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 also bridge the physical–mental health divide in healthcare.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
- 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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
- 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.
BY DAY 7 OF WEEK 8
Submit your Assignment. Attach copies of or links to the suicide and violence risk assessments you selected.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. (Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
- To submit your completed assignment, save your Assignment as WK8Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NRNP_6675_Week8_Assignment_Rubric
NRNP_6675_Week8_Assignment_Rubric
CriteriaRatingsPts
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
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
Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay
Considering the dynamic nature of client cases presenting mental health conditions, legal and ethical concerns related to psychiatric emergencies can be challenging and complex. PMHNPs have a key role in ddressing ethical and legal issues in this case. This assignment explores the legal and ethical concerns related to mental health emergencies and identifies evidence-based violence and suicide risk assessments.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
New Jersey 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.
In New Jersey, involuntary psychiatric holds are guided by NJ statutes. For an individual to be committed involuntarily, they must be mentally ill, which causes risks to self, others, or property as outlined in the New Jersey Statutes, and there are no appropriate services or facilities. The law states that an individual is deemed at risk to self and others when they have tried suicide, caused significant self-harm, or acted in a matter that justifies their inability to nourish themselves or seek medical care or shelter. Moreover, individuals are committed to involuntary hospitalization when it is determined that they are likely to inflict bodily injuries to others or damage property. Such determinations consider the patient’s history, current behavior, and recent acts threatening psychiatric deterioration.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
For adults, admission to a psychiatric facility should be based on referral, and a facility can keep an individual for up to 72 hours after that (Treatment Advocacy Centres, 2015). The facility must pursue a court process for the involuntary hold/commitment to obtain a temporary order, which the court issues within 72 hours of admission. Moreover, a designated law enforcement officer or psychiatric facility can initiate an involuntary psychiatric hold if they believe the individual is mentally ill and poses a danger to themselves or others. The hold can last for up to 72 hours, during which time the individual may be evaluated and treated by mental health professionals (New Jersey Courts, n.d). After 72 hours, a court hearing must be held to establish whether the individual should be committed/held in a psychiatric facility for further treatment.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
For children, an involuntary psychiatric hold can be initiated by a psychiatric facility, a designated law enforcement officer, a parent, a guardian, or a legal custodian (New Jersey Courts, n.d). However, no child should be involuntarily committed to a psychiatric facility for mental health treatment unless the court issues an order based on court proceedings initiated by the psychiatric facility. The hold can last up to 12 hours, during which mental health professionals may evaluate and treat the child. After 12 hours, a court hearing must be held to establish whether the child should be committed/held in a psychiatric facility for further treatment. Only mental health professionals can release an emergency hold if it is determined that the individual no longer meets the criteria for an involuntary hold and can be picked by family members or friends designated by the individual or the facility director for adults and parents or guardians for children.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
Emergency hospitalization for evaluation/psychiatric hold, inpatient and outpatient commitment in your state.
A psychiatric hold is a temporary hold of up to 72 or 12 hours for adults and children, respectively. Emergency hospitalization for psychiatric hold is employed when a person is considered a danger to themselves or others (State of New Jersey, 2018). As such, the psychiatric hold allows for psychiatric evaluation and stabilization of mental health personnel who recommend further action. A court hearing is necessary to determine the need for further commitment. On the other hand, inpatient commitment is determined by the court decision when a person is considered a danger to themselves or others, and treatment in a secure environment is necessary (State of New Jersey, 2018). Inpatient commitment can be initiated by a practitioner, a designated law enforcement authority, or a family member or legal representative for children. A court hearing is held to establish if the person meets the criteria for inpatient commitment.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
Outpatient commitment is determined by a court proceeding that requires a person to receive treatment for their mental illness while living in the community. Outpatient commitment is applied when an individual poses a danger to themselves or others but does not require inpatient hospitalization (State of New Jersey, 2018). The outpatient commitment may include regular mental health appointments, medication compliance, and regular check-ins with a mental health professional. A court hearing is held to establish if the person meets the criteria for outpatient commitment. Generally, psychiatric holds are short-term interventions to stabilize individuals in crisis, while outpatient and inpatient commitments are long-term interventions to treat and support individuals diagnosed with mental illnesses.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
Capacity and competency in mental health contexts.
