In the state of California, involuntary psychiatric holds fall under the so-called “5150” legal code which specifies guidelines for involuntary psychiatric commitment for eligible persons. Involuntary psychiatric commitment is a controversial practice exercised with the sole aim of protecting society from individuals exhibiting suicidal tendencies and capable of harming others (Sisti, 2017). A majority of the individuals committed to psychiatric facilities often exhibit symptoms commonly associated with mental health disorders. Hence, involuntary psychiatric holds in states such as California are viewed as a last-ditch effort to intervene in desperate scenarios, while actively participating in providing in-depth inpatient assessments and care to address patient’s mental health needs.
California’s State Law for Psychiatric Holds for Child and Adult Psychiatric Emergencies
California’s Code Section 5150 specifies that only designated personnel can hold juvenile or adult patients during psychiatric emergencies. Furthermore, they may only hold eligible persons for a total of 72-hours, after which a decision is made on whether to refer them to an in-patient psychiatric treatment facility for crisis intervention or have the patient agree to receive outpatient services. Personnel capable of placing juveniles or adults under an involuntary 72-hour hold in the State of California include law enforcement officers, mobile crisis team members and designated mental health experts. Yet, they are required to exercise discretion during psychiatric emergencies to ensure that only eligible persons are committed to an inpatient psychiatric facility. Personnel responding to psychiatric emergencies must demonstrate probable cause before making an informed decision to execute an involuntary hold. Eligible persons should demonstrate a susceptibility to harming themselves (DTS) or others (DTO) and austerely disabled (GD) (California Legislative Information, 2021). Each hold should be preceded the reading of rights and competing paperwork before formally commencing with placing the patient under the 72-hour inpatient psychiatric hold. It is noteworthy to acknowledge that attending staff at respective mental health facilities will be solely responsible for evaluating and recommending treatment before deciding to lift the hold, initiate crisis intervention, or provide voluntary outpatient services. Based on the judgment of attending staff, the patient can then be released to a “responsible relative”, guardian, or primary healthcare provider.
Emergency Hospitalization for Evaluation, Inpatient Commitment and Outpatient Commitment in the State of California
Major defining differences when reviewing hospitalization for evaluation, inpatient commitment, and outpatient in California. Emergency hospitalization only becomes necessary when the patient has a mental health disorder and may harm themselves (DTS) or others (DTO) (California Legislative Information, 2021). In this case, designated personnel are authorized to execute a 72-hour hold pending the commencement of an in-depth evaluation of the subject in question. After reading the patients their rights paperwork is then completed before being handed over to attending staff in a county facility.
Attending psychiatric specialists are tasked with evaluating patients during the 72-hour hold to determine the most appropriate intervention and whether or not they should proceed with inpatient commitment. Only recommendations for inpatient commitment from staff sanctioned by the State Department of Health Care Services can be approved to ensure that such endorsements are pursuant to a facility’s subdivision provision (California Legislative Information, 2021). Inpatient commitment is particularly necessary in cases where there is evidence of imminent harm by the patient and is normally implemented with the sole aim of protecting and the general public. Furthermore, attending staff must also review the patient to determine whether or not they should be detained during inpatient commitment.
In California, the judgment of attending staff determines patient’s qualification for outpatient commitment. This decision is typically arrived at after the patient completes their hold successfully without being detained within the facility but still in dire need of mental health services. Outpatient commitment is, therefore, a form of alternative mental health service with key treatment recommendations falling squarely under the domain of the County Mental Health Director (California Legislative Information, 2021). Responsible relatives who take patients into their custody play an important role in ensuring they participate and complete requirements for outpatient treatment, in addition to providing a written report of the progress made.
Capacity and Competence in Mental Health Contexts
Capacity and competence are two closely related terms often used within a mental health context. Attending staff have an obligation to committed patients to ensuring they have a proper understanding of mental health lexicon as part of patient education. Capacity is a functional evaluation as to whether an individual is capable of making rational medical decisions within a specified mental health context (Fogel, 2015). It entails a thorough evaluation of the patient, given the prevailing circumstances confronting them, and implications of recommended interventions. Competency, on the other hand, is an individual’s ability to actively participate in legal proceedings (Fogel, 2015). However, tangible evidence must always be provided to either prove or disprove competency given that it is formally determined by a judge.
HIPPA Privacy Rules in Involuntary Commitment
Privacy rules, within the context of involuntary commitment, represent a complex matter, especially in relation to guardianship. Although designated personnel are allowed to place individuals who pose an imminent DTS or DTO threat under a 72-hour hold, HIPPA privacy rules still require such facilities to share relevant information pertaining to the commitment with family members and their primary healthcare provider (Nicholls & Wilkins, 2011). Yet, the facility is still required to guarantee the fidelity of patient’s data by protecting their health information; only disclosing it to their family, members of clergy, and religious affiliation.
Evidence-Based Suicide Risk Assessment Tool
The Patient Health Questionnaire (PHQ-9) is a common evidence-based suicide risk assessment tool ideal for screening at-risk patients during a psychiatric emergency. PHQ-9 is also a self-administered risk assessment that has particularly been successful identifying patients with a spectrum of mental health disorders (Thombs et al., 2014). During involuntary commitment, its strength is majorly in its ability to promote successful completion of criteria-based diagnoses, which boosts its profile and eligibility for use.
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