Rights of Psych Patients?

[sewingkelli]

What rights do psych patients have? Specifically when a new patient comes into the ED and a urine sample is needed for medical clearance.

What if the patient refuses or simply is non verbal to the request and won't move?

Do we wait until they spontaneously void placing a hat in the toilet or 4-pt them and straight cath them against their will?

Just wondering.

[Meriwhen, ASN, BSN, MSN, RN]

If the ED attending doesn't feel there is a psyc issue going on they will discharge them, if they feel they need psyc to "clear them" they have to wait until the morning. We do tell these patient right up front that they will have to stay overnight and usually they are ok with it, because they are usually the same patients and kind of know how it works at our hospital. Not that I agree with it.

I think your facility needs to have a better system for handling psych patients because as it stands right now, it's not very good. I hope your facility realizes that they can't legally detain a psych patient (actual or suspected) in the ED who wants to leave, because that could be construed as false imprisonment. If a psych patient wants to go, they have every legal right to go unless you get them TDO-ed. It may be an AMA discharge, but they can go.

You could encourage them to stay the night--after all, no one says you have to push them out the door, and you could make staying as appealing as possible. But "waiting for psych to arrive in the morning to clear them" isn't a valid legal excuse to detain them against their will.

I think your facility needs to fix the larger problem of what to do with psych patients in the off hours, before your facility finds itself at the wrong end of a legal action.

Oh yeah, a TDO means you can hold them for X hours...however the patient can still refuse treatment while under a TDO. To force treatment on a patient requires a seperate court order in most states.

[sewingkelli]

I think your facility needs to have a better system for handling psych patients because as it stands right now, it's not very good. I hope your facility realizes that they can't legally detain a psych patient (actual or suspected) who wants to leave, because that could be construed as false imprisonment. If a psych patient wants to go, they have every legal right to go unless you get them TDO-ed. It may be an AMA discharge, but they can go.

You could encourage them to stay the night--after all, no one says you have to push them out the door, and you could make staying as appealing as possible. But "waiting for psych to arrive in the morning to clear them" isn't a valid legal excuse to detain them against their will.

I think your facility needs to fix the larger problem of what to do with psych patients in the off hours, before the facility finds itself at the wrong end of a legal action.

Oh yeah, a TDO means you can hold them for X hours...however the patient can still refuse treatment while under a TDO. To force treatment on a patient requires a seperate court order in most states.

Thank you. I have a feeling I have just opened a HUGE can of worms.

[thehipcrip]

If you'd rather not stir up things at your hospital without being sure there is a problem, contact your state's Protection and Advocacy for Individuals with Mental Illness (PAIMI, pronounced "Pammy") Program, which advocates for individuals with mental illnesses. PAIMI services include general information and referrals; investigation of alleged abuse, neglect, and rights violations in facilities; and use of legal, legislative, systemic, and other remedies to correct verified incidents.

The staff at Protection and Advocacy Services will be able to advise you about all of your concerns, and depending on their available resources and current priorities, may even be able to take the lead on remedying rights violations that occur within your facility.

You can look up contact info for the PAIMI program in your state through the HHS Center for Mental Health Services.

Kudos to you for your concern about these suspect practices, Sewingkelli. You're an excellent nurse to advocate for the rights of people with mental illness who seek out help at your hospital.