NRNP 6675 Legal and Ethical Issues Related to Psychiatric Emergencies
Psychiatric emergencies encompass severe disruptions in mood, thought, behavior, and social interactions that necessitate immediate interventions, as determined by the individual, their family, or social support system. These interventions are crucial for preventing potential harm, including self-harm, to the patient and others. In many U.S. states, including Illinois, laws and regulations govern involuntary admissions of individuals with acute mental illness to healthcare facilities (Zakhari, 2021). This paper delves into the legal and ethical aspects of psychiatric emergencies and explores evidence-based suicide and violence risk assessments in Illinois.
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Illinois State Laws on Involuntary Psychiatric Holds for Adult and Child Psychiatric Emergencies
In Illinois, individuals, whether adults or children, can be placed under psychiatric holds if they pose a risk of self-harm or harm to others. There are two types of involuntary admissions in Illinois: court-ordered and application-based. Involuntary admissions for mental health and substance abuse treatment in northern Illinois often involve the certification process. This process allows admission without a court order by filing a petition for immediate hospitalization in the circuit court of the individual’s respective county (Illinois Legal Aid Online, 2023).
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The petitioner must be at least 18 years old. The facility may release the individual after 24 hours unless a certification is filed, which allows the person to remain under hold for an additional 72 hours, including the initial 24 hours. An individual under involuntary hold can only be released to a guardian or attorney after 24 hours or transported to a mental health facility based on physician certification following an examination (Zakhari, 2021). For children, they can be released when a current assessment indicates they no longer require emergency hospitalization. In the case of adults, involuntary commitment applies to individuals with psychiatric disabilities who pose a danger to themselves or others or are gravely disabled.
Distinguishing Between Emergency Hospitalization, Inpatient Commitment, and Outpatient Commitment
In Illinois, emergency hospitalization or psychiatric hold refers to a response to a crisis, where an individual is admitted to a hospital’s emergency department or a treatment facility for a psychiatric assessment or examination. The typical admission duration is 24 hours, extendable through court petition or application. Inpatient commitment, on the other hand, occurs when a circuit court judge orders an individual’s hospitalization after two mental health providers’ emergency evaluation, provided the individual meets state civil commitment criteria. Outpatient commitment involves filing a petition for involuntary admission in an outpatient setting, submitted to a judge who determines if the individual should follow a mental health treatment plan while outside the facility. The petition must be supported by at least two outpatient certificates from a psychiatrist and another clinician (Illinois Legal Aid Online, 2023b).
Distinguishing Capacity and Competence in Mental Health
Capacity and competence are fundamental concepts in mental health care and significantly impact the roles of psychiatric mental health nurse practitioners (PMHNPs). Capacity refers to the cognitive ability to make informed and effective decisions based on provided information. Competence, on the other hand, entails the capability to carry out actions necessary to implement those decisions (Bipeta, 2019). Capacity issues in mental health stem from legal considerations, while competence requires the cognitive ability to execute decisions, requiring expertise, skills, mental abilities, and personality traits to shape one’s perspective.
Legal and Ethical Implications of Confidentiality in Psychiatric Emergencies
Confidentiality is a cornerstone of the patient-PMHNP relationship. Psychiatric nurses are obligated to maintain patients’ confidentiality and refrain from disclosing their information. Patient consent is essential for any disclosure, and it should be informed and documented, safeguarding nurses from legal actions and fostering ethical practice (Becker et al., 2020). However, ethical dilemmas may arise, prompting nurses to divulge information to third parties, particularly in situations where non-disclosure could endanger others. Nurses may be compelled to disclose information during emergencies to protect individuals at risk due to the patient’s actions or condition.
Evidence-Based Suicide Risk Assessment Tool
The Patient Health Questionnaire-9 (PHQ-9) is a validated suicide risk assessment tool used to screen, diagnose, and monitor mental health conditions like depression and anxiety. It also gauges the severity of mental health issues, including suicidal ideation (King et al., 2019). Early screening for suicide risk is essential to initiate timely interventions and treatment plans.
One Evidence-Based Violence Risk Assessment Tool
The Forensic Violence Oxford (FoVOx) is a validated violence risk assessment tool that screens for potential violent behavior in mental health patients. Comprising 12 items, this tool assists in determining violence risks. It is practical, easy to use, and helps clinicians make better decisions, especially during patient discharge (Cornish et al., 2019).
In Conclusion
Mental health nurse practitioners, like PMHNPs, must have a comprehensive understanding of the legal and ethical dimensions governing patient care in psychiatric emergencies within their respective practice jurisdictions. Comprehending these provisions is vital for delivering optimal care while adhering to legal requirements. Suicide and violence risk assessment tools play a pivotal role in tailoring interventions to achieve positive patient outcomes.
References
Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies. Frontiers in Psychiatry, 11, 127. DOI: 10.3389/fpsyt.2020.00127
Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian Journal of psychological medicine, 41(2), 108-112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19
Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones &Bartlett Learning.
Cornish, R., Lewis, A., Parry, O. C., Ciobanasu, O., Mallett, S., & Fazel, S. (2019). A clinical feasibility study of the forensic psychiatry and violence Oxford (FoVOx) tool.
Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.0090
Illinois Legal Aid Online (2023). Being admitted to a mental health facility in an emergency. https://www.illinoislegalaid.org/legal-information/being-admitted-mental-health-facility-emergency
Illinois Legal Aid Online (2023b). Getting an outpatient commitment order. https://www.illinoislegalaid.org/legal-information/getting-outpatient-commitment-order
King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). Suicide Risk Screening in HealthcareSettings: 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-
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company. Chapter 15, “Violence and Abuse”
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