Involuntary Admission vs. Voluntary admission, Implied vs. Informed Consent, Capacity vs. competency, Psychiatric advance directives (PAD)

Voluntary Admission

Request of client and client recognition of need of care

Involuntary Admission

Danger to self, others, unable to meet basic self-care needs, and mental illness preventing recognition or need for care

Implied consent

Occurs in an emergency situation

• Client unconscious

• Unable to provide informed consent

• Person is coding

• Legal representative is unavailable

• Assumes client actions demonstrates willingness for treatment

Informed Consent

Must include:

• Description of the treatment

• Possible benefits from the treatment

• Possible risks involved in receiving the treatment 

• Possible consequences of not receiving the treatment 

• Alternative treatments available

• Client is unable to provide informed consent 

  • Deemed legally as mentally Incompetent 

  • Alternate decision-maker such as power of attorney, state guardian or medical surrogate decision maker

Capacity

• Generally medical term

  • Determining if cognitive processes are intact 

  • Determining if able to provide informed consent

• Determined by qualified medical provider/physician 

• Not by nurse

Competence

• Legal term 

• Global impairment

  • Unable to make decisions

  • Unable to provide informed consent 

• Determined by judge

Psychiatric advance directives (PAD)

• Legal Tool - Protecting client

  • Self-direction

  • Autonomy

  • Allows patient to dictate for themselves how they want to be treated during a mental health crisis when they’re not in a mental health crisis

  • Clients preferences regarding psychotropic meds, use of electroconvulsive therapy, preferred hospital or mental health unit, choice of attorney/psychiatrist/therapy, determine power of attorney

• Provides plan if loss of capacity/incompetence determined

  • Health care power of attorney

    • Names surrogate decision-maker

  • Advanced directives for mental health care 

    • Treatment choices

    • Medication choices

    • Choices of provider