NRNP 6675 Legal and Ethical Issues Related to Psychiatric Emergencies
Psychiatric emergencies entail severe disturbances in mood, thought, behavior, and social relationships and interactions that necessitate immediate intervention plans as defined by an individual, their family, or social unit. These immediate interventions are essential to save the patient and those close to them from possible or impending harm (including self-harm) and danger to themselves and others. Across many states in the U.S., psychiatric emergency holds laws and statutes, including in Illinois, permit involuntary admission of an individual with an acute mental illness to a healthcare facility under prescribed circumstances (Zakhari, 2021). The purpose of this paper is to explore legal and ethical issues concerning psychiatric emergencies and identify evidence-based suicide and violence risk assessments in Illinois.
Illinois State Laws for Involuntary Psychiatric Holds for Child & Adult Psychiatric Emergencies
In Illinois, an individual, either an adult or a child, can be admitted on psychiatric holds if there is a possibility of self-harming or posing danger to others. There are two types of involuntary admission in Illinois; by a court or through an application. Individuals who are involuntarily admitted to a psychiatric hold or are being treated for mental health and substance abuse and live in northern Illinois have more protections. In this case, admission by certification is the main process through which most individuals get admitted to a psychiatric hold in Illinois (Illinois Legal Aid Online, 2023). This can happen even without a court order as it entails filing a petition for immediate hospitalization of the affected person in the circuit court in their respective county.
The person filing the petition should be at least 18 years. The facility can release the individual after 24 hours of admission unless a certificate is filed upon which the person can be on hold for a further total of 72 hours that include the initial 24 hours. The emergency hold can only release an individual under involuntary hold to the guardian, or lawyer after 24 hours or process transportation to a mental health facility based on certification after examination by the physician (Zakhari, 2021). In the case of a child, the process provides that a child can be released or discharged if the current assessment shows that they no longer require emergency hospitalization. For adults, involuntary commitment applies to individuals with psychiatric disabilities and can cause harm to themselves or others or gravely disabled.
Differences: Emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient Commitment
In Illinois, emergency hospitalization for evaluation or psychiatric hold entails response to a crisis where one is admitted to a hospital’s emergency setting or treatment facility for providers to carry out a psychiatric assessment or examination. The admission time is usually 24 hours and can be extended through a court petition or application. Inpatient commitment entails a circuit court judge ordering the hospitalization of an individual who meets the state civil commitment criteria upon the emergency evaluation by at least two mental health providers. On its part, outpatient commitment occurs when one files a petition for involuntary admission in outpatient and presents it to a judge who determines if the individual in question should be committed to the described facility. The petition should be supported by at least two pieces of evidence called outpatient certificates from a psychiatrist and another clinician (Illinois Legal Aid Online, 2023b). The judge orders the qualifying individual presenting mental illness symptoms to adhere to a mental health treatment plan while outside the facility.
Differences Between Capacity and Competence in Mental Health
Capacity and competence are core aspects of mental health that affect the provision of care and interventions by psychiatric mental health nurse practitioners (PMHNPs). Capacity is the ability and cognitive functionality that allows one to make conscious and effective decisions based on the information offered. Competence on its part implies the ability to perform or execute actions required to effect the decisions and choices that one makes (Bipeta, 2019). Questions of capacity in mental health emanate from legal aspects while competence requires cognition to effect the decisions. Competence requires knowledge based on expertise and experience, skills or mental abilities and attitudes as well as personality traits that inform one’s perspective or worldview.
Legal and Ethical Issues of Confidentiality in Psychiatric Emergencies
Confidentiality is a core aspect that influences and affects the relationship between PMHNP and patients. Psychiatric nurses have a responsibility of keeping patients’ data and conditions confidential and never disclose such information. When a patient allows a nurse to disclose such information, the nurse should ensure that the process emanates from informed consent signed by the individual (Becker et al., 2020). The written authorization protects the nurse from any legal suits or redress that a patient may pursue and also lays the foundation for ethical practice by the nurse.
Despite the expected legal provision, ethical situations may compel nurses to disclose such information to third parties, especially in situations where non-disclosure can cause harm to others. The nurse may be compelled to give information during emergencies to protect other people who may be harmed because of the patient’s actions and situation (Bipeta 2019). Others include having infectious diseases and treating injuries that may lead to a criminal investigation or require directives from courts.
Evidence-Based Suicide Risk Assessment Tool
The Patient Health Questionnaire-9 (PHQ-9) is an evidence-based suicide risk assessment tool that contains questions that a provider can use in screening, diagnosing, and monitoring mental health conditions like depression and anxiety. The tool also evaluates the degree of severity of the mental issues. The tool contains one question that screens for the presence and duration of suicidal ideation (King et al., 2019). Screening patients for suicidal risks is essential as it allows the initiation of early treatment interventions and plans.
One Evidence-Based Violence Risk Assessment Tool
The Forensic Violence Oxford (FoVOx) is an evidence-based violence risk assessment tool that helps screen possible violent conduct of individuals in healthcare settings. The tool consists of 12 items that assist in determining the violence risks in mental health patients. The tool is not only feasible but also practical and easy to use (Cornish et al., 2019). It also assists in addressing the inconsistency at the time of discharge and may help clinicians to make better decisions if used routinely.
Mental health nurse practitioners like PMHNPs need to understand the different legal and ethical aspects that govern the treatment of patients in psychiatric emergencies, especially within their practice jurisdictions. Ensuring that they understand these provisions is critical to offering the best care and complying with the requirements. Assessment tools for suicide and violence are key to developing the right interventions to help patients get better outcomes.
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 &
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.
Illinois Legal Aid Online (2023b). Getting an outpatient commitment order.
King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). 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-
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual.
Springer Publishing Company. Chapter 15, “Violence and Abuse”