adults in medical settings. The Joint Commission has approved this quick and easy test that asks only four simple yes/no questions and takes about 20 seconds to complete. Healthcare providers can use the ASQ to better detect and evaluate patients at risk for suicide (National Institute of Mental Health, 2022). It is a vital resource for suicide prevention because of its reliability in identifying suicidal ideation in young people and adults receiving medical care.

Violence risk assessment tool: The Violence Assessment Tool

The Violence Assessment Tool is reliable in determining an individual’s potential for violent acts. It has widespread application in institutional settings like hospitals, psychiatric wards, and prisons. The tool uses a systematic assessment to identify warning signs that may indicate violent tendencies. To reduce the likelihood of adverse outcomes and increase the security of the individual and their surroundings, professionals can use the VAT to comprehend better and manage the risk of violence in individuals.

Conclusion

Maintaining patient rights while ensuring public safety is an extremely difficult way to navigate legal and ethical considerations in psychiatric emergencies. Professionals in the healthcare sector have an important duty to protect the confidentiality of patients while also providing effective, timely care. Improved mental health outcomes result from the use of trustworthy evaluation tools, which improve the capacity to recognize and treat those in need of care.

References

Bani Issa, W., Al Akour, I., Ibrahim, A., Almarzouqi, A., Abbas, S., Hisham, F., & Griffiths, J. (2020). Privacy, confidentiality, security, and patient safety concerns about electronic health records. International Nursing Review, 67(2), 218–230. https://doi.org/10.1111/inr.12585

LawServer. (n.d.). Arizona Laws > Title 36 > Chapter 5 > Article 4 – Court-Ordered Evaluation» LawServer. Retrieved July 19^th, 2023, from https://www.lawserver.com/law/state/arizona/az-laws/arizona_laws_title_36_chapter_5_article_4

National Institute of Mental Health. (2022). Ask Suicide-Screening Questions (ASQ) Toolkit. Retrieved July 19^th, 2023, from https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials

King, K. C., Martin Lee, L. M., & Goldstein, S. (2022). EMS Capacity and Competency. In StatPearls. StatPearls Publishing.

Appendix

The Ask Suicide-Screening Questions (ASQ) Tool

The Violence Assessment Tool

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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.

You need to 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 include 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.

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NRNP_6675_Week8_Assignment_Rubric

NRNP_6675_Week8_Assignment_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeIn 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 pts Excellent 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 pts Good 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 pts Fair 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 pts Poor 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 pts Excellent 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 pts Good 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 pts Fair 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 pts Poor 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 pts Excellent 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 pts Good 80%–89% The response includes an accurate explanation of the difference between capacity and competency in mental health contexts. 7 to >6.0 pts Fair 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 pts Poor 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 pts Excellent 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 pts Good 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 pts Fair 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 pts Poor 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 pts Excellent 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 pts Good 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 pts Fair 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 pts Poor 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 pts Excellent 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 pts Good 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 pts Fair 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 pts Poor 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 OutcomeWritten 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 pts Excellent 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 pts Good 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 pts Fair 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 pts Poor 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 OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 pts Excellent 90%–100% Uses correct grammar, spelling, and punctuation with no errors 4 to >3.5 pts Good 80%–89% Contains 1-2 grammar, spelling, and punctuation errors 3.5 to >3.0 pts Fair 70%–79% Contains 3-4 grammar, spelling, and punctuation errors 3 to >0 pts Poor 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 OutcomeWritten 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 pts Excellent 90%–100% Uses correct APA format with no errors 4 to >3.5 pts Good 80%–89% Contains 1-2 APA format errors 3.5 to >3.0 pts Fair 70%–79% Contains 3-4 APA format errors 3 to >0 pts Poor 0%–69% Contains five or more APA format errors	5 pts
Total Points: 100

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