Psychiatric Emergencies
Involuntary Psychiatric Holds in Texas
In Texas, involuntary psychiatric holds are called emergency detentions or emergencies. These holds can be initiated by peace officers, mental health professionals, or physicians. To initiate emergency detention, the individual must pose a substantial risk of harm to themselves or others or be unable to provide for their basic needs due to a mental illness. The hold can last for up to 48 hours, during which time a mental health professional can evaluate the individual to determine if further treatment is necessary.
After the evaluation, the individual may be released or held for further treatment. If the individual is held for further treatment, a court hearing must be held within 4 days to determine if the individual should be committed involuntarily to a mental health facility. The maximum length of a court-ordered commitment is 90 days.
A mental health professional or physician can only release the emergency hold, and a responsible party, such as a family member or friend, must pick up the individual.
Emergency Hospitalization, Inpatient Commitment, and Outpatient Commitment
Emergency hospitalization for evaluation/psychiatric hold, as described above, is a short-term hold that allows for evaluation and determination of the need for further treatment. Inpatient commitment is a court-ordered involuntary commitment to a mental health facility for individuals deemed a danger to themselves or others due to a mental illness. The maximum length of an inpatient commitment is 180 days.
Outpatient commitment, also known as assisted outpatient treatment, is a court-ordered treatment plan for individuals with severe mental illness who have a history of noncompliance with treatment and have a high risk of relapse or deterioration without treatment. Outpatient commitment can include medication management, therapy, and other support services.
Capacity vs. Competency
Capacity refers to an individual’s ability to decide on their own care and treatment. Competency refers to an individual’s ability to understand legal proceedings and make decisions related to their legal rights. A mental health professional determines capacity and can be influenced by cognitive impairment or mental illness. A court determines competency and is relevant in legal proceedings.
Legal and Ethical Issues Related to Treating Psychiatric Emergencies
One legal issue related to treating psychiatric emergencies is EMTALA, the Emergency Medical Treatment and Active Labor Act. EMTALA requires hospitals to provide emergency medical treatment to anyone who comes to the emergency department, regardless of their ability to pay. This includes individuals experiencing psychiatric emergencies. One ethical issue related to treating psychiatric emergencies is patient autonomy. Individuals with mental illness may have difficulty making decisions regarding their care and treatment, and healthcare professionals must balance their autonomy with their need for treatment.
Evidence-Based Suicide Risk Assessment
The Columbia-Suicide Severity Rating Scale (C-SSRS) is an evidence-based suicide risk assessment that can be used to screen patients. The C-SSRS assesses the severity of suicidal ideation and behavior and can be used to determine the level of intervention needed.
Evidence-Based Violence Risk Assessment
The Historical Clinical Risk Management-20 (HCR-20) is an evidence-based violence risk assessment that can be used to screen patients. The HCR-20 assesses the individual’s history of violence, clinical factors, and situational factors to determine the level of risk for future violence.
References:
Texas Health and Safety Code Chapter 573.
Texas Health and Safety Code Chapter 574.
Texas Health and Safety Code Chapter 592.
The Columbia-Suicide Severity Rating Scale.
The Historical Clinical Risk Management-20.
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.