Chapter 8 Legal Ethical Context Legal and Ethical

Chapter 8 Legal & Ethical Context

Legal and Ethical Context of Psychiatric Nursing Care • Ethic: A standard of behavior or a belief valued by an individual or group • Essential Ethics Skills in Psychiatric Practice (See Stuart text-p. 111) • Ability to be aware of one’s own values, strengths, and biases as they apply to work with patients

Legal and Ethical Context of Psychiatric Nursing Care • Ethical Decision Making: involves trying to distinguish right from wrong without clear guidelines • • • Gather background information Identifying ethical components Clarification of the rights and responsibilities of all ethical agents All possible options must be explored Application of principles Resolution into action

Model for Ethical Decision-Making Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc. 4

Legal and Ethical Context of Psychiatric Nursing Care • Hospitalized psychiatric patient • Can be either traumatic or supportive for patient depending upon: • • Institution Attitude of family and friends Response of staff Type of admission • Voluntary • Involuntary

Legal and Ethical Context of Psychiatric Nursing Care • Characteristics of Voluntary Admission (see Stuart text) • Similar to medical admission and discharge initiated by patient • Patient retains all civil rights • Patient actively agrees and participates in treatment

Legal and Ethical Context of Psychiatric Nursing Care • Characteristics of involuntary admission or commitment • Patient did not request • Based on 2 legal theories • Police: Protect community from dangerous acts of mentally ill • Parens patriae (pa-tree-aye) powers: State cares for citizens who cannot care for themselves

Legal and Ethical Context of Psychiatric Nursing Care • Criteria for involuntary commitment • Mentally ill person is: • a danger to self • A danger to others • Unable to care for self (gravely disabled) • And in need of treatment

Legal and Ethical Context of Psychiatric Nursing Care • Yet all patients have rights, even the mentally ill See patient’s rights (See Stuart text, pg. 117) • Right to privacy – HIPAA protects personal health information- required permission for disclosure • Must protect third parties: Duty to warn intended victims (Tarasoff)

Legal and Ethical Context of Psychiatric Nursing Care • Commitment process • In Nevada, requires signed, dated, and timed Legal 2000 • Registered nurse can do this process • After or within 72 hours, court decides if commitment continued, discontinued • Patient allowed to sign-in voluntarily

Legal and Ethical Context of Psychiatric Nursing Care • Most mentally ill people are not violent, but many are victims of violence • Research suggests that a subgroup with MI may be more dangerous and share features with violent offenders including poverty.

Legal and Ethical Context of Psychiatric Nursing Care • Who is a danger to self or others? • Mentally ill with • • Violent behavior Psychosis Noncompliant with medications Current substance abuse Antisocial personality disorder Lack of perceived need for treatment Lack of perceived treatment effectiveness

Legal and Ethical Context of Psychiatric Nursing Care • Mental Health Courts • In Las Vegas, held at Rawson-Neal Psychiatric Hospital • Every Wednesday and Friday except holidays and weekends • • Keeps the mentally ill from being jailed Supervise cases Coordinate treatment plans Social services: Arrange housing, job placement, relapse prevention

Policy and Advocacy in Mental Health Care • Four other psychiatric disorders in top 10 • • Alcohol use Bipolar disorder Schizophrenia Obsessive-compulsive disorder • In the U. S. , there approx. 20% of adults with any mental illness and 5% with a serious mental illness (2009 stats)

Policy and Advocacy in Mental Health Care • Policy and Legislation • Access: how easy are services and information obtained • 2 main policy approaches to equalizing care • Mandated coverage for mental health care • Mental health parity • Mental Health Parity Act of 1996 • Mental Health and Addiction Equity Act of 2008 • Patient Protection and Affordable Care Act of 2010 (Health Reform Law) • Expanded health coverage to uninsured and to small business • Excludes preexisting conditions

Policy and Advocacy in Mental Health Care • Protection and Advocacy for Mentally Ill Individuals Act of 1986 • Americans with Disabilities Act • Prevents discrimination against physical and mental disabilities • Advance Directives • Directives when written, a person is competent, to be implemented if the person becomes incompetent • Mental Health Courts • Helps keep people with minor criminal offences out of the jails and prisons, and into treatment instead

Policy and Advocacy in Mental Health Care • Advocacy • • Advocacy is a personal and professional call to action Fight stigma Share your personal experience with mental illness with others Influence public opinion and the legislature