1. Patient Rights and Legal Issues Chapter 4

2. Patient Rights Bill of Rights – Necessary because of vulnerability to abuse and mistreatment – Universal Bill of Rights for Mental Health Patients (Text Box 4.1) Americans with Disabilities Act (ADA) – Outlaws discrimination against individuals with disabilities – Protects people with mental disorders

3. Issues of Consent Self-determinism: The right to choose one’s own health-related behaviors, which, at times, may differ from those recommended by health professionals Competence: Degree to which the patient is able to understand and appreciate the information given during the consent process Informed consent: The right to determine what shall be done with body and mind

4. Types of Treatment Voluntary: Full legal rights Involuntary commitment: Confined hospitalization of a persons without the person’s consent (finding of dangerousness, sine qua non)

5. Least Restrictive Environment Patients have the right to refuse treatment. A person cannot be restricted to an institution when he or she can be successfully treated in the community. Medication cannot be given unnecessarily.

6. Issues of Confidentiality Privacy: Part of person’s life not governed by society’s laws and government intrusion Confidentiality: Ethical duty of nondisclosure (Provider has information about patient and should not disclose it.) Breach of confidentiality: Release of patient information without the patient’s consent in the absence of legal compulsion or authorization

7. Mandates to Inform A legal obligation to breach confidentiality “Duty to warn” - when there is a judgment that the patient has harmed any person or is about to injure someone (based on Tarasoff v. Regents of University of California)

8. Documentation It is common for all disciplines to record on one progress note. Patients have access to their records. Nursing documentation is based on nursing standards.

9. Required Nursing Documentation Observations of subjective/objective responses Interventions implemented Evaluation of outcomes of interventions

10. Documentation Documentation is mandatory for patients who are suicidal, homicidal, aggressive or restrained in any way. Always write in pen. Corrected entries are initialed. Avoid judgmental statements (i.e., “patient manipulating staff”).

11. Laws and Psychiatry NGRI - Not Guilt by Reason of Insanity GBMI - Guilty but Mentally Ill Forensic Commitment

12. Misconceptions about the Insanity Plea Very few insanity pleas are successful (less than 2%). Insanity is usually determined by whether the person has substantial appreciation or understanding of the criminality (wrongfulness) of his or her conduct. Public safety? Patients are more likely to be the victims than the perpetrators.

13. Laws and Systems of Protection Internal Rights Protection System – Public law 99-319 (1986) – Each mental health system establishes a system to protect and advocate for the rights of persons being treated. – Canadian Charter of Rights and Freedoms (1982) External Advocacy Systems – Bills of Rights - AHA, APHA, WHO Accreditation - JCAHO, HCFA