Berenice Cys

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Discussion Week 2

Ethical considerations of involuntary hospitalization and due process of civil commitment in ADULT.

Methods of coercion are frequent in psychiatry but call for legal and ethical rationales (Chieze, et al, 2021). Involuntary hospitalization and forced treatment are common in mental health. The coercion puts a limit to a patient’s movement, and some pressure to comply with treatment. Once the patient complies, he/she gets released from the hospital. Legitimization of this method is justified when someone is not responsible and becomes a danger to others or themselves. However, these short-term rules to control one’s autonomy can be seen as soft paternalism. This contradicts the societal evolution that encourages patients to make decisions and act in their best interests. In recent years, caregivers have been discouraged from thinking that they know better than the patient and can make decisions for them. Giving someone a position of power can always create a risk of abuse. The ethical problems come when someone’s rights are not respected. Coercion into involuntary admission prevents patients from their principle of autonomy. As a result, patients can’t make choices and decisions. Therefore, to authorize this coercion under protection, additional evidences must be provided. Those justifications must demonstrate how this hospitalization will reduce danger. In the same way, when patients are coerced into taking medications, justification must be proven to benefit the patient. Currently, scientific evidence showing coercion efficacy is lacking. Helping to justify the hospitalization would relieve some stress in the hospital setting. Also, it would be more ethically acceptable. Coercion should not be done only to reduce danger but also to help rebuild the patient’s identity and autonomy. Additionally, continuous assessment should be done to show that hospitalization is still necessary.

Ethical consideration in involuntary hospitalization and due process of civil commitment in CHILDREN.

The involuntary hospitalization of children and adolescents presents ethical problems according to some studies (Voultsos, et al, 2020). The removal of freedom and autonomy can have lasting consequences on a child’s level. As a result, negative outcomes can occur and damage the relationship between the therapist and the child. Moreover, the cost of involuntary admission in healthcare is becoming significant. The other ethical problem comes when commitment puts the whole family in distress, and the coercion becomes a negative experience. Compulsory admission should only be done when necessary and should not be done in a paternalistic way. The decision to authorize compulsory admission with children and adolescents should be justified and respect the patient’s autonomy.

Legal considerations in involuntary hospitalization and due process of civil commitment IN ADULT.

Involuntary admission of mental health patients is often permitted in high-income countries (Feiring and Ugstad, 2014). However, the criteria for admission can be subjective depending on the clinician’s view and interpretation of risk to self and others. Studies have shown that extra-circumstances such as network, resistance or functioning also had an impact on the criteria for admission. Coercion’s measures depend on the jurisdictions. Different influential factors are financing, sociodemographic factors, or legislation. Even the cultures and staff’s beliefs influence involuntary admissions. Common criteria used by clinicians are vague. E.g., patient’s best interest or serious mental disorders. The legal consideration for admission is not clear and depends on the clinician’s perception. As a result, the clinician’s understanding of paternalism, moral deliberation, and patient autonomy all have an impact on the decision for admission. Coercion measures should be recognized and balanced to prevent harm to patients. For instance, legal norms and reasoning should be supplemented with professional guidelines.

Legal considerations in involuntary hospitalization and due process of civil commitment in CHILDREN.

Involuntary hospitalizations are possible under certain conditions (Schölin, et al, 2024). However, children and adolescent admissions are even more complex since the parents in some cases are requesting detention. Due to some increase in mental health and substance abuse involuntary admission, legislative reforms have taken place in the UK and Scotland. The UN Convention on the Rights of the Child and the Rights of Persons with Disabilities demands solid reasons for involuntary admission. The detention should not be subjective or arbitrary and should not be non-discriminatory. Studies are missing on the role of legislation in detention as well as the views of children/adolescents, or the clinician’s opinions.

Summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic.

Involuntary admissions in children/adolescents are ethically disturbing because they could destroy the trust of the child in the future toward clinicians and therapists. This could have a negative impact in the future since mental health is often a lifelong struggle. Controversy exists today about how mental health can damage a person’s autonomy and cause more suffering. Additionally, the lack of legislation puts children/adolescents at risk for discrimination. Some research demonstrates that children of minority groups and those with an abuse history are more prone to be admitted involuntarily. Ethical concerns with adults’ warrants happen when someone imposes soft paternalism over someone else and removes their autonomy and self-determination. The legal problem with adult admission is the lack of clear criteria to admit someone on a warrant. Finances and other socio-economic factors play a role in the involuntary process. Even the staff’s beliefs and culture impact the admissions. Finally, the clinician’s reasons are vague and lack guidelines.

