Voluntary and Involuntary Commitment

Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment

Assignment (2–3 pages):

Introduction

Any minor 14 years of age or older may request admission to a psychiatric facility, special psychiatric hospital, or children’s crisis intervention service provided that the court finds that the minor’s request is informed and voluntary and enters an order approving the admission. If voluntarily admitted, a minor may discharge himself or herself from the facility in the same manner as an adult who has voluntarily admitted himself or herself.

No court approval is needed for the admission of a minor by the minor’s parent, parents, or other person in loco parentis to a psychiatric facility, special psychiatric hospital, or children’s crisis intervention service for the evaluation or diagnosis of a 56 childhood mental illness provided the admission is independently approved by a physician on the staff of the facility and does not exceed 7 days.

The admitting parent or other person in loco parentis may have the minor discharged upon oral or written request. Discharge shall take place as soon as practicable, but no later than 48 hours after the request unless the facility obtains a temporary order of commitment.

in suicide include a family history of suicidal behavior, exposure to family violence, impulsivity, substance abuse, and availability of lethal methods

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment

Mental health illnesses affect all populations across the lifespan. Adolescents’ individuals with mental health alterations especially behavioral disorders are always perceived as a dangerous population. This has lead to the willingness of mental health professionals and families to use coercion in getting care for affected youth (Kaltiala-Heino &Kaltiala-Heino, 2010). Therefore, in most cases, the majority of adolescents who receive treatment are via involuntary psychiatric evaluations. They are mainly referrals from law enforcement officials following those exhibiting self-harm behaviors.

Depending on the age, these individuals have the right to make decisions including those concerning their health. In certain situations, some of the decisions they make may be considered harmful by mental health experts. In psychiatry, mental illness is considered to alter clients’ cognition and understanding of various situations. This makes clients with mental illness incompetent and incapable of making the right choices. To make the right decisions, the client must show a proper understanding of the information relevant to the situation. Minors, in particular, are perceived as incompetent in many ways and therefore their self-determination is limited.

Consequently, parents or legal guardians are expected to act as trustees in making decisions, especially concerning healthcare. This paper is purposed to determine and support the appropriateness of voluntary and/or involuntary commitment with minors given a certain situation.

 

Commitment Choice

Presented with this scenario as the provider, I would recommend involuntary commitment. This is because the individual has exhibited danger to himself. This behavior is one of the factors that predict why involuntary commitment must be initiated. According to Lindsey, Muroff, and Ford (2010), involuntary admission to inpatient psychiatric care has been variously defined, but the consensus dictates the commitment to include various combinations of need for treatment and danger to self or others.

Besides, civil commitment may also be initiated when there are no alternatives to hospitalization; the client is presenting with acute symptoms, is in severe psychotic crisis, and currently is actively involved with drug abuse or dependence (McGarvey, Leon-Verdin, Wanchek, & Bonnie, 2013). A minor can be committed involuntarily if suffering from a mental illness which requires immediate treatment and failure to treat would lead to the severity of the disorder or will endanger health and/or safety (Kaltiala-Heino &Kaltiala-Heino, 2010).

New Jersey (NJ) State Laws

According to NJ state laws, the client is eligible for an involuntary commitment. NJ court may enter an order of commitment for a minor aged fourteen years or older if it finds the minor is suffering from childhood mental illness, and the illness is causing the minor to be dangerous to self or others. This is also permitted if the minor needs intensive psychiatric treatment that can only be provided at a mental health institution and cannot be provided at home, the community or an outpatient clinic.

Understanding the state laws confirmed my decision. The law explains and clarifies the criteria that allow involuntary commitment. In this case study, the individual present with a suicide attempt. This behavior confirms potential mental illness causing the client to be dangerous to self. The minor is therefore in need of inpatient psychiatric evaluation and treatment. This is congruent with the NJ laws’ recommendations.

