Practicum Journal: Voluntary and Involuntary Commitment.

Posted: November 28th, 2022

Practicum Journal: Voluntary and Involuntary Commitment.

MHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

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Practicum Journal: Voluntary and Involuntary Commitment.In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment. Scenario for Week 7 Case: You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. Practicum Journal: Voluntary and Involuntary Commitment.At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. Practicum Journal: Voluntary and Involuntary Commitment.The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed? Learning Objectives Students will: Evaluate clients for voluntary commitment Evaluate clients for involuntary commitment based on state laws Recommend actions for supporting parents of clients not eligible for involuntary commitment Recommend actions for treating clients not eligible for involuntary commitment To Prepare for this Practicum: Review the Learning Resources concerning voluntary and involuntary commitment. Practicum Journal: Voluntary and Involuntary Commitment. Read the Week 7 Scenario in your Learning Resources. Research your state’s laws concerning voluntary and involuntary commitment. The Assignment (2–3 pages): Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not? Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not. Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain. If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment. If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client. Practicum Journal: Voluntary and Involuntary Commitment.

Voluntary and Involuntary Commitment

Recommending the client for voluntary commitment

I would recommend the client to be voluntarily committed because he is undergoing a mental health crisis and an inpatient stay is essential for his safety.   Voluntary commitment is appropriate for the minor since he is presently the risk of harming himself, and failure to hospitalize him and provide the necessary care and treatment can put the safety of the client at risk. According to Selbst   (2014),  both a person who is 14 years old or more can be voluntarily committed if a medical assessment shows that they require treatment or care and without treatment or care,  there is a  significant probability that in the near future the individual will inflict grave bodily harm on self. However, the patient is free to leave the hospital, even if it is against medical advice but must provide a seventy-two written notice prior to leaving the hospital. Practicum Journal: Voluntary and Involuntary Commitment.

Eligibility of the client for involuntary commitment based state laws

Base on the South Carolina civil commitment laws the client is eligible for involuntary commitment because he poses danger to self by suicide attempts.   Like other states, South Carolina has civil commitment laws that allow involuntary commitment and mandatory treatment. The following criteria must be met by the individual:  be in need of treatment and is not capable of making responsible decisions concerning treatment, or is likely to cause harm to others or serious. According to Sadock et al (2016), involuntary hospitalization often involves the question of whether a patient is suicidal and therefore poses danger to self or homicidal and therefore poses danger to others. Practicum Journal: Voluntary and Involuntary Commitment.

How the understanding of state laws challenges my initial recommendation regarding involuntarily committing the client

My understanding of South Carolina civil commitment laws has challenged my initial proposal concerning the involuntary commitment of the client.  Although an individual who is a danger to self or others qualify to be involuntarily hospitalized, there should be proof that the patient needs treatment and is not able to make responsible decisions concerning his or her treatment.  According to Sadock et al., (2016), n all states, individuals who are considered to be a danger to themselves or others can be involuntary hospitalized and provided with essential treatment. Nevertheless, there should be convincing evidence that the individual is dangerous, and without this evidence, involuntary commitment can be deemed unlawful.

Actions that I might be able to take to support the parents for or against voluntary commitment if the client were not eligible for involuntary commitment

A suicide risk assessment is what I might be able to do to support the client’s parents for or against voluntary hospitalization. A suicide risk assessment would help me to establish if the patient is at the risk of harming himself and thus requires an inpatient stay for further care and monitoring.  As Gold and Frierson (2020) indicate, as with any emergency department evaluation the risk of a patient for self-injurious behavior in the current crisis should be established and compared to the baseline risk of a patient for self-injurious behaviors.  When the risk is considerably high and cannot be modified via emergency department intervention, then the patient might need psychiatric hospitalization. Practicum Journal: Voluntary and Involuntary Commitment.

Initial actions that I may take to initiate treatment for the client if he were ineligible for involuntary commitment

If the client did not qualify for emergency commitment is the first action I can take to start initiate treatment for the patient.  According to Riba et al (2015), an emergency commitment is aimed at evaluating and providing emergency care and treatment to the patient. Emergency commitment is sought when a person displays behavior that is clearly or imminently dangerous to self or others or an individual who is greatly confused to the extent that they are not in a position to make decisions independently.   Authorized health care providers, including PMHNPs, can initiate emergency commitment. Practicum Journal: Voluntary and Involuntary Commitment.