People with mental illness tend to have limited constitutional and basic rights regarding their treatment. States have laws governing involuntary inpatient treatment of people with mental illness. In Florida, involuntary psychiatric holds are governed by the Baker Act (“How Do You Baker Act in Florida?”, 2020). According to this law, family members, doctors, or the police can authorize an involuntary mental health examination for 72 hours on someone believed to have a mental illness (“How Do You Baker Act in Florida?”, 2020). This law is subject to both children and adults. The Baker Act is often employed when the person believed to have mental illness fails to consent to a voluntary mental health examination. Additionally, this law can apply to persons who cannot determine whether a mental health examination is necessary. Lastly, Baker Act is often employed on people whose mental condition is likely to influence them to cause harm to themselves and those around them.
Backer Act outlines various steps involved in the involuntary psychiatric hold. Firstly, once the notification has been made, the patient must be transported by the police. If it is a child, the police can transport the child without the consent of their parents or guardian. Secondly, the patient must be admitted to a psychiatric facility for a 72-hour mental health examination (“How Do You Baker Act in Florida?”, 2020). Within this period, the facility must either request the patient for voluntary admission if they are competent, release the patient, or request permission to hold the patient for a longer period. After the emergency hold, the patients can be picked up by their family or friends whom the patient identifies with (“How Do You Baker Act in Florida?”, 2020). Additionally, the law allows for discharge transportation after the patient’s relatives have been notified.
In Florida, the differences in emergency hospitalization for evaluation, inpatient commitment, and outpatient commitment are determined by the mental state of the subject and the party that can initiate the process. A person qualifies for an emergency evaluation if they are believed to have mental illness and their condition has influenced them to refuse voluntary treatment, or they cannot decide the necessity of an examination (“How Do You Baker Act in Florida?”, 2020). For one to qualify for an inpatient placement, the court must be convinced that due to their mental illness, they cannot survive alone, and all the alternative services cannot improve their condition. For outpatient placement, there must be evidence that the person has a history of failing to comply with the mental illness treatment (“How Do You Baker Act in Florida?”, 2020). Moreover, the person must have been admitted twice involuntarily within the preceding three years.
Regarding authorization, only the mental health facility administrator can petition for the involuntary placement of the patient in a court within their county of residence. For the outpatient placement, the authorization for the placement can be initiated through a petition by the treatment facility administrator or the administrator of the receiving hospital (“How Do You Baker Act in Florida?”, 2020). Law enforcers who believe the patient meets the qualifications of involuntary examination may initiate an emergency evaluation. Additionally, the placement can be initiated by physicians, family, and other mental health counselors who believe the person meets the involuntary examination criteria (“How Do You Baker Act in Florida?”, 2020). Moreover, the court may initiate the placement through an ex parte order if the person meets the conditions for involuntary examination.
In mental health, capacity is one’s ability to make informed decisions. Furthermore, mental capacity is demonstrated when people portray an understanding of their situations and the consequences of their decisions (Calcedo-Barba et al., 2020). A person may demonstrate a lack of capacity if they cannot make sensible decisions or understand situations that require them to make decisions. One’s mental capacity may be impaired by developing mental illnesses such as schizophrenia, using toxic substances or alcohol, or brain damage. On the contrary, competency involves having the ability to express oneself (Calcedo-Barba et al., 2020). Competent persons are aware of their environment and can communicate their preferences.
Patient autonomy in psychiatric emergencies is one of the critical issues that has attracted controversies. It is legal for the patient to consent to the mode of treatment they are being subjected to. However, the patient’s lack of capacity to make such a decision during a psychiatric emergency allows the healthcare provider to offer the treatment without the patient’s consent (Becker & Forman, 2020). Additionally, the healthcare provider is likely to be charged with negligence if their failure to provide treatment to the patient due to their lack of consent worsens their condition. Ethically, patient autonomy in psychiatric emergencies can be overlooked because the patient’s inability to reason limits their autonomy, and it is the physician’s responsibility to restore their autonomy through treatment (Becker & Forman, 2020). Moreover, forced medication may be justified to reduce the patients’ probability of harming themselves or others, including patients in the emergency facility.
I would use the Columbia-Suicide Severity Rating Scale (C-SSRS) to assess the risk of suicide in patients. This model is ideal for assessing both children and adults. It is ideal for identifying active and passive suicidal thoughts (Interian et al., 2018). This tool has a scale that shows the severity of the thoughts depending on the patient’s responses. I would use the Historical Clinical and Risk Management 20 (HCR-20) to assess patient violence (Cheng et al., 2019). This assessment tool contains various items categorized into three major risk classes: historical, clinical, and risk management. Each category offers insight into the level of risk of the patient.
References
Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies.Frontiers in Psychiatry, 11, 127. Web.
Calcedo-Barba, A., Fructuoso, A., Martinez-Raga, J., Paz, S., Sánchez de Carmona, M., & Vicens, E. (2020). A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare.BMC psychiatry, 20(1), 1-14. Web.
Cheng, J., Haag, A. M., & Olver, M. E. (2019). Predictors of Historical Clinical Risk Management-20 Version 3 (HCR–20: V3) summary risk ratings.Psychiatry, Psychology and Law, 26(4), 682-692. Web.
How Do You Baker Act in Florida?. Port St. Lucie Hospital, Inc. | Florida Mental Health Services. (2020). Web.
Interian, A., Chesin, M., Kline, A., Miller, R., St. Hill, L., Latorre, M., & Stanley, B. (2018). Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to classify suicidal behaviors.Archives of suicide research, 22(2), 278-294. Web.