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.
Psychiatric emergencies are situations that are dangerous to oneself or others that need immediate attention. Some examples of psychiatric emergencies include attempts at suicide, threats of violence, or drug overdoses. As a provider, when and to whom do you have to report incidents of psychiatric emergencies to authorities?
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.
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.
Identify one evidence-based violence risk assessment that you could use to screen patients.
Full Answer Section
One of the most important legal issues surrounding psychiatric emergencies is the right to treatment. In the United States, people have a right to receive treatment for mental illness, even if they are involuntarily committed. This means that people who are experiencing a psychiatric emergency cannot be denied treatment, even if they do not want it.
Another important legal issue is the right to informed consent. This means that people have the right to be informed about their treatment options and to give their consent before any treatment is given. In the case of psychiatric emergencies, this can be a challenge, as people who are experiencing a mental health crisis may not be able to make informed decisions about their treatment.
There are also a number of ethical issues that need to be considered when responding to psychiatric emergencies. One of the most important ethical principles is the principle of beneficence, which means that we should act in a way that promotes the well-being of others. In the case of psychiatric emergencies, this means that we should take steps to protect people who are at risk of harming themselves or others.
Another important ethical principle is the principle of autonomy, which means that we should respect the right of people to make their own decisions. In the case of psychiatric emergencies, this means that we should try to involve people in their treatment plans, even if they are not able to make fully informed decisions.
Evidence-Based Suicide and Violence Risk Assessments
There are a number of different risk assessment tools that can be used to assess the risk of suicide and violence in psychiatric emergencies. These tools are based on research that has identified factors that are associated with an increased risk of suicide and violence.
Some of the most common risk factors for suicide include:
- A history of suicide attempts
- Thoughts of suicide
- Access to lethal means
- Hopelessness
- Substance abuse
Some of the most common risk factors for violence include:
- A history of violence
- Thoughts of violence
- Anger
- Substance abuse
- Impulsivity
Risk assessment tools can be used to help clinicians identify people who are at an increased risk of suicide or violence. This information can then be used to develop treatment plans that are designed to reduce the risk of harm.
It is important to note that risk assessment tools are not perfect. They can only provide an estimate of the risk of suicide or violence. It is also important to remember that risk factors are not always predictive. Just because someone has a risk factor for suicide or violence does not mean that they will actually attempt or commit suicide or violence.
Conclusion
Psychiatric emergencies are complex and challenging situations. There are a number of legal and ethical issues that need to be considered when responding to them. There are also a number of evidence-based risk assessment tools that can be used to assess the risk of suicide and violence. By understanding the legal and ethical issues surrounding psychiatric emergencies and using evidence-based risk assessment tools, clinicians can help to reduce the risk of harm to people who are experiencing a mental health crisis.