2 Historical Review Roman Law Concerned with legal status of mentally disabledMiddle AgesIncompetence decided by juryMentally ill committed to care of friend
3 Historical Events United States 1600s Cared for by families or wandered1752 First hospital for mentally illDorothea Dix crusadesLate 1800s Civil commitment1900–1950s State hospital populations
4 Historical Events, cont’d. 1963: Community Mental Health ActDeinstitutionalizationLack of community treatment resourcesExpanded commitment laws
5 Historical Events, cont’d. Managed Behavioral HealthTreatment access restrictedCarve outs to control costsInsurance benefits meagerPremature discharges
6 Commitment Voluntary Patient consents to admission Patient may request dischargeEmergencyRisk of harm to self or othersShort termLonger-term judicial or civilProtects community from persons posing a threatMandatory outpatient treatment
7 Least Restrictive Alternative Use least restrictive environmentUse least restrictive treatmentEvolved to:Use most clinically appropriate treatmentUse most cost-effective interventions
8 Confidentiality and Privileged Communication Protection and privacy of health information guaranteed by HIPAASigned release necessaryPrivileged CommunicationNo forced disclosure in court of certain information given to professionals
9 Tarasoff Duty to Warn and Protection A treating mental health professional has a duty to warn potential identifiable victims.
10 Rights of Patient Vote Manage financial affairs Make contracts Seek advice of attorneySend and receive unopened mailWear own clothesReceive visitorsMake phone callsHave Informed consent regarding treatment and research participation
11 Right to Be Restraint Free Seclusion and RestraintCMS standards:Client right to be restraint free is paramountUse only when less restrictive alternatives failOne hour rule
12 Right to TreatmentA nondangerous individual cannot be hospitalized without being provided with some form of treatment.
13 Right to Refuse Treatment MedicationsVoluntary and involuntary patients can refuse medication.In emergency situations, if potential danger is present, patient can be medicated against his or her will.ECTRequires informed consent.State laws vary regarding refusal.
14 Right to Advocacy Nursing Responsibilities Obtain authorization for treatment.Inform client of right to appeal for denial of care.Provide data for utilization review.Report violation of rights.
15 Competency to Stand Trial Does the person understand:The criminal charges?The legal process?The consequences of the charges?Can the person advise an attorney and defend the charges?
16 Criminal Responsibility M’Naghten Rule (Insanity Defense)Refers to person’s state of mind at the time of the offense.To be found guilty, person must be able to form intent.If unable to form intent because of mental illness, person cannot be found guilty.If not guilty, person is usually evaluated for commitment to a hospital for treatment.
17 Guilty but Mentally Ill Possible plea in some statesPerson found guilty, but mental illness caused commission of offenseSent to prison and treated for mental illness
18 MalpracticeA health professional omits or commits an act that a reasonable prudent professional would not do.
19 Elements of Malpractice Suit Based on Negligence Legal duty to provide a certain standard of careBreach of dutyProximate cause“But-for” testSubstantial factor testProven injury
20 Documentation in the Medical Record Legal documentCommunication with other professionalsValidation that professionals adhered to scope of practiceValidation for reimbursementSupport for ongoing care/chosen care level
21 Other Malpractice Lawsuits Involving Health Professionals Sexual misconductWrongful death actions for:SuicideHomicideInjury to third party
22 Ethics Explores moral problems raised about specific issues. Ethical dilemmas in psychiatric nursing often relate to conflicts between mental health law and nurses’ personal beliefs.