Psychiatric Emergencies Ethical and Legal Issues

Legal and Ethical Issues Related to Psychiatric Emergencies

Psychiatric emergencies usually occur in children and adults due to mental problems such as change in mood and behavior. These emergencies can lead to involuntary holds of the individual by either the police or health institutions that deal with psychiatric disorders. These holds help ensure the safety of the patient. The emergencies arise from cases such as suicide attempts, agitation, etc. There are various state laws that allow patients to be held against their consent. The context in this case happens to be the state of New York. From a general perspective, the law allows an individual with mental illness to be held against their will if they pose a threat to others, if they pose a threat to their own life, or if they are disabled and unable to provide for themselves due to the mental illness.

One of the persons that are allowed to hold a patient involuntary are the police. Police hold mentally ill individuals who have broken the law with the hope that by having him or her in their custody, they will be able to protect the society. Medical providers are also allowed to involuntary hold patients with mental illness so as to help them recover. Involuntary hold involves a maximum of 3-days or 72-hour period whereby the patient receives emergency medical care before further help is offered. According to the Welfare and Institutions Code (2014), “if you were brought into a mental health facility against your will due to the psychiatric emergencies, you may be held for up to 72 hours for treatment and evaluation unless the person in charge can establish that you need an additional 14 days of mental health treatment.” Medical practitioners and the police are the ones involved in releasing emergency holds depending on the condition of the patient or after a court ruling to release the patient. After the hold is over and the patient is released, the patient’s rights advocate picks up the patient.

Emergency hospitalization for psychiatric hold involves the involuntary admission of patients with mental illness in a health facility or a law enforcement facility. In emergency hospitalization of inpatient commitment, a person voluntarily goes to a health facilities and talks to a health practitioner about their mental illness. The patient agrees on their own to be admitted in the hospital after meeting the available criteria for admission. In emergency hospitalization of outpatient commitment, the affected patient is assisted in the form of treatment used. Patients involved in outpatient commitment are those with no family members or are facing a severe form of mental illness.

In the words of Namboodiri (2019), “capacity in mental health includes analysis and diagnosis of a mental condition, treatment, care, and rehabilitation of a person with diagnosed or suspected mental illness”. The capacity to treat or diagnose a patient with a mental illness is mainly dependent upon the psychiatrist or health professional involved in assessment. Competency in mental health context involves situations whereby health providers are supposed to assess patients with mental illness. It involves the capability to respect and listen to mentally ill patients since they are vulnerable and have less access to emergency care.

EMTALA

Emergency Medical Treatment and Labor Act – EMTALA, is a legislation act that was established for emergency departments to help screen, stabilize and offer appropriate transfers to patients despite their insurance or their ability to pay. Financially needy patients were not properly stabilized and this act helped stop this practice. Many EMTALA cases involve patients with mental illnesses. EMTALA was mainly aimed at providing emergency care to all patients.

Legal issues related to EMTALA

Violating EMTALA laws is a serious offence and can lead to a hospital or medical provider being severely penalized. Maugham (2019) indicates that “all individuals should have access to quality and affordable primary and emergency health care services.” This is unfortunate to many because these benefits come at a cost. This law is clear, but it also requires the hospital to conduct screening and treatment according to its capabilities. The hospital decides for itself on the procedures to follow during the screening process.

One ethical issue that might arise on the equitable treatment of all patients is in a situation whereby two patients requiring emergency attention are brought in the hospital. The two patients might be brought at a time when, for instance, the hospital has only one vacant bed. In such a scenario, it becomes difficult for the hospital to follow EMTALA laws. The hospital will then decide on which patient to accept in their facility.

Due to the increased cases of suicide resulting from mental illnesses, methods of preventing suicide must be put in place. One of the method used is risk assessment. Suicide risk assessment involves presenting those at risk to clinical settings and monitoring them directly so as to ensure that the relevant interventions are offered. Brodsky et.al (2018) reveal how in the U.S., National Action Alliance for Suicide Prevention came up with a Zero Suicide Model. This model involves assessing, evaluating, and monitoring the patients in order to achieve zero suicide.

Violence from mentally ill patients have become a great concern in the society. As Anderson & Jenson (2018) tell us, “approximately 90% of physicians and nurses working in mental health areas have been subject to violence from patients.” In order to end the violence, various screening tools on violence risk assessment must be used. Danger Assessment tool is one of the tool nurses and physicians use to assess risks associated with violence. This involves assessing a potential dangerous behavior in a patient by checking the patient’s history of assaults or threats.