1983 – In Rennie v. Klein , a patient claimed a hospital violated his rights when he was forced to take psychotropic medications. The ruling again addressed the right to refuse treatment and the right to privacy, and it furthered the necessity of obtaining informed consent (https://pubmed. ncbi.nlm.nih.gov/11648483/). 1992 – Foucha v. Louisiana demonstrated that the nature of an ongoing psychiatric commitment must bear some reasonable relation to the purpose for which the patient is committed (Foucha v. Louisiana, 1992). When Foucha was first hospitalized, the indication was a patient who was considered mentally ill and dangerous. The ruling recognized that patients who are no longer mentally ill do not require hospitalization and that patients are not required to prove themselves to be no longer dangerous (https://www.law.cornell.edu/supct/html/90-5844.ZO.html). Mental health laws have been created to protect patients with psychiatric disorders and regulate their care. These laws often vary by state. Check the Nurse Practice Act within the respective state of practice to determine state-level regulation.
1976 – In the well-known case of Tarasoff v. The Regents Of the University of California , the parents of Tatiana Tarasoff sued the university following the 1969 death of their daughter at the hands of Prosenjit Poddar. Poddar had told his therapist that he planned to kill Tarasoff when she returned from summer break. Although the therapist had contacted the police, law enforcement released Poddar because he appeared rational. The court found that the therapist had a duty to warn of threats of harm to others and was negligent in not notifying Tarasoff of the threats that had been made against her (https://law.justia.com/ cases/california/supreme-court/3d/17/425.html). 1979 – Patients at Boston State Hospital sought the right to refuse treatment in Rogers v. Okin . Based on the 1965 decision regarding the right of personal privacy, the court found that the hospital could not force nonviolent patients to take medication against their will. This ruling also included the directive that patients or their guardians must give informed consent before medications could be given
(https://pubmed.ncbi.nlm.nih.gov/6134270/ and https://muse.jhu.edu/article/404046).
MENTAL HEALTH AND DEINSTITUTIONALIZATION
it means that nurses need to try to manage patients’ symptoms and behaviors with psychotherapeutic interventions (milieu management, communication, and behavioral approaches) first. If symptoms are not fully or adequately managed, nurses should document what was attempted and ineffective in order to move to more restrictive measures or levels of care (i.e. move up the treatment hierarchy to more restrictive approaches such as medications/chemical restraints, seclusion, and/or physical restraints). Each time a more restrictive measure is applied, documentation needs to support which lesser restrictive strategies were attempted and describe their lack of efficacy. An understanding of civil rights and state regulations is important to patient care procedures. Admission of psychiatric patients can be voluntary or involuntary, but neither voluntary nor involuntary admission indicates the ability of the patient to make decisions (Halter, 2018). Admission procedures are in place to protect the patient and the public. Involuntary admission is used when patients are a danger to self or others or cannot take care of themselves. However, all patients are to be treated with respect and have the right to informed consent, the right to refuse medications, and the right to the least restrictive treatments (Boyd, 2018). Furthermore, the patient must be seen by a specified number of providers who confirm that the patient meets the criteria for involuntary admission.
The changes in mental healthcare over the years show a shift in care from institutionalization to community settings, also known as deinstitutionalization (Boyd, 2018). Deinstitutionalization was also significant because this shaped our current community and mental health treatment for many vulnerable individuals including the homeless and those with substance use disorders. During the era of state hospitals, mentally ill individuals were less likely to be chronically homeless. While deinstitutionalization was a noble concept, it was not well implemented. The lack of existing public health infrastructure left communities unprepared to manage those with chronic mental illness. Additionally, the arrival of inexpensive and accessible illicit drugs like crack cocaine, changed the face of communities and left those with mental illness even more vulnerable. The lack of affordable treatment for mental health disorders contributes to both individual and public health risk. Two of the most important concepts in civil rights law are the writ of habeas corpus and the least restrictive alternative doctrine (Halter, 2018). The writ of habeas corpus pertains to holding people against their will. Psychiatric patients are included in this protection and they have the right not to be detained unless individual welfare is involved. Additionally, the least restrictive alternative doctrine states that a patient’s autonomy must be upheld whenever possible (https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC2733575/pdf/behavan00025-0105.pdf). In practice
THE CONSUMER BILL OF RIGHTS AND CONFIDENTIALITY
on confidentiality of health information. Patients with psychiatric disorders are expressly protected in the confidentiality of their records; practitioners may not share information with any third party without the express written consent of the patient or their legal guardian. The patient can withdraw consent to release information at any time.
In 1997, President Clinton appointed the Advisory Commission on Consumer Protection and Quality in the HealthCare Industry. The Commission, co-chaired by Donna Shalala, secretary of the Department of Health and Human Services at the time, issued its final report, which included a Consumer Bill of Rights & Responsibilities. Of interest to psychiatric nurses is the section
Book Code: ANCCUS3023
EliteLearning.com/Nursing
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