Assessment of capacity and civil commitment

What is civil commitment and what are the two types?

being committed to a psych unit

can be voluntary or involuntary

what is the difference between an emergency admission and a physicians certificate

Emergency: has to be an emergency; the ED doctor admits the pt and then within 48 hrs another physician (usually a psychiatrist) cosigns on the admission

physicians certificate: this is when two physicians simultaneously admit a patient and sign for admission

What are the 4 criteria for treatment against pt’s will

one time tx is allowed if they are a danger to themselves or others; ongoing tx must have due process

1. lacks capacity

2. usually due to a mental illness

3. likely to benefit from the treatment

4. there is no less restrictive treatment available

What are some considerations for capacity determination?

Does the pt have:

1. mental illness: psychosis

2. mental retardation

3. cognitive impairment: like dementia, delirium, or acute intoxication

What are the 4 domains/pillars of capacity?

CRAM

1. communication of a stable choice

2. relevant info is understood

3. appreciation of the situation

4. manipulation of information in rational manner (The patient should be able to display an ability to assess the facts and to use them in a logical manner to come to a decision)

Capacity vs competency

capacity: ability to make informed decisions about clinical treatment’s/procedures

competency: this is a legal ruling about the ability to stand trial, make a will, etc.