Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies in the State of Delaware Essay

Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies in the State of Delaware Essay

Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies in the State of Delaware Essay

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  Legal and Ethical Issues Related to Psychiatric Emergencies

In the United States, each state has established a distinct set of regulations governing the temporary and involuntary hospitalization of individuals, both minors and adults, who are afflicted with mental disorders and present a potential danger to themselves or others (Stubbe, 2023). Nevertheless, various factors, such as legislative mandates and their enforcement, the availability of care for the selected intervention, and the accuracy of the emergency hold procedure, impact the legality and value of the decision regarding therapeutic intervention. This paper provides a comprehensive examination of the legal and ethical considerations about psychiatric emergencies in the state of Delaware. Additionally, it identifies evidence-based methodologies for conducting suicide and violence risk assessments.  

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Delaware State Laws

The State of Delaware has implemented a civil commitment procedure that enables the involuntary confinement of individuals who have mental health issues and pose a potential risk of harm. As per the Delaware Code Title 16, specifically Health and Safety § 5002, the involuntary admission or confinement of individuals as involuntary patients in designated psychiatric treatment facilities or hospitals is strictly prohibited. Such facilities or hospitals are prohibited from involuntarily admitting or confining any person unless that person has been determined to have a mental condition and poses a danger to themselves or others. These determinations must be made by the procedures outlined in this chapter, and all procedural requirements must be adhered to (Lee & Cohen, 2021).

The Marchman Act provides a legal mechanism for individuals to seek assistance on behalf of a family member or close associate who is engaged in substance abuse, with the understanding that continued substance use poses a significant risk to their overall welfare in the absence of appropriate intervention and treatment. According to Rumschik and Appel (2019), the duration of this period of involuntary treatment can span up to 60 days, with the possibility of additional 90-day extensions if determined to be essential. After this period, if the psychiatrist fails to meet the necessary criteria for retaining custody of the patient, the judge will expeditiously discharge the patient. Once the discharge order has been given, the patient may be picked up by a friend or family member if they so want.

Evaluation/Psychiatric Hold, Inpatient Commitment, and Outpatient Commitment

In the state of Delaware, there exists a clear distinction between Emergency holds and civil inpatient or outpatient commitments. The latter involves the involuntary treatment of individuals with mental illness for a duration spanning several days or weeks. An emergency hold refers to a brief civil restriction on personal freedom, typically implemented in anticipation of a commitment proceeding (Rumschik & Appel, 2019). The implementation of emergency holds, as well as other types of involuntary commitment, raises concerns regarding constitutional rights about autonomy, liberty, and due process. In the event of an involuntary commitment, the patient is subsequently retained within the hospital premises for ongoing therapeutic interventions, with the duration of this confinement not exceeding three months, and without the requirement of a subsequent hearing. Alternatively, he may be released from the facility, either with or without being subject to involuntary outpatient treatment. It is important to highlight that in both contexts, treatment does not necessarily involve medication, as a distinct procedure must be undertaken. Consequently, an individual who is subjected to involuntary commitment retains the right to decline medications, except in cases of emergencies or when specifically mandated by judicial authorities.

Capacity and Competency

The concept of capacity for mental health pertains to an individual’s cognitive ability to provide informed consent and exercise sound judgment (Bruckner et al., 2019). By ethical principles, patients possess the entitlement to receive comprehensive information about their mental condition, diagnostic assessment, treatment plan, and its suitability for their specific circumstances. In contrast, competence pertains to an individual’s capacity to autonomously engage in decision-making processes that impact their well-being.    

Legal and Ethical Issues

In 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted by the United States Congress (Zhou et al., 2019). The aforementioned element was considered to be a constituent of COBRA, primarily focused on addressing challenges related to Medicare. One of the primary ethical and legal concerns associated with the Emergency Medical Treatment and Labor Act (EMTALA) pertains to the potential infringement upon patients’ privacy and autonomy, particularly regarding financial considerations.  

