Involuntary Admission to Inpatient Psychiatric Units (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 Now, when there's an involuntary psychiatric admission.

    00:06 Now, involuntary means the person says, "I don't want to be in the hospital.

    00:10 I don't think I need being in the hospital." A healthcare provider can seek to have a patient admitted involuntarily.

    00:20 An involuntary admission to an acute inpatient psychiatric hospital occurs when the patient doesn't agree to hospitalization on the locked inpatient psychiatric unit.

    00:32 So a mental health professional, and we usually say a 2-Pc.

    00:38 It's a 2 physician certificate is required to do this against the will of the patient.

    00:46 So the physicians, the psychiatrist evaluate the patient, and see and determine if the patient has a diagnosable mental illness and is at risk of harming themselves or others, or is unable to care for themselves.

    01:04 And in that case, the patient is involuntarily admitted.

    01:11 Before that patient is able to be discharged from the hospital, even before the next admission, they must have a court hearing.

    01:21 This is a legal document, that the patient has been put in this hospital for his or her own safety, or the safety of those around them.

    01:33 So the criteria for admissions are legal standards, under which it is the court deciding whether or not the admission is necessary, and oftentimes whether the person can even be discharged.

    01:49 And hospitalized patients still retain their rights as citizens.

    01:54 They are not losing their rights, they are not being "locked up" in prison, they are being admitted to a locked ward and oftentimes a double locked ward, which I will talk about.

    02:08 They are still citizens. They can still vote.

    02:11 Their safety and their rights as a patient have to be balanced with their rights as a citizen.

    02:23 So mental health facilities have written statements of patient's rights, as well as the applicable state laws.

    02:30 And it's important to remember that these laws are state determined.

    02:37 And so a patient's right in a specific hospital depends on what state that person is in.

    02:44 Whether or not they are in New Jersey or Connecticut or Iowa, or California.

    02:51 We as nurses need to know our nursing practice rules and regulations, which is also state.

    03:01 We also need to know what the laws are that protect persons with mental illness.

    03:09 Patients have the right to treatment.

    03:12 Patients have the right to refuse treatment.

    03:16 So they can say, "I am not taking my medication." There is no time that we are allowed to as nurses treating a patient with psychiatric problems in an inpatient setting.

    03:30 There is no time that we are allowed to violate their human rights of the refusal.

    03:36 In the event that it is deemed unnecessary, it is not a nursing judgment that overrides the patient's will.

    03:44 It is either a court judgment, or it is the physician designating the fact that this patient right now is in imminent danger of hurting themselves or others.

    03:59 Our respect for our patient, and oftentimes the therapeutic relationship that we develop with our patients eliminates the need to have these kind of serious interventions.

    04:16 But there are times that will arise where the court or the physician may have to make that determination.

    04:26 Patients have the right to the least restrictive environment.

    04:31 And so unless it is really deemed that they are someone who might hurt themselves or someone else, you wouldn't want to put that person in a double locked ward.

    04:45 They have the right to informed consent.

    04:48 And what does that mean? Well, if we have to do surgery, if we are thinking of doing any procedure, that procedure needs to be explained to them, and they have the right for informed consent.

    05:03 That means that the patient has been provided with a basic understanding of the risks, of the benefits, and of any alternatives to the thing that we are offering them.

    05:17 The person must voluntarily accept the treatment that we are providing.

    05:22 We don't force them to do what we want them to do, they must accept the treatment voluntarily.

    05:32 And to be effective legally, it must be informed in the general physician or advanced practice provider.

    05:39 We have to give them that information.

    05:44 And we must obtain that consent.

    05:47 We have to cosign, we have to say yes.

    05:49 I'm here. I'm seeing this person consent.

    05:53 Now, one of the hospitals I worked at, we also had a video.

    05:58 And why would you think we might have a video? Because with some of our patients afterwards, they would say, "That is not my signature. I never consented that person." If especially, if they're paranoid, "That person wrote my handwriting, and that's not me." So in those situations, we actually videotaped the signing of consent.

    06:21 So that when and if we had to go to a court of law, which oftentimes you may be brought into a court of law, you actually have the information that demonstrates that you got consent.

    About the Lecture

    The lecture Involuntary Admission to Inpatient Psychiatric Units (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Accessing Acute Psychiatric Care (Nursing).

    Included Quiz Questions

    1. The criteria for admissions and discharges are legal standards
    2. The initial hold is usually 24 hours
    3. The client must be at risk of harming themselves
    4. A court hearing is mandatory and must be initiated when the client is first admitted
    1. “As you are admitted involuntarily, you will unfortunately not be able to vote in tomorrow’s federal election.”
    2. “As you are on an involuntary psychiatric hold, it is the court that must decide when you are ready for discharge.”
    3. “You mentioned that the admission process is different here than it was in your home state, that’s because patient rights are governed by state, not federally.”
    4. “Even though you are on an involuntary psychiatric hold, you still have the right to refuse treatment.”
    1. “You have the right to be told the benefits and risks of this procedure, and you have the right to refuse at any time.”
    2. “You have the right to refuse this treatment, but that means that you will remain on the double-locked unit instead of transitioning to the single-locked unit.”
    3. “You, unfortunately, are unable to refuse this procedure as you are admitted involuntarily.”
    4. “You are unable to consent to this procedure as you are admitted involuntarily, so a court-appointed guardian will consent or decline on your behalf.”

    Author of lecture Involuntary Admission to Inpatient Psychiatric Units (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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