LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCY

LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCY

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of the 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.

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 between 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.

LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCY

Psychiatric emergencies are acute situations in which individuals with mental health issues present with severe disturbances in thought, mood, or behavior, posing a risk to themselves or others. Navigating these emergencies involves balancing legal and ethical considerations with the immediate need for treatment.

1. Informed Consent: Informed consent is an ethical and legal requirement for all medical treatments, including psychiatric interventions. However, obtaining informed consent can be challenging in a psychiatric emergency, especially if the patient’s mental state compromises their capacity to understand the nature of the treatment, its benefits, risks, and alternatives.
2. Confidentiality: Confidentiality is another key legal and ethical principle in healthcare. However, in a psychiatric emergency, it may be necessary to break confidentiality if the patient is at immediate risk of harming themselves or others.
3. Involuntary Hospitalization: If a patient poses a serious risk to themselves or others, involuntary hospitalization, also known as civil commitment, may be necessary. This practice raises ethical and legal issues around personal liberty and autonomy. Laws about involuntary hospitalization vary by jurisdiction but typically require clear evidence of imminent danger.
4. Use of Restraint or Seclusion: In some cases, physical or chemical restraints or seclusion may be necessary to prevent harm. These practices must be used as a last resort when less restrictive interventions have failed, and they must be applied in the least restrictive way possible to protect the patient’s rights.
5. Duty to Warn: If a psychiatrist believes that a patient poses a specific and imminent threat to another person, they may have a legal duty to warn the potential victim or to notify law enforcement, even if this requires breaking patient confidentiality. This principle, which arises from the landmark Tarasoff case in the United States, can raise complex ethical and legal dilemmas.

Navigating these legal and ethical issues requires a careful balancing act, taking into consideration the patient’s rights and autonomy, the safety of the patient and others, and the legal and professional obligations of the healthcare providers. When dealing with these complex situations, healthcare providers often rely on established ethical principles, professional guidelines, and consultation with ethicists or legal advisors.