2. Legal and Ethical Context of Psychiatric Nursing Care
• Ethic: A standard of behavior or a belief valued by an individual or
group
• Essential Ethics Skills in Psychiatric Practice (See Stuart text-p.111)
• Ability to be aware of one’s own values, strengths, and biases as they apply to
work with patients
3. Legal and Ethical Context of Psychiatric Nursing Care
• Ethical Decision Making: involves trying to distinguish right from
wrong without clear guidelines
• Gather background information
• Identifying ethical components
• Clarification of the rights and responsibilities of all ethical agents
• All possible options must be explored
• Application of principles
• Resolution into action
5. Legal and Ethical Context
of Psychiatric Nursing Care
• Hospitalized psychiatric patient
• Can be either traumatic or supportive for patient depending upon:
• Institution
• Attitude of family and friends
• Response of staff
• Type of admission
• Voluntary
• Involuntary
6. Legal and Ethical Context
of Psychiatric Nursing Care
• Characteristics of Voluntary Admission (see Stuart text)
• Similar to medical admission and discharge initiated by patient
• Patient retains all civil rights
• Patient actively agrees and participates in treatment
7. Legal and Ethical Context
of Psychiatric Nursing Care
• Characteristics of involuntary admission or commitment
• Patient did not request
• Based on 2 legal theories
• Police: Protect community from dangerous acts of mentally ill
• Parens patriae (pa-tree-aye) powers: State cares for citizens who cannot care
for themselves
8. Legal and Ethical Context
of Psychiatric Nursing Care
• Criteria for involuntary commitment
• Mentally ill person is:
• a danger to self
• A danger to others
• Unable to care for self (gravely disabled)
• And in need of treatment
9. Legal and Ethical Context of Psychiatric Nursing Care
• Yet all patients have rights, even the mentally ill See patient’s rights (See
Stuart text, pg. 117)
• Right to privacy – HIPAA protects personal health information- required
permission for disclosure
• Must protect third parties: Duty to warn intended victims (Tarasoff)
10. Legal and Ethical Context of Psychiatric Nursing Care
• Commitment process
• In Nevada, requires signed, dated, and timed Legal 2000
• Registered nurse can do this process
• After or within 72 hours, court decides if commitment continued,
discontinued
• Patient allowed to sign-in voluntarily
11. Legal and Ethical Context
of Psychiatric Nursing Care
• Most mentally ill people are not violent, but many are victims of
violence
• Research suggests that a subgroup with MI may be more dangerous
and share features with violent offenders including poverty.
12. Legal and Ethical Context of Psychiatric Nursing Care
• Who is a danger to self or others?
• Mentally ill with
• Violent behavior
• Psychosis
• Noncompliant with medications
• Current substance abuse
• Antisocial personality disorder
• Lack of perceived need for treatment
• Lack of perceived treatment effectiveness
13. Legal and Ethical Context
of Psychiatric Nursing Care
• Mental Health Courts
• In Las Vegas, held at Rawson-Neal Psychiatric Hospital
• Every Wednesday and Friday except holidays and weekends
• Keeps the mentally ill from being jailed
• Supervise cases
• Coordinate treatment plans
• Social services: Arrange housing, job placement, relapse prevention
14. Policy and Advocacy in Mental Health Care
• Four other psychiatric disorders in top 10
• Alcohol use
• Bipolar disorder
• Schizophrenia
• Obsessive-compulsive disorder
• In the U.S., there are approx. 20% of adults with any mental illness
and 5% with a serious mental illness (2009 stats)
15. Policy and Advocacy in Mental Health Care
• Policy and Legislation
• Access: how easy are services and information obtained
• 2 main policy approaches to equalizing care
• Mandated coverage for mental health care
• Mental health parity
• Mental Health Parity Act of 1996
• Mental Health and Addiction Equity Act of 2008
• Patient Protection and Affordable Care Act of 2010 (Health Reform Law)
• Expanded health coverage to uninsured and to small business
• Excludes preexisting conditions
16. Policy and Advocacy in Mental Health Care
• Protection and Advocacy for Mentally Ill Individuals Act of 1986
• Americans with Disabilities Act
• Prevents discrimination against physical and mental disabilities
• Advance Directives
• Directives when written, a person is competent, to be implemented if the person
becomes incompetent
• Mental Health Courts
• Helps keep people with minor criminal offences out of the jails and prisons, and into
treatment instead
17. Policy and Advocacy in Mental Health Care
• Advocacy
• Advocacy is a personal and professional call to action
• Fight stigma
• Share your personal experience with mental illness with others
• Influence public opinion and the legislature
