Assignment: Legal and Ethical Issues Related To Psychiatric Emergencies

Assignment: Legal and Ethical Issues Related To Psychiatric Emergencies

Assignment: Legal and Ethical Issues Related To Psychiatric Emergencies

A psychiatric emergency is defined as an acute disturbance of a patient’s thoughts, behavior, or mood which if left untreated can cause harm, to the persons or others around the patient. The care of patients with psychiatric emergencies is weighed down by legal and ethical challenges. The purpose of this paper is to discuss state laws regarding involuntary psychiatric holds in psychiatric emergencies and explain the concepts of emergency hospitalization, inpatient commitment, outpatient commitment, capacity, and competency in mental health contexts.

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Georgia State Laws for Involuntary Psychiatric Holds for Child and Adult Psychiatric Emergencies

Georgia has a 72-hour hold rule that authorizes a 72-hour involuntary psychiatric hold. The rule applies to persons with a significant risk of imminent harm to themselves or others. This should be manifested by recent obvious acts or conveyed threats of violence that present a likelihood of physical injury to that individual or other persons. Besides, the 72-hour hold applies to persons unable to care for their physical health and safety to create an imminently life-endangering crisis and those in need of involuntary inpatient treatment (McGuffey, 2022). However, a physician must assess the patient and establish that the patient is mentally ill and needs hospitalization. If the patient is not examined by a physician, they must be discharged within 48 hours.

Emergency Hospitalization for Evaluation/Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment in Georgia

Emergency hospitalization for psychiatric hold in Georgia occurs when a physician signs a certificate stating that they have personally examined the patient in the past 48 hours and established that the examined patient is mentally ill and requires involuntary treatment (McGuffey, 2022). Inpatient commitment in Georgia is initiated when the treating physician determined that the patient meets or continues to meet the criteria for involuntary hospitalization (McGuffey, 2022). Outpatient commitment occurs when the treating physician identifies that the patient meets the criteria for mandated outpatient treatment.

The Difference between Capacity and Competency in Mental Health Contexts

Capacity is a person’s ability to make logical decisions, which is determined by a person’s ability to communicate their choice, understand the pertinent information, understand the risks and benefits, and rationally manipulate information (Dalal, 2020). On the other hand, competency is the mental and cognitive capability needed to rationally implement a legally recognized act.

Legal and Ethical Issues Related To This Topic

            A legal issue related to the treatment of psychiatric emergencies is privacy and confidentiality. Physicians must respect patient privacy and only disclose confidential information with the patient’s consent or when obligated by an overriding duty to protect others or to obey the law (Moskvitina et al., 2020). The law on disclosures differs between jurisdictions. Thus, emergency providers should understand the law in their jurisdictions and the primary ethical tensions in patient confidentiality. Nonmaleficence is an ethical issue related to psychiatric emergencies and involuntary holding. The aim of involuntary treatment should be to protect the patient from harm that they would not be exposed to, if they had the capacity or not impaired by their mental illness (Moskvitina et al., 2020). Physicians must consider if involuntary hospitalization outweighs the risks related to the deprivation of liberty.

Evidence-Based Suicide Risk Assessment

The Columbia-Suicide Severity Rating Scale (C-SSRS) is an assessment tool to screen patients for suicide. C-SSRS is a standardized suicide risk screening tool authorized for use with children, adolescents, and adults. It assesses passive and active suicidal ideation, plan, method, intent to execute the plan, and suicidal behavior (Salvi, 2019). It is based on a patient’s responses to screening questions but also incorporates information from other sources like family and friends.

Evidence-Based Violence Risk Assessment

The Historical Clinical Risk Management-20 tool (HCR-20) is a violence risk assessment tool that can be used to screen patients. It is widely adopted in forensic clinical practice for risk management planning. It assesses a person’s risk of violence, the relevance of the risk to their current situation, and the appropriate risk management strategies (Turton et al., 2022).  It accurately predicts violent behavior during treatment and after discharge in patients with psychological difficulties.

Conclusion

Georgia has a law allowing a 72-hour involuntary psychiatric hold to persons with a significant risk of imminent harm to themselves or others. Mental health providers regularly confront legal and ethical issues of confidentiality, privacy, capacity, consent, and involuntary treatment in psychiatric emergencies. Capacity is determined by healthcare professionals, while competency is a judicial decision.

References

Dalal, P. K. (2020). Consent in psychiatry – concept, application & implications. The Indian Journal of medical research, 151(1), 6–9. https://doi.org/10.4103/ijmr.IJMR_1518_19

McGuffey, D. (2022, September 6). Involuntary hospitalization and treatment of involuntary patients. EZ Elder Law. https://www.ezelderlaw.com/involuntary-hospitalization-and-treatment-of-involuntary-patients/

Moskvitina, U. S., Khamskaya, I. S., Ruzhenkova, V. V., Ruzhenkov, V. A., & Rzhevskaya, N. K. (2020). Psychiatric coercion and violence: ethical, legal and preventive aspects. Archivos Venezolanos de Farmacología y Terapéutica, 39(5), 568-575. https://doi.org/10.5281/zenodo.4265434

Salvi, J. (2019). Calculated Decisions: Columbia-Suicide Severity Rating Scale (C-SSRS). Emergency medicine practice, 21(5), CD3–CD4.

Turton, E., Myles, L., Lee, J., Saffin, V., & Lawson, A. (2022). Improving awareness of the HCR-20 and risk assessment process. The International journal of risk & safety in medicine, 33(S1), S79–S83. https://doi.org/10.3233/JRS-227029