Explain your state laws for involuntary psychiatric holds

Written By: Dan Palmer, RN

Edited By: Ethan Green, MSN-FNP

Legal and Ethical Issues Related to Psychiatric Emergencies

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.

In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.

To Prepare

Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.

The Assignment

In 2–3 pages, address the following:

Explain your state laws 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.

Expert Answer and Explanation

Mental Health Laws in Texas

There are various guiding PMHNP when providing mental health services to patients. Mental health laws play a significant role in the integration of mental health in primary health care, community integration of people with mental health problems, and provision of high-quality care. In the US, states have different laws prescribing how their citizens should be handled when mental health emergency occurs.

The state that will be focused on in this assignment in Texas. The legislative body of Texas has enacted various guiding PMHNP on how to provide mental health services among various populations. It is the responsibility of PMHNP to understand these laws and follow them to avoid legal problems. This assignment has discussed legal and ethical principles regarding mental health emergencies in the state of Texas.

Texas Laws

The law guiding involuntary psychiatric holds for child and adult psychiatric emergencies is known as the Texas Health and Safety Code – HEALTH & SAFETY § 574.014 (FindLaw.com, 2021). The involuntary psychiatric holds can be initiated by an adult by applying detention, evaluation, and treatment of the individual with the county courts.

A law enforcement officer is also allowed to detain an individual they believe to be a threat due to substance abuse or mental disorders and transport the individual to a mental health facility for evaluation for admission under their police powers. Mental health facilities recognized by the Department of Mental Health can initiate the process of holding a patient if they believe that the individual has a serious mental health problem and needs emergency psychiatric treatment (FindLaw.com, 2021).

Mental health professionals allowed to begin an on-site civil involuntary detention for an individual in need of emergency mental health care include psychiatric residents, licensed physicians, psychiatrists, licensed professional counselors, a qualified addiction professional, and PMHNP. An individual should only be detained for 72 hours, excluding holidays and weekends (FindLaw.com, 2021).

However, if the psychiatrist still believes that the individual needs further treatment beyond 72 hours, they can begin a court hearing to get court permission to continue holding the patient. The mental health professional can release the emergency hold if they believe that the individual does not need emergency care (FindLaw.com, 2021). The emergency hold can be picked by their family members or people they chose.

Differences

Emergency hospitalization for psychiatric hold or evaluation can be initiated by an adult, a police officer, or a health professional qualified to handle mental health services. This process does not need a court order (FindLaw.com, 2021). However, for a person to be committed to receiving mental health services as an inpatient or outpatient, a court order must be sought.

The guardian or applicant must go to court and seek a court order. The individual patient must also be given a chance to explain themselves (FindLaw.com, 2021). Therefore, the difference is emergency hospitalization for evaluation/psychiatric hold does not need a court order while inpatient and outpatient commitment need a court order.

Capacity and Competency

In the mental health context, capacity is a clinical determination and functional assessment of a specific decision that can be made by a health professional who has interacted with the patient’s case (Keene et al., 2019). However, competency is a legal determination and global assessment made in court by a judge. In other words, competency is determined by a judge while capacity by a health professional (Keene et al., 2019).

HIPAA Privacy Rule

HIPAA privacy rule requires that healthcare professionals protect patients’ information and prevent unauthorized persons from accessing them (Edens et al., 2018). The healthcare professionals are only allowed to share the information with the courts during hearing on whether the patients should receive involuntary inpatient or outpatient care. The healthcare professionals are only allowed to share the information with patient’s family member when the patient is incapacitated ad cannot make informed decisions (Edens et al., 2018).

Suicide Risk Assessment

The suicide risk assessment tool I could use to screen patients is the Columbia-suicide severity rating scale. This tool is validated to be used in adults, adolescents, and children (Matarazzo et al., 2019). The authors argue that it assesses both active and passive suicidal ideation, plan, method, suicidal behavior, and intent to act on the plan.

Violence Risk Assessment

The violence risk assessment I would use is the historical, clinical, and risk management-20 (HCR-20) tool. The tool is used to assess violence by health professionals across the globe. Ramesh et al. (2018) found that the tool accurately identifies patients with violent behaviors. They also noted that the tool is valid and reliable.

Conclusion

In Texas, individuals in need of mental healthcare emergencies can be detained at a mental health hospital for 72 hours by a police officer, an adult, or a healthcare provider. Competency is determined by a judge while capacity by a health professional. Healthcare professionals are legally and ethically needed to respect patients’ autonomy. However, during mental health emergencies, the professionals can detain the patient for 72 hours if they believe that the patient is a threat.

References

Edens, J. F., Petrila, J., & Kelley, S. E. (2018). Legal and ethical issues in the assessment and treatment of psychopathy. In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 732–751). The Guilford Press.