Risk Assessment and Violence Risk Assessment

In instances of psychiatric crises, a range of diagnostic techniques are commonly utilized to evaluate the extent of the patient’s mental disorder. The Patient Health Questionnaire 2 (PHQ2) is an empirically supported screening tool that has demonstrated utility in identifying individuals who may be experiencing suicidal thoughts. Additionally, the Brøset Violence Checklist and Violence Risk Screening-10 are effective in assessing the probability of engaging in violent behavior (Chunduri et al., 2019).  

Conclusion

Psychiatric emergencies necessitate the compulsory hospitalization of individuals with psychiatric conditions to conduct comprehensive evaluations and administer appropriate therapeutic interventions. There are variations in state legislation concerning mental emergencies. Nevertheless, the primary aim of the entire process is to ensure the protection of residents from potential harm that may be caused by individuals with mental illness.

References

Bruckner, T. A., Singh, P., Chakravarthy, B., Snowden, L., & Yoon, J. (2019). Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers. Psychiatric Services, 70(10), 901–906. https://doi.org/10.1176/appi.ps.201800553

Chunduri, S., Browne, S., Pollio, D. E., Hong, B. A., Roy, W., Roaten, K., … & North, C. S. (2019). Suicide risk assessment and management in the psychiatry emergency service: psychiatric provider experience and perceptions. Archives of suicide research, 23(1), 1-14. https://doi.org/10.1080/13811118.2017.1414648

Lee, G., & Cohen, D. (2021). Incidences of Involuntary Psychiatric Detentions in 25 U.S. States. Psychiatric Services, 72(1), 61–68. https://doi.org/10.1176/appi.ps.201900477

Rumschik, S. M., & Appel, J. M. (2019). Malingering in the Psychiatric Emergency Department: Prevalence, Predictors, and Outcomes. Psychiatric Services, 70(2), 115–122. https://doi.org/10.1176/appi.ps.201800140

Stubbe, D. E. (2023). Psychiatric Emergencies: Empowering Connections to De-escalate Aggression. FOCUS, 21(1), 54–57. https://doi.org/10.1176/appi.focus.20220079

Zhou, J. Y., Amanatullah, D. F., & Frick, S. L. (2019). EMTALA (Emergency Medical Treatment and Active Labor Act) Obligations. The Journal of Bone and Joint Surgery, 101(12), e55. https://doi.org/10.2106/jbjs.18.01166‌

Appendices

Appendix 1: Patient Health Questionnaire-2 (PHQ-2)

Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days

 

More than half the days

 

Nearly every day

 

1. Little interest or pleasure in doing things 0 1 2 3
2. Feeling down, depressed, or hopeless 0 1 2 3
         

For office coding:                 0          +          +          +         

= Total Score             

Appendix 2: Brøset Violence Checklist

Appendix 3: Violence Risk Screening-10

THE ASSIGNMENT– Please Follow The Rubric

In at least 3 pages, address the following:

Explain the DELAWARE 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 the state of DELAWARE.

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. Attach a copy or a link to the assessment you identified.

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

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NRNP_6675_Week8_Assignment_Rubric

Criteria Rating Pts

In at least 3 pages, address the following: • Explain your state of Delaware 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.

15 to >13.0 pts

Excellent 90%–100%

The response includes a thorough and well-organized explanation of Delaware state laws for involuntary psychiatric holds for child and adult emergencies.

15 pts

• Explain the differences between emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state of Delaware.

15 to >13.0 pts

Excellent 90%–100%

The response includes an accurate and concise explanation of the differences between emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state of Delaware.

15 pts

• 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.

10 pts

• 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.

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.

15 pts

•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.

15 pts

• 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.

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.

15 pts

Written 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.

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.

5 pts

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 pts

Excellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors

5 pts

Written 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.

5 to >4.0 pts

Excellent 90%–100%

Uses correct APA format with no errors.

5 pts

Total Points: 100

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