In 2–3 pages, address the following: Explain your state laws (Texas) 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.
. Attach copies of or links to the suicide and violence risk assessments you selected.
Involuntary Psychiatric Holds in Texas
In Texas, the law allows for the involuntary hospitalization of individuals who are experiencing a mental health crisis and pose a danger to themselves or others. An individual may be held for up to 48 hours for evaluation and treatment under a psychiatric emergency detention. A peace officer, mental health professional, or medical professional may initiate the hold, which requires a written statement describing the person’s behavior and the reason for the hold. The individual may be held for a longer period if the court finds that the person meets the criteria for continued detention.
Once the 48-hour hold has expired, a physician may release the patient if they no longer meet the criteria for involuntary hospitalization. A patient may be picked up by a responsible person designated by the patient or the court.
Emergency Hospitalization vs. Inpatient/Outpatient Commitment
Emergency hospitalization, also known as a psychiatric hold, is a short-term measure to provide evaluation and stabilization for individuals experiencing a mental health crisis. Inpatient commitment is a longer-term, court-ordered treatment for individuals with severe and persistent mental illness who require hospitalization for their own safety or the safety of others. Outpatient commitment is a court-ordered treatment that allows an individual to receive treatment while living in the community, with regular check-ins and requirements for medication compliance and therapy.
Capacity vs. Competency
Capacity refers to an individual’s ability to make a specific decision, such as consenting to medical treatment. Competency is a legal determination made by a court that an individual is capable of understanding the nature and consequences of a legal proceeding and can participate in their own defense.
Legal and Ethical Issues in Psychiatric Emergencies
Confidentiality is a critical ethical issue in psychiatric emergencies. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule requires health care providers to protect the privacy of patients’ health information, but there are exceptions for emergency situations. Providers must balance the patient’s right to privacy with the need to provide necessary information to those involved in the patient’s care.
EMTALA, the Emergency Medical Treatment and Labor Act, is a federal law that requires hospitals to provide emergency medical treatment to patients who seek care, regardless of their ability to pay. However, psychiatric emergencies can be challenging to address under EMTALA because they may not involve a medical condition that requires emergency medical treatment.
Evidence-Based Risk Assessments
The Columbia-Suicide Severity Rating Scale (C-SSRS) is an evidence-based tool for assessing suicide risk. The C-SSRS is a brief, standardized interview that assesses suicidal ideation, behavior, and intent.
The HCR-20V3 is an evidence-based tool for assessing violence risk. The HCR-20V3 is a structured professional judgment tool that evaluates 20 factors related to violence risk, including historical, clinical, and contextual factors.
Links to Suicide and Violence Risk Assessments
Columbia-Suicide Severity Rating Scale (C-SSRS): https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/