As a current nurse working inpatient mental health, I have been able to take care of acutely ill psychiatric patients that have been involuntarily hospitalized or committed. Involuntary hospitalization requires legal actions for psychiatric evaluations or treatment through the court system. The purpose of this discussion is to explain the legal and ethical considerations of involuntary hospitalization due to commitment in both adults and children/adolescents.
Commitment Process in Mississippi
In my state of Mississippi, specific actions must be taken before starting a commitment process. According to the Mississippi Department of Mental Health (2021), an affidavit is filed through the chancery clerk along with a one–hundred and fifty dollar filing fee. A writ is issued to the county sheriff to take that person into custody for pre-evaluation screening at a local community mental health center. Two healthcare providers must evaluate the client within forty-eight hours to determine if the client meets the criteria for commitment. A hearing is set between seven to ten days, and the judge will make the final decision based on the evidence presented in court. Based on availability, the judge can order a civil commitment to a crisis stabilization unit, state, or outpatient program.
The purpose of involuntary civil commitment is to help protect one that is an immediate threat to themselves or others; however, there are specific ethical and legal considerations to be aware of while considering commitment. An ethical concern that may arise during the commitment process is viewing human rights. For example, pregnant women involuntarily committed related psychosis and required treatment with antipsychotics. The rights of the patient and the fetus must be considered during treatment, and the clinician must identify the risk and benefits of untreated mental illness (Friedman et al., 2018).
The rights of children and adolescents are essential to treatment as well. A controversial treatment area is seen in adolescents with eating disorders, such as anorexia nervosa. Severe cases of anorexia nervosa can lead to irreversible effects that can be detrimental to the patient’s health which meets the criteria for involuntary commitment (Ramasamy, 2021). It is essential to understand what ethical considerations may lead to legal concerns.
Legal concerns can arise when patients feel they have the right to refuse treatment. The example provided previously of pregnant women with psychosis who require treatment is an excellent example in identifying the legal concerns in this situation. States like California recognize fetuses as “human beings.” If the mother chooses to refuse treatment, this poses a threat to her and the fetus. According to Nau, Bender, and Street (2011), clinicians must be aware of the rules and regulations of the state when it comes to decision-making for treatment.
The challenges that may arise during the involuntary commitment of children and adolescents may be due to the age requirements that vary from state to state. The parents of a child play a significant role in the commitment process. The example provided of the adolescent with anorexia nervosa requires a parent or guardian to decide and sign consent for treatment. According to Neiman and Pelkey (2016), minors are protected by constitutional and state laws that provide treatment based on clinical needs.
In conclusion, involuntary commitment requires ethical and legal considerations before initiating the process. As a clinician, it is essential to know the state laws for commitment.
Friedman, S. H., Hall, R. C., & Sorrentino, R. M. (2018). Involuntary treatment of psychosis in pregnancy. The journal of american academy of psychiatry and the law, 46(2), 217-223. https://doi.org/10.29158/JAAPL.003759-18
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