- Explain your state laws (STATE OF MARYLAND USA) 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 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.
- Identify one evidence-based suicide risk assessment that you could use to screen patients.
How to solve
LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCIES
Introduction:
In the State of Maryland, the laws regarding involuntary psychiatric holds for child and adult psychiatric emergencies aim to ensure the safety and well-being of individuals experiencing mental health crises. These laws outline the procedures for holding patients involuntarily, releasing emergency holds, and determining who can pick up the patient after the hold is released. Additionally, the state recognizes the importance of differentiating between emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment. Understanding the distinctions between these terms is crucial when addressing psychiatric emergencies in Maryland.
Answer 1:
In the State of Maryland, a qualified health professional, an authorized officer of an approved facility, or a designated agent of the Department of Health can hold a patient involuntarily for psychiatric emergencies. The duration of the hold depends on the age of the patient. For child psychiatric emergencies (under 18 years old), the initial hold can last up to 48 hours, followed by a 7-day hold if necessary. However, adult psychiatric emergencies (18 years and older) have an initial hold period of up to 48 hours, extendable for an additional 7 days if required.
The release of an emergency hold in Maryland can only be authorized by a licensed physician or a mental health professional designated by the facility. This decision must be made based on a thorough assessment of the patient’s condition and risk to themselves or others. Once the hold is released, the patient can be discharged, transferred to another facility or program, or released to a responsible individual defined either by kinship or a significant relationship with the patient.
Answer 2:
Emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment represent three distinct levels of psychiatric care in Maryland.
Emergency hospitalization for evaluation/psychiatric hold refers to the involuntary admission of an individual for immediate assessment when their mental health condition poses a risk to themselves or others. This hold is typically short-term and focused on stabilization and evaluation purposes.
Inpatient commitment involves the voluntary or involuntary admission of an individual to a psychiatric facility for a more extended period. It requires the criteria of the individual being dangerous to themselves or others or being unable to provide for their own basic needs due to a mental disorder. Inpatient commitment allows for comprehensive treatment and planning.
Outpatient commitment, also known as assisted outpatient treatment, allows individuals with mental illnesses to receive treatment while living in the community instead of a psychiatric facility. It may involve court-ordered treatment plans, medication compliance, therapy, or other required interventions. Outpatient commitment aims to strike a balance between patient autonomy and ensuring necessary treatment.
Answer 3:
Capacity and competency are two essential concepts in mental health contexts, although they represent different aspects.
Capacity refers to an individual’s ability to make informed decisions regarding their healthcare or treatment. It evaluates whether an individual can understand the relevant information about their condition, comprehend the risks and benefits of available treatment options, and communicate their decision effectively. Capacity assessments are situation-specific and can change over time.
Competency, on the other hand, relates to a person’s legal ability to make decisions or participate in legal proceedings, such as signing contracts or making healthcare choices. It is a determination made by a court rather than a clinical assessment. Competency evaluations assess a person’s mental ability to understand the nature of legal proceedings and assist in their own defense.
While capacity centers around clinical decision-making within the realm of healthcare, competency involves legal decision-making and participation in legal processes.
Answer 4:
One legal issue related to treating psychiatric emergencies is patient autonomy. Patient autonomy refers to an individual’s right to make decisions regarding their healthcare, including the refusal of treatment. In psychiatric emergencies, there may be instances where a patient’s decision to refuse recommended or necessary treatment conflicts with the healthcare provider’s judgment. Balancing patient autonomy with ensuring the patient’s safety and well-being can present ethical and legal challenges.
One ethical issue that may arise within the context of treating psychiatric emergencies is confidentiality. Mental health professionals are bound by strict confidentiality rules to protect patients’ sensitive information. However, in emergency situations where an individual poses a danger to themselves or others, there may be a need to disclose relevant information to ensure the safety of all parties involved. Balancing the duty to maintain patient confidentiality with the duty to protect individuals from harm can create ethical dilemmas.
Answer 5:
One evidence-based suicide risk assessment that can be used to screen patients is the Columbia-Suicide Severity Rating Scale (C-SSRS). This tool is widely recognized and utilized in the mental health field. It consists of several questions that aim to assess the severity of suicidal ideation, behavior, and intent. The C-SSRS helps identify individuals at risk of suicide and guides appropriate interventions and treatment planning.
Conclusion:
Understanding the laws and regulations regarding involuntary psychiatric holds, differentiating between emergency hospitalization, inpatient commitment, and outpatient commitment, and distinguishing between capacity and competency are essential for medical professionals working in the field of mental health. Awareness of legal and ethical issues that may arise in treating psychiatric emergencies allows healthcare providers to navigate these complex situations while upholding patient rights and ensuring the best possible care. Additionally, utilizing evidence-based suicide risk assessments, such as the C-SSRS, enhances the identification and management of patients at risk of suicide.