Explain how this information could apply to your clinical practice, including

specific implications for practice within your state

In 2024, more than 590,000 emergency holds happened in 24 different states (Morris and Kleinman, 2023). All states in the US allow emergency hospitalization for patients who are a danger to themselves and others. Psychiatric advance directives can be useful to avoid involuntary admission but don’t always have legal recognition. Despite being controversial, holds are often necessary for people who can’t care for themselves anymore. Policies are different according to state laws. I work in a psychiatric hospital in the state of Texas. We regularly have inpatient admissions brought in by the police under warrant. According to the State Bar of Texas, involuntary commitment is necessary when a person is too sick to recognize that treatment is needed. To qualify for a mental health warrant in Texas, one must be confused, delusional, or violent among other possibilities. After a patient is brought to the psychiatric hospital, a psychiatrist has 24 hours to make a certificate. This certificate must show evidence that the patient needs stabilization to reduce the possible harm to self or others. Once the document is filed, the court provides an order of protective custody. This document must set up a hearing within 72 hours unless it falls on the weekend, then it should be done by 0400 pm on the next business day. In some cases, the court can dismiss the case, and recommend outpatient treatment or inpatient treatment. At the mental health hospital, some patients under warrants can be very distressed by the fact that they cannot leave freely. Also, they can even become agitated and violent and require emergency restraints and medications. The other challenges occurred when the family of a patient under warrant came to the hospital to pick up the patient. Sometimes, the police must be contacted to de-escalate family members. It can be difficult for the family to accept the fact that a patient is held against their will and must comply with the commitment procedure. Having more evidence-based research to justify the need for the intervention could help relieve the tension between the hospital staff, the patient, and their family.

My sources are scholarly because this is an extract from the National Library of Medicine. Pub Meds is a national online database that provides literature such as MEDLINE, Life Science, and other medical journals. This database offers reliable resources for health research. Since 1997, the database has offered free research online to all users. Scientific and biomedical journals are available through Pub Med Central. This database is user-friendly and provides easy access to reliable resources.

References

Chieze M, Clavien C, Kaiser S, Hurst S. Coercive Measures in Psychiatry: A Review of Ethical Arguments. Front Psychiatry. 2021 Dec 14;12:790886. doi: 10.3389/fpsyt.2021.790886. PMID: 34970171; PMCID: PMC8712490.

Committed to healing: involuntary commitment procedures. (February 7th, 2023). State Bar of Texas. Retrieved on August 31, 2024. From https://www.texasbar.com/AM/Template.cfm?Section=Free_Legal_Information2&Template=/CM/ContentDisplay.cfm&ContentID=30801Links to an external site.

CommittedtoHealingInvoluntaryCommitmentProcedures.pdfDownload CommittedtoHealingInvoluntaryCommitmentProcedures.pdf

Feiring E, Ugstad KN. Interpretations of legal criteria for involuntary psychiatric admission: a qualitative analysis. BMC Health Serv Res. 2014 Oct 25;14:500. doi: 10.1186/s12913-014-0500-x. PMID: 25344295; PMCID: PMC4209226.

Legal criteria.pdfDownload Legal criteria.pdf

Morris NP, Kleinman RA. Taking an Evidence-Based Approach to Involuntary Psychiatric Hospitalization. Psychiatr Serv. 2023 Apr 1;74(4):431-433. doi: 10.1176/appi.ps.20220296. Epub 2022 Sep 21. PMID: 36128697.

taking-an-evidence-based-approach-to-involuntary-psychiatric-hospitalization.pdfDownload taking-an-evidence-based-approach-to-involuntary-psychiatric-hospitalization.pdf

Ossom Williamson P, Minter CIJ. Exploring PubMed as a reliable resource for scholarly communications services. J Med Libr Assoc. 2019 Jan;107(1):16-29. doi: 10.5195/jmla.2019.433. Epub 2019 Jan 1. PMID: 30598645; PMCID: PMC6300231.

Pub Med.pdfDownload Pub Med.pdf

Schölin L, Tucker Z, Chopra A, Borschmann R, McKay C. Detention of children and adolescents under mental health legislation: a scoping review of prevalence, risk factors, and legal frameworks. BMC Pediatr. 2024 Jan 4;24(1):12. doi: 10.1186/s12887-023-04464-6. PMID: 38178014; PMCID: PMC10765764.

Detention.pdfDownload Detention.pdf

Voultsos P, Tsamadou E, Karakasi MV, Raikos N, Pavlidis P. Involuntary psychiatric hospitalization of children and adolescents in Northern Greece: Retrospective epidemiological study and related ethical issues. Psychiatriki. 2020 Apr-Jun;31(2):129-139. doi: 10.22365/jpsych.2020.312.129. PMID: 32840217.