Respond to your colleagues by recommending at least one additional way you would treat a child or adolescent client differently than you would an adult and at least one additional way you would address the legal and ethical issues involved.
NOTE: Positive Comment
This discussion requires one to discuss the case of an adult client that had a psychiatric emergency and discuss the different approaches that would be taken if the client was a child or an adolescent. Indeed, this is a common in the behavioral and psychiatric health facilities or settings. What clinicians working in this setting may fail to consider is the fact that different approaches should be used when interacting with an adult and when interacting with a child or an adolescent and this is regardless of whether the case is a psychiatric emergency or not. However, in this discussion, attention to context shall be on a psychiatric emergency.
Psychiatric emergencies may be manifested in different ways and others may require that the patient should be involuntarily admitted to a mental health facility because of the potential of causing harm to self or others. When such decisions have to be made, it is always important to note that the freedom of the client may be disregarded and this presents serious ethical and legal issues that should not be ignored (Marty et al., 2019). An adult male was presented to the behavioral health facility with bruises on his neck. His wife narrated that she got into the house at the right time and found him on the living room. He had purchased a rope with the view of committing suicide. This was a patient with a history of major depressive disorder that was recurrent. Suicidal attempt is a major psychiatric emergency (Sudarsanan et al., 2004). Because of this psychiatric emergency, it was decided that he had to undergo involuntary admission for purposes of mental health stabilization. All states including the District of Columbia have laws regarding emergency hold due to psychiatric emergencies. The only differences pertain to the length of the hold, the extent of judicial oversight, persons that can initiate the making of these decisions and the rights of the person that has been put on emergency hold. For instance, 2 states require some aspects of judicial review before the decision is made. 9 require a judge to certify the decision and 5 states have no guarantee regarding the assessment by a qualified mental health professional at the time of the hold (Hedman et al., 2016). These are laws that guide the involuntary admission of adults due to psychiatric emergencies.
If this a case of a child or adolescent, state laws still apply, and such laws should be adhered to at all times. In many states, minors are considered to be incompetent when it comes to making decisions about their health. In this case, due to a psychiatric emergency cause by a suicide attempt, a parent can initiate the decisions and give consent to the hospitalization of the child even if the child protests. When this happens, the child may also not be discharged from the hold until the parent or the guardian authorizes the release. In some states, younger minors up to the age of 14 may not have a say. In other states, older minors may be heard if their protest. A counsel may be required to make sure that the due process is followed (Menninger, 2001). In this case, the parents would be consulted and advised accordingly. If they consent to the involuntary hold due to a suicide attempt, it would be implemented immediately.The rights of a child have to be protected at all times and there is need to make sure that the surrogate decision makers of the child are involved in the decisions that shall affect the rights of the child especially if the freedom of the child is going to be affected through an involuntary psychiatric hold.
Hedman, L. C., Petrila, J., Fisher, W. H., Swanson, J. W., Dingman, D. A., & Burris, S. (2016). State laws on emergency holds for mental health stabilization. Psychiatric Services, 67(5), 529-535
Marty, S., Jaeger, M., Moetteli, S., Theodoridou, A., Seifritz, E., & Hotzy, F. (2019). Characteristics of psychiatric emergency situations and the decision-making process leading to involuntary admission. Frontiers in psychiatry, 9, 760.
Menninger, J. A. (2001). Involuntary treatment: Hospitalization and medications. Jacobson, James L. y Jacobson, Alan M.; Psychiatric Secrets, second edition. Philadelphia, PA: Hanley & Belfus, Inc, 477-484.
Sudarsanan, S., Chaudhury, S., Pawar, A. A., Salujha, S. K., & Srivastava, K. (2004). Psychiatric emergencies. Medical Journal, Armed Forces India, 60(1), 59
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