Supporting Voluntary Commitment

As a mental health provider, clients who are not fully eligible for involuntary commitment may be encouraged to consent to voluntary admission. This will allow also voluntary discharge. No court approval is required for this type of commitment. The admission will allow the mental health professionals to evaluate the client more to ensure there are no behaviors or symptoms that the client may be masking or rather minimizing to retain his freedom when discharged. If the parent is involved in admission, he/she can request for discharge too.

Initiating Treatment for Non-illegible Involuntary Commitment

Most children and adolescents who exhibit suicidality suffer other comorbidities. Therefore the first step to begin treatment for this population is to conduct an initial comprehensive assessment including the family psychiatric history. In many cases, suicidal youths suffer from depression. According to Sadock, Sadock, and Ruiz (2014), there is epidemiological evidence suggesting that depressed youth with recurrent active suicidal ideation, including a plan, and who have made prior attempts, are at higher risk to complete suicide, compared to the ones who express only passive suicidal ideation. Therefore, completing a comprehensive psychiatric assessment is essential to determine the suicide risk factors and to guide the treatment.

Conclusion

Determining the type of commitment is based on many factors. Every decision made must consider the client’s safety first. The acuity and severity of the symptoms presented accounts for a substantial portion of the variance in predicting whether emergency services mental health providers initiate voluntary or involuntary commitment. If suicidality with a plan is present, involuntary commitment is initiated.

References

Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010). Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. General Hospital Psychiatry32(3), 300–309. https://doi- org.ezp.waldenulibrary.org/10.1016/j.genhosppsych.2010.01.007

Kaltiala-Heino R, &Kaltiala-Heino, R. (2010). Involuntary commitment and detainment in adolescent psychiatric inpatient care. Social Psychiatry & Psychiatric Epidemiology, 45(8), 785–793. https://doi- org.ezp.waldenulibrary.org/10.1007/s00127-009-0116-3

McGarvey, E. L., Leon-Verdin, M., Wanchek, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors. Psychiatric Services, 64(2), 120-6. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1176/appi.ps.000692012

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

depressive disorders neither attempt nor complete suicide; however, severely depressed youth often have suicidal ideation, and suicide remains the most serious risk of major depression. Nevertheless, many depressed youth do not ever have suicidal ideation, and many children and adolescents who engage in suicidal behavior do not have a depressive disorder. There is epidemiological evidence to suggest that depressed youth with recurrent active suicidal ideation, including a plan, and who have made prior attempts, are at higher risk to complete suicide, compared to youth who express only passive suicidal ideation especially suicidality with a plan requires involuntary commitment.

A lack of intensive community-based treatment and support in lieu of hospitalization accounted for a significant portion of variance in actions to initiate involuntary commitment. Comprehensive community services and supports for individuals experiencing mental health crises may reduce the rate of involuntary hospitalization. There is a need to enrich intensive community mental health services and supports and to evaluate the impact of these enhancements on the frequency of involuntary mental health interventions- McGarvey, E. L., Leon-Verdin, M., Wanchek, T. N., & Bonnie, R. J. (2013Lorant, V., Depuydt, C., Gillain, B., Guillet, A., & Dubois, V. (2007). Involuntary commitment in psychiatric care: What drives the decision? Social Psychiatry and Psychiatric Epidemiology, 42(5), 360-5. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1007/s00127-007-0175-2

 

Suicidal ideation, gestures, and attempts are frequently, but not always, associated with depressive disorders. Reports indicate that as many as half of suicidal individuals express suicidal intentions to a friend or a relative within 24 hours before enacting suicidal behavior.

Suicidal ideation occurs in all age groups and with greatest frequency in children and adolescents with severe mood disorder

risk factors in suicide include a family history of suicidal behavior, exposure to family violence, impulsivity, substance abuse, and availability of lethal methods

Factors that may increase the probability of psychiatric treatment include psychoeducation for the family in the emergency room, diffusing acute family conflict, and setting up an outpatient follow-up during the emergency room visit. Emergency room discharge plans often include providing an alternative if suicidal ideation reoccurs, and a telephone hotline number provided to the adolescent and the family in case suicidal ideation reappears.

CBT alone and in combination with SSRIs have been shown to decrease suicidal ideation in depressed adolescents over time in the Treatment of Adolescent Depression (TADS) study

 

individuals basically have a right to make decisions concerning themselves, including decisions concerning their health that experts consider harmful. In psychiatry, however, the patient’s wish not to be treated can be overridden both referring to her/his need for treatment and to dangerousness to her/himself or others. Mental illness is considered to alter the patient’s understanding of her/his situation and the consequences of her/his choices so that s/he can no longer be deemed competent to make decisions-Kaltiala-Heino R, &Kaltiala-Heino, R. (2010).

In order to be competent to make decisions, a patient must be able to understand information as relevant to her/ his situation, process that information and express a choice [2]. Minors are seen by definition incompetent in many ways, and therefore their self-determination is limited, and parents are expected to see to their best interests, forexample, in decision-making concerning health care.

 

client is such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment

According to McGarvey, Leon-Verdin, Wanchek, and Bonnie (2013), involuntary commitment is considered following the clinical factors related to the commitment criteria, which include risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence.

 

should be imitated when the provider is presented with a case whereby there is no alternatives to hospitalization, such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment; and clinical factors related to the commitment criteria, including risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence.

 

Several factors predicted 84% of the actions taken to initiate involuntary commitment. These included unavailability of alternatives to hospitalization, such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment; and clinical factors related to the commitment criteria, including risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence-McGarvey, E. L., Leon-Verdin, M., Wanchek, T. N., & Bonnie, R. J. (2013).

Why? Because, Criteria for civil commitment (i.e., involuntary admission to inpatient psychiatric care) have been variously defined, but the general consensus among research studies has been that civil commitment includes various combinations of need for treatment and danger to self or other-Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010).

Additionally, symptom severity was the strongest predictor, suggesting that those most in need appropriately received care-self-harm and perceived dangerousness by others have also been found to be associated with inpatient psychiatric admission-Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010).

the acuity and severity of the individuals’ presenting symptoms accounted for a substantial portion of the variance in predicting whether emergency services clinicians initiated action to initiate involuntary commitment-McGarvey, E. L., Leon-Verdin, M., Wanchek, T. N., & Bonnie, R. J. (2013).

· Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?

· A minor can be involuntarily hospitalized if she/he suffers from a severe mental disorder and, due to the disorder, is in need of treatment because failure to treat her/him would result in a deterioration of her/his severe mental disorder (need for treatment), or would endanger her/his health or safety (dangerousness to self), or other persons’ health or safety (dangerousness to others), and other treatment options are inadequate-Kaltiala-Heino R, &Kaltiala-Heino, R. (2010

· In need of involuntary commitment” is defined by the statute as:5 …an adult who is mentally ill, whose mental illness causes the person to be dangerous to self or dangerous to others or property and who is unwilling to be admitted to a facility voluntarily for care, and who needs care at the short-term care, psychiatric facility or special psychiatric hospital because other services are not appropriate or available to meet the person’s mental health care needs. N.J.S.A. 30:4-27.2(m).

· If a minor is under 14 years of age, dangerous to self also means that there is a substantial likelihood that the failure to provide immediate, intensive, institutional, psychiatric therapy will create in the reasonably foreseeable future a genuine risk of irreversible or significant harm to the child arising from the interference with or arrest of the child’s growth and development and, ultimately, the child’s capacity to adapt and socialize as an adult. R. 4:74-7A(a)(3). In the Matter of the Commitment of N.N., supra.

· that can be provided at a psychiatric hospital, special psychiatric hospital or

· children’s crisis intervention service and which cannot be provided in the home, the community or on an outpatient basis.

 

· Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.

The NJ state laws confirm the initial recommendation-it explains the different criteria used to initiate involuntary commitment. The childhood mental illness causes the patient to be dangerous to self or others or property as defined by R. 4:74-7A(a)(3); and The minor is in need of intensive psychiatric treatment that can be provided at a psychiatric hospital, special psychiatric hospital or children’s crisis intervention service and which cannot be provided in the home, the community or on an outpatient basis

· If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.

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