ethical and legal basis for mental health nursing practice

principles of ethics

beneficience, veracity, autonomy, justice, fidelity

humphrey v. cady, 1972

involuntary civil commitment to a mental hospital is a massive curtailment of liberty requiring due process protections

due process

governments must follow fair procedures before depriving someone of life, liberty, or property

writ of habeus corpus

a formal written request to “deliver the body”, or to appear before court

least restrictive alternative doctrine

mandates that the least drastic means be taken to achieve a specific purpose

olmstead v. l.c., 1999

patients with mental health illness are to be placed in less restrictive community settings rather than institutions

a medical standard or justification for admission should exist

illness must present immediate crisis

guidelines of the centers of medicare and medicaid services and the joint commission

all patients have the right to be free from physical or mental abuse and corporal punishment

all patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff

restraint or seclusion may only be imposed to ensure immediate physical safety of the patient, a staff member, or others and must be continued at the earliest possible time

types of involuntary hospitalization

emergency hospitalization

oberservational or temporary hospitalization

long-term or formal commitment

outpatient commitment

patient’s rights

right to refuse treatment

right to treatment

right to informed consent

1964 hospitalization of mentally ill act

medical and psychiatric care and treatment must be provided to everyone admitted to a public hospital

treatment must be humane, have qualified and sufficient staff, and an individualized plan of care

1972 canterbury vs. spence

right to self-determination

an adult with sound mind has a right to determine what shall be done with his or her own body

exception to confidentiality

duty to warn and protect third parties

assess and predict the patient’s danger of violence

identify individual targeted

take appropriate action to identify and protect victims

tarasoff doctrine

duty to warn third parties is applied to advanced practice registered nurses and psychiatric mental health nurses

staff nurses and members of the mental health team should report threats of harm

baker act 52

short term psychiatric committment (not to exceed 72 hours)

he or she has a mentall illness and has refused voluntary inpatient treatment, is unable to determine if treatment is necessary, is incapable of surviving alone, there is substantial likelihood that they will harm themselves or others, and available less restrictive treatments have been deemed inappropriate

the use of medications against the will of the patient can only be done in extenuating circumstances to support safety

baker act 32

petition to court for involuntary patient placement

requires agreement and documentation of two mental health professionals

petition must be filed within 72 hour window of ba52

allows patients to be held until earliest possible court hearing, not to exceed 28 days

patient has right to refuse or accept treatment as well as right to informed consent

the use of medications against the will of the patient can only be done in extenuating circumstances to support safety

patient has right to legal counsel

baker act 8

order for involuntary placement

ordered by a judge after reviewing evidence provided by mental health professionals, the patient, and legal counsel

ordered in 30 day increments up to 6 months, or 180 days

if inpatient hospitalization is necessary beyond court-ordered timeline, the client must have another hearing before the expiration of the current ba8

court can order specific treatments and medications be given on an involuntary basis

guardian is appointed for the client during inpatient hospitalization

the client does not have the right to refuse, or be informed, of court-ordered medications during a ba8