Unit 17

Legal Aspect of Mental Health Nursing

Clients Bill of Rights  nurse must follow this no matter what mental illness a patient has
 Civil rights
 Client consent
 Communication
 Freedom from harm
 Dignity and respect
 Confidentiality
o HIPPA
o Nurses cannot answer any question over the phone about the patient
 Participation in care planning
 Due process in civil commitment
 The right to treatment
 The right to refuse treatment
 Informed consent
o Clients permission granted to physician to perform a therapeutic procedure
o Patient should be explained about procedures, its props and cons, other
alternatives
o Possible outcomes, risk and adverse effects should be explained
o Come conditions may be performed without consent
 When a client is mentally incompetent
 Refusal or treatment endangers life
 During emergency
 In case of child
 In case of therapeutic privilege
 Restraint and seclusion

Commitment
 Voluntary
o 48 hours
o Patient has to write a letter to be discharged. The doctor can keep the patient if
he feels they are not safe to go home
 Emergency
o 72 hour the patient must stay
o Common way
 Civil or judicial
o Longer time than emergency
o Legal basis is parens patriae
 Provides time for a defense or an attorney
  Least restrictive alternative**
o Means providing treatment in the least restrictive environment using the least
restrictive treatment
o The least restrictive most clinically appropriate and most cost-effective
intervention should be selected.

Emergency commitment
 When effects of the client’s mental illness result in immediate risk of self-harm or harm
to others, or is unable to provide food, clothing, or shelter (i.e. gravely disabled)
o Client seen by screener
o In NJ usually 72 hours
o Examination by 2nd professional
o ***CLEAR and CONVINCING EVIDENCE (supreme court)
 For involuntary commitment
 Gravely disabled
 Screener has to see them

Privileged Communication
 Statutes allow certain information given to a professional client to remain SECRET
during any litigation. The privilege belongs to the client and can be asserted or waived
only by the client
 Statutes exclude
o Child, elder, impaired adult domestic violence
o Communicable disease related to public safety EX: TB
o Information that could prevent the commission of a felony such as murder

Duty to warn
 Protective privilege where the pubic perils begin
 It is the responsibility of a treating mental health profession to notify an intended,
identifiable victim.

BIG TOPIC restraints/ seclusions

 When particular behavior is physically harmful to the patient or a third party (other
patients)
 When alternative or less restrictive measures are insufficient in protecting the patients
or others from harm
 When a decrease in sensory overstimulation (seclusion only) is needed
o Controlled can be voluntary
 When a patient anticipates that a controlled environment would be helpful and
requests seclusion
Contradictions for restraints*** very important concept
 Extremely unstable medical and psychiatric conditions
 Delirium or dementia leading to inability to tolerate decrease stimulation
 Severe suicidal tendencies*
 Severe drug reactions or overdoses or need for close monitoring od drug dosages*
 Desire for punishment of patients or convivence of staff
 Unless close supervision and direct observation are provided** 1:1
 Cannot use restraints to treat confusion at all** very important

Restraints and Seclusion

 In an emergency, restraints or seclusion may be initiated without order
o Within 1 hour a verbal or written order must be obtained
o When orders are confined to specific time periods 2-4 hours
o When the patient’s condition is reviewed and documented regularly
o Follow policy on renewal or orders and protocols

Chemical restraints
 Medications may be given to an involuntary client against their wishes in the events of
an emergency and with an order  always has to be with a order.