Capacity refers to the ability of a patient to make informed decisions about their healthcare (Wheeler, 2020). This includes decisions related to mental health treatment and refusal of treatment. An individual’s capacity is affected by mental health, and legal requirements necessitate determining their capacity to process the information on their condition, the consequences of their decision, and provide informed consent. On the contrary, competency is the ability of an individual to participate in legal proceedings (Justia Law, 2019). Such competency is determined by a judge based on the person’s ability to comprehend legal charges, engage their attorney, and make decisions about their defense.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
Patient Autonomy
The legal concern of patient autonomy in treating psychiatric emergencies is the use of involuntary commitment or hospitalization. While involuntary hospitalization is crucial in upholding the safety of patients and others, it limits the individual’s autonomy and can deprive their civil liberties (Fariba & Gupta, 2020). The legal issue surrounds whether an individual meets the criteria for a psychiatric hold which the court determines. This process aims to balance the individual’s autonomy with the need to protect them from harm. The ethical concern of patient autonomy is seclusion and restraint in emergencies. While seclusion and restraint may be essential to prevent harm to the individual or others, they can also be traumatizing and result in the deprivation of the individual’s autonomy (Fariba & Gupta, 2020). In this regard, practitioners must balance non-maleficence with the individual’s right to autonomy and dignity.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
Evidence-based suicide risk assessment
The Columbia-Suicide Severity Rating Scale (C-SSRS) is a valid and effective tool for screening suicide ideation, intent, and behavior (Salvi, 2019). C-SSRS is administered by mental health personnel and can accurately predict suicide risks among patients in the past month and across a person’s lifetime. The risks of suicide are categorized as low, moderate, or high. Here’s the link to the assessment tool https://cssrs.columbia.edu/wp-content/uploads/C-SSRS_Pediatric-SLC_11.14.16.pdf.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
Evidence-based violence risk assessment
Historical Clinical Risk Management – 20 (HCR-20) is a tool for screening risk for violence among patients. HCR-20 examines clinical, situational, and historical risk factors (Cheng et al., 2019). HCR-20 is effective and administered by mental health personnel. Here is the link to the assessment tool http://hcr-20.com/hcr/wp-content/uploads/2013/03/HCR-V3-Rating-Sheet-2-page-CC-License-16-October-2013.pdf.(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
References
Cheng, J., Haag, A. M., & Olver, M. E. (2019). Predictors of Historical Clinical Risk Management-20 Version 3 (HCR–20: V3) summary risk ratings. Psychiatry, Psychology and Law, 26(4), 682-692. https://doi.org/10.1080%2F13218719.2019.1618753
Fariba, K., & Gupta, V. (2020). Involuntary Commitment. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557377/ (Accessed 9 March 2023)(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
Justia Law. (2019). 2019 New Jersey Revised Statutes Title 30 – Institutions and Agencies Section 30:4-27.33 – Involuntary commitment of a person lacking mental competence to stand trial. Available at: https://law.justia.com/codes/new-jersey/2019/title-30/section-30-4-27-33/ (Accessed 9 March 2023)
New Jersey Courts. (No date-a).RULE 4:74-7 – Civil Commitment – Adults. Available at: https://www.njcourts.gov/attorneys/rules-of-court/civil-commitment-adults (Accessed 9 March 2023)
New Jersey Courts. (No date-b). RULE 7:74-7A – Civil Commitment-Minors. Available at: https://www.njcourts.gov/attorneys/rules-of-court/civil-commitment-minors (Accessed 9 March 2023)
Salvi, J. (2019). Columbia-Suicide Severity Rating Scale (C-SSRS). Emergency medicine practice, 21(5), CD3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7974826/#(Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)
State of New Jersey. (May 2018). Assembly, No. 3986: 218th Legislature. Available at: https://pub.njleg.gov/bills/2018/A4000/3986_I1.HTM (Accessed 9 March 2023)
Treatment Advocacy Centres. (August 2015). Judges’ Quick Reference Guide to the New Jersey Involuntary Commitment Code and Related Rule of Court. Available at: (Legal and Ethical Issues Related To Psychiatric Emergencies Comprehensive Essay)https://www.treatmentadvocacycenter.org/storage/documents/NJ_Judges_Guide.pdf (Accessed 9 March 2023
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