NURS6660 Week 7 Assignment 1 Paper

NURS6660 Week 7 Assignment 1 Paper

Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice. In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment. Scenario for Week 7 Case: NURS6660 Week 7 Assignment 1 Paper You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed? