Can pts be treated compulsorily (sp?) in the US?

[kermit27]

I'm an UK student nurse (going for adult RN) in the middle of my 4 week "insight" mental health placement.

In Britain they can "section" someone under the Mental Health Act and force treatment, including, sometimes ECT.

I saw ECT in action for the first (and LAST!) time today and was pretty unimpressed. One patient got on the table and then changed her mind and demanded to be let out and withdrew consent, and 5 people held her down, the anaesthetist put the venflon in and she had it anyway.

The team did have the sense to look pretty sheepish in front of me -- a first-year nursing student (even though a mature one) and tried to reassure me that that was pretty rare event and "she was under section anyway, so she had to have it..."

What about all the consent stuff we're being force fed at school? Is this type of thing common? Any opinions gratefully received.

[elkpark]

All 50 states in the US have laws which allow for people to be held against their will for psychiatric evaluation, but the order must be issued by a magistrate after someone has convinced the magistrate that the person in question is dangerous to him/herself or others. After the person is taken to a psychiatric facility, there must be a hearing (with a judge, and a lawyer to represent the patient) to determine whether there is a need to detain the person beyond the evaluation. The details of the laws vary quite a bit from state to state.

In my state, even if you are admitted to the hospital involuntarily, you still cannot be treated against your will unless it is an emergency (i.e., you are actively harming yourself or others) or two physicians agree that, without the medication, you will continue to deteriorate or be unable to benefit from the treatment available. Medication can be forced on people if these conditions are met, but ECT cannot be forced on anyone in my state.

Ooops, wait, I suppose that, in the case of someone who had been adjudicated incompetent (again, by the court system) and had an appointed guardian, it would be possible that the guardian could give consent for ECT even though the patient would refuse. That would be the only situation I can imagine in which ECT would be forced on someone, and, in that case, it would be someone who was not legally able to give or withhold consent.

I cannot speak to how things are done in the UK. I have been a psych nurse here for ~20 years, though, and I can tell you truthfully that, if I were intractably depressed (the only dx for which ECT is used in this country, after all the options have failed), I'd choose ECT before I'd take some of the medications we routinely give psych patients ... I've seen it help a lot of people, and have known a lot of "satisfied customers." :)

[kermit27]

Thanks Elkpark. I'm American myself but have lived over here most of my adult life. As a result, I'm constantly comparing the two societies.

I had wondered whether compulsory treatment was more regulated because of all the civil rights laws in the US, which they don't really have down on paper in the UK...

[normj]

Thanks Elkpark. I'm American myself but have lived over here most of my adult life. As a result, I'm constantly comparing the two societies.

I had wondered whether compulsory treatment was more regulated because of all the civil rights laws in the US, which they don't really have down on paper in the UK...

Basically, there is an unfunded federal mandate requiring each county to employ Mental Health Professionals who have the power to involuntarily detain individuals who: are in iminent danger of harming themselves or another; are gravely disabled and unable to care for themselves secondary to mental illness; or are a grave danger to the property of others (rarely used). Here in King County, WA, USA, these individuals are known as the County Designated Mental Health Professionals ... they are generally masters-trained, and they and ONLY they have the power to involuntarily detain someone (NOT a doctor nor psychologist nor anyone else). it works similarly over most of the US, in some states a doc or two docs can do it, but the main point of the federal law is that the detaining authority may NOT work for any potential receiving facility (i.e., an ER doc cannot detain someone at his own facility, the pt. would have to go somewhere else).

It's complex and varies from state to state, hope that is a good start to help your research.

[normj]

but the main point of the federal law is that the detaining authority may NOT work for any potential receiving facility (i.e., an ER doc cannot detain someone at his own facility, the pt. would have to go somewhere else).

oops, that should have read "one major point is that ..."

[Hellllllo Nurse, BSN, RN]

ECT has a terrible stigma and image attached to it, but I've had quite a few psych nurses tell me that it works wonders with severely depressed pts. I bet the general public has no idea that ECT is alive and well. I'm sure it would cause a huge uproar if the public knew how widespread use of ECT is.

[chris_at_lucas_RN, RN]

Just on the face of what you had posted, this would be assault and battery in the US, a criminal act (felony) punishable by fines and imprisonment.

I don't see any reference to anyone telling her, each other or you that she had no consent to withdraw.

Frankly, I find the scenario horrifying.