FindLaw.com. (2021). Texas Health and Safety Code – HEALTH & SAFETY § 574.014. Compilation of mental health commitment records. https://codes.findlaw.com/tx/health-and-safety-code/health-safety-sect-574-014/

Keene, A. R., Kane, N. B., Kim, S. Y., & Owen, G. S. (2019). Taking capacity seriously? Ten years of mental capacity disputes before England’s Court of Protection. International Journal Of Law And Psychiatry, 62, 56-76. https://doi.org/10.1016/j.ijlp.2018.11.005

Matarazzo, B. B., Brown, G. K., Stanley, B., Forster, J. E., Billera, M., Currier, G. W., & Brenner, L. A. (2019). Predictive validity of the Columbia‐Suicide Severity Rating Scale among a cohort of at‐risk Veterans. Suicide and Life‐Threatening Behavior, 49(5), 1255-1265. https://doi.org/10.1111/sltb.12515

Ramesh, T., Igoumenou, A., Vazquez Montes, M., & Fazel, S. (2018). Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: A systematic review and meta-analysis. European psychiatry : the journal of the Association of European Psychiatrists, 52, 47–53. https://doi.org/10.1016/j.eurpsy.2018.02.007

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Rubric Detail

Excellent 90%–100%	Good 80%–89%
In 2–3 pages, address the following: • Explain your state laws 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.	14 (14%) – 15 (15%) The response includes a thorough and well-organized explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.	12 (12%) – 13 (13%) The response includes an accurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
• Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.	14 (14%) – 15 (15%) The response includes an accurate and concise explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.	12 (12%) – 13 (13%) The response includes a well-organized explanation of 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.	9 (9%) – 10 (10%) The response includes an accurate and concise explanation of the difference between capacity and competency in mental health contexts.	8 (8%) – 8 (8%) The response includes an accurate explanation of 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.	14 (14%) – 15 (15%) The response accurately and concisely explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.	12 (12%) – 13 (13%) The response accurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
•Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.	14 (14%) – 15 (15%) The response identifies and explains an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.	12 (12%) – 13 (13%) The response identifies an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
• Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.	14 (14%) – 15 (15%) The response identifies and explains an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.	12 (12%) – 13 (13%) The response identifies an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors	4 (4%) – 4 (4%) Contains 1-2 grammar, spelling, and punctuation errors
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 (5%) – 5 (5%) Uses correct APA format with no errors	4 (4%) – 4 (4%) Contains 1-2 APA format errors
Total Points: 100

Excellent

90%–100%

Good

80%–89%

In 2–3 pages, address the following:

• Explain your state laws 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.

14 (14%) – 15 (15%)

The response includes a thorough and well-organized explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

12 (12%) – 13 (13%)

The response includes an accurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

• Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

14 (14%) – 15 (15%)

The response includes an accurate and concise explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

12 (12%) – 13 (13%)

The response includes a well-organized explanation of 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.

9 (9%) – 10 (10%)

The response includes an accurate and concise explanation of the difference between capacity and competency in mental health contexts.

8 (8%) – 8 (8%)

The response includes an accurate explanation of 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.

14 (14%) – 15 (15%)

The response accurately and concisely explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

12 (12%) – 13 (13%)

The response accurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

•Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.

14 (14%) – 15 (15%)

The response identifies and explains an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

12 (12%) – 13 (13%)

The response identifies an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

• Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.

14 (14%) – 15 (15%)

The response identifies and explains an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

12 (12%) – 13 (13%)

The response identifies an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors

4 (4%) – 4 (4%)

Contains 1-2 grammar, spelling, and punctuation errors

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 (5%) – 5 (5%)

Uses correct APA format with no errors

4 (4%) – 4 (4%)

Contains 1-2 APA format errors

Total Points: 100

Fair 70%–79%	Poor 0%–69%
11 (11%) – 11 (11%) The response includes a somewhat vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.	0 (0%) – 10 (10%) The response includes a vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies. Or the response is missing.
11 (11%) – 11 (11%) The response includes a somewhat vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.	0 (0%) – 10 (10%) The response includes a vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Or the response is missing.
7 (7%) – 7 (7%) The response includes a somewhat vague or incomplete explanation of the difference between capacity and competency in mental health contexts.	0 (0%) – 6 (6%) The response includes a vague or inaccurate explanation of the difference between capacity and competency in mental health contexts. Or the response is missing.
11 (11%) – 11 (11%) The response somewhat vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.	0 (0%) – 10 (10%) The response vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies. Or, response is missing.
11 (11%) – 11 (11%) The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.	0 (0%) – 10 (10%) The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.
11 (11%) – 11 (11%) The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.	0 (0%) – 10 (10%) The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.
3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 grammar, spelling, and punctuation errors	0 (0%) – 3 (3%) Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding
3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 APA format errors	0 (0%) – 3 (3%) Contains five or more APA format errors

Fair

70%–79%

Poor

0%–69%

11 (11%) – 11 (11%)

The response includes a somewhat vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

0 (0%) – 10 (10%)

The response includes a vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies. Or the response is missing.

11 (11%) – 11 (11%)

The response includes a somewhat vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

0 (0%) – 10 (10%)

The response includes a vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Or the response is missing.

7 (7%) – 7 (7%)

The response includes a somewhat vague or incomplete explanation of the difference between capacity and competency in mental health contexts.

0 (0%) – 6 (6%)

The response includes a vague or inaccurate explanation of the difference between capacity and competency in mental health contexts. Or the response is missing.

11 (11%) – 11 (11%)

The response somewhat vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

0 (0%) – 10 (10%)

The response vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies. Or, response is missing.

11 (11%) – 11 (11%)

The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.

0 (0%) – 10 (10%)

The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.

11 (11%) – 11 (11%)

The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.

0 (0%) – 10 (10%)

The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 (0%) – 3 (3%)