Psychiatric Mental Health, part 1: Introduction, Patient Rights
by Cathy Parkes July 22, 2021 Updated: December 29, 2021 7 min read
Welcome to the Psychiatric Mental Health Nursing video and article series. This series follows along with our Psychiatric Mental Health Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Why is psychiatric mental health important in nursing?
Psychiatric Mental Health Nursing concepts are essential for ALL nursing students and nurses.
Understanding Psychiatric Mental Health concepts will not only help you be better prepared for your exams, it will also help you be more successful in your clinical rotations and in your nursing career.
You will regularly encounter patients with mental health concerns and disorders in every type of nursing environment. It is essential that nurses be able to effectively assess for mental health concerns, advocate for their patients, ensure patient safety (AND their own personal safety), and provide therapeutic communication.
Mental Health admissions & commitments
Patients can be admitted (by themselves) to a psychiatric facility or unit, or they can be committed (by someone else).
Admit and commit both use the same Latin root mittere which means to put or send. Commit comes from committere which means "to place in the keeping of" and admit comes from admittere which means "to allow entrance or approach."
Voluntary psychiatric admission can happen when a patient requests admission to a psychiatric facility or unit, and the patient may sign out at any time.
Please note that admission may be changed to involuntary if the patient meets certain criteria established by state law.
Involuntary psychiatric commitment is when a patient is admitted to a psychiatric facility or unit without their consent because they pose a risk to self or others, or is gravely disabled (unable to care for basic personal needs). Involuntary commitment requires a certain number of physician (usually 2, but it varies by state) to confirm justification for commitment.
Emergency psychiatric commitment is when a patient is admitted to a psychiatric facility or unit because they are an imminent threat to self or others. This type of commitment requires a court hearing within 24-72 hours to determine if the patient may be discharged, or if involuntary commitment is required. Laws vary by state.
Both involuntary commitment and emergency commitment are without the patient's consent, but emergency commitment is considered more of a short-term solution in emergency cases.
HIPAA law protects a patient's right to privacy. Patient information may not be disclosed to anyone that is not directly involved in the care of the patient without the patient's consent. One exception to this is that you as a nurse have a duty to warn.
Duty to warn
A nurse's duty to warn is if the nurse determines the patient poses a serious threat to another person, the nurse has to protect the third party. So information that would normally be protected by HIPAA is not protected in the case of warning against possible harm.
For example, if your patient says, "When I get out of here I'm going to kill somebody/hurt someone," then you have a duty to warn that third party due to those safety concerns.
Right to Refuse Treatment
Patients have the right to refuse medications or other therapies even if they were involuntarily admitted, except in an emergency. This right is available to the patient even after they have signed an informed consent form. Check out our Fundamentals of Nursing article on Right to Refuse for more information on the right to refuse as it pertains to all of nursing, not just the mental health setting.
For example, if you have a patient with bipolar disorder who is refusing their bipolar medications, as the nurse, you would talk to this patient and explain the benefits and risks of not taking that medication, but at the end of the day, it is that patient's choice and you will have to respect it. This helps you to uphold the nursing ethical standard of autonomy.
In the mental health setting, the emergency exception to the right to refuse would usually be a situation where a patient was getting violent and posing a risk of harm to themselves or other people, in which case medications may need to be provided regardless if the patient is consenting or not.
Right to Least Restrictive Environment
In the mental health setting, a patient has a right to the least restrictive environment. This means that restraints or seclusion should only be used as a last resort and for the shortest duration of time possible.
In the mental health setting, what this means is the care team would try other alternatives before resorting to restraints or seclusion.
Check out our video on patient restraints in the mental health setting for more information!
Hi. I'm Cathy with Level Up RN, and this is the first video in our Psychiatric Mental Health Nursing video playlist. If you are new to our channel, welcome. Be sure to subscribe. And we are just happy to have you here, and we'll do everything we can to help you get through this material. So in this video series, I will be going over the most important facts and concepts you need to know to be successful in your psychiatric nursing class, on your nursing exams, including the NCLEX, and in nursing practice.
So, no matter where you end up working as a nurse, understanding key mental health concepts and certain disorders is going to be so important because mental health issues, they can be found everywhere. It's just an important thing to know as a nurse.
So in this video series, I will be following along with my Psychiatric Mental Health Nursing flashcards. You don't need our flashcard deck to get value out of this video series. However, there's a lot of-- there's a lot of information. And it takes repetition to really have that information sink in, and that's where flashcards really come in handy. If you do have our flashcards, pay special attention to all the bold, red text that you'll find throughout the flashcard deck because that means that those particular concepts or facts are going to be particularly important to know.
So this video series can be used by both RN as well as well as PN students, there's a huge amount of overlap between those two programs. The important thing for my practical nurse students to remember is your scope of practice.
One thing I'd like to try with this video series is, at the end of each video, I want to give you guys a little quiz, a little knowledge check to make sure that you've been listening and that you've learned some of the key concepts that I've covered in the video. So these won't be complicated nursing-style questions, like no "select all that apply" or case studies. They're going to be pretty simple questions. But I thought that might be a fun way to end each video.
So tell me what you think. Leave me a comment. And if you like it, I'll keep doing it.
Alright. Let's dig into the principle section of our Psychiatric Mental Health Nursing deck. The first thing I'm going to talk about are the different types of admission or commitment to a mental health facility.
So, first of all, a patient can come in voluntarily. So we have a voluntary admission. It's where they sign themselves in, and they can sign themselves out at any time.
Now, if the situation changes such that the patient poses a risk to themselves or others, then that voluntary admission may turn into an involuntary commitment. But, initially, as long as they're not a threat to others or themselves, they can come in and and they can leave voluntarily.
Then we have involuntary commitment. So this is where a patient poses a threat to themselves or others or is gravely disabled.
So their mental illness prevents them from taking care of themselves, like eating, bathing, just taking care of the basic things they need to do.
So if a patient's going to be involuntarily committed, it usually requires two physicians to confirm justification for the commitment, but that will vary depending on the state.
Then we have an emergency commitment. So this is where a patient poses an imminent threat to themselves or others. And typically, this requires a court hearing between 24 and 72 hours (depending on what state you're in) to determine if the patient can be discharged or if an involuntary commitment is required.
So again, the laws that dictate admission and court hearings, etc., it will vary by state. So regardless if the patient was voluntarily or involuntarily admitted, they have certain rights. And I'm going to go over those rights here in this video and talk about some more in my next video as well.
One right is the right to confidentiality. So HIPAA law protects a patient's right to privacy. And patient information may not be shared with anyone who is not directly involved in the care of the patient without the patient's permission.
There is one exception to this rule, which is "duty-to-warn." So if the patient poses a risk to a third party, like if the patient says, "When I get out of here I'm going to kill somebody or hurt someone," then you as a nurse have a duty to warn that third party due to those safety concerns. So that is an exception.
A patient also has the right to refuse treatment. And this is the case whether the patient was voluntarily admitted or involuntarily admitted. So if an individual is refusing his bipolar medications, as the nurse, you want to talk to him and explain the benefits and the risks of not taking that medication, but at the end of the day, he can make that call and you need to respect that choice. Now, if there's an emergency situation where a patient is getting really violent and posing a risk of harm to themselves or to other people, then medications may need to be provided regardless if the patient is consenting or not.
And then the third right that I'm going to talk about here in this video is the patient has a right to the least restrictive environment, which means that restraints and seclusion should only be used as a last resort and for the shortest duration of time possible.
So really, we're going to try all sorts of other alternatives before we resort to restraints or seclusion.
Alright. Quiz time. I have two questions for you guys.
First question, what is the exception to a patient's right to confidentiality?
If you answered, "Duty to warn," you are correct.
So if a patient poses a threat to a third party, that third party must be warned.
Second question, a patient who has been involuntarily admitted does not have the right to refuse treatment. True or false?
The answer is false.
Even patients who have been involuntarily admitted have the right to refuse treatment, so procedures or medications.
Alright. So that's it for this video. In my next video, we will be talking about informed consent. So stay there with me!
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