Posted: January 26th, 2023

LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCIES

LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCIES
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of 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 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.
• Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
In 2–3 pages, address the following:
• Explain your state (ILLINOIS) 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 Assessment/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.
Submit your Assignment. Attach copies of or links to the suicide and violence risk assessments you selected.
RUBRIC
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. The response includes a thorough and well-organized explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
Explain the differences among emergency hospitalization for Assessment/psychiatric hold, inpatient commitment, and outpatient commitment in your state. The response includes an accurate and concise explanation of the differences among emergency hospitalization for Assessment/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.
The response accurately and concisely explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
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.
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.
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.
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.
Written 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.
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.
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In Illinois, laws for involuntary psychiatric holds for child and adult psychiatric emergencies are outlined in the Mental Health and Developmental Disabilities Code. According to the code, a person can be placed on an involuntary hold if they are deemed a danger to themselves or others, or if they are unable to provide for their basic needs and are in need of treatment. The hold can be placed by a licensed physician, clinical psychologist, or qualified examiner. The initial hold can last up to 72 hours, after which a hearing must be held to determine if the hold should be extended for up to 14 additional days. The hold can be released by a court order or by a licensed physician, clinical psychologist, or qualified examiner. The patient can be picked up by a family member or a designated caregiver after the hold is released.
In Illinois, there are several different types of commitments that can occur in a psychiatric emergency. Emergency hospitalization for Assessment, also known as a psychiatric hold, is a short-term involuntary commitment that allows for a person to be evaluated and treated in a hospital setting. Inpatient commitment is a longer-term involuntary commitment that allows for a person to be treated in a hospital or other inpatient facility. Outpatient commitment is a court-ordered treatment plan that allows for a person to receive treatment while living in the community.
In the context of mental health, capacity refers to a person’s ability to understand and make decisions about their own treatment. Competency refers to a person’s ability to stand trial or make decisions in a legal context. A person can have capacity but lack competency, or vice versa.
One legal and ethical issue that may apply within the context of treating psychiatric emergencies is patient autonomy. In terms of the legal aspect, involuntary holds and commitments can be seen as a violation of a person’s right to make decisions about their own treatment. On the ethical side, involuntary holds and commitments can also be seen as a violation of a person’s autonomy and dignity.
An evidence-based suicide risk assessment that could be used to screen patients is the Suicide Behaviors Questionnaire-Revised (SBQ-R). The SBQ-R is a four-item self-report measure that assesses suicide risk by asking about past suicide attempts, thoughts of suicide, and suicidal intent.
Another evidence-based violence risk assessment that could be used to screen patients is the Historical Clinical Risk Management-20 (HCR-20). The HCR-20 is a 20-item assessment tool that assesses a person’s risk of violence by looking at historical and clinical factors such as past violent behavior and mental health diagnosis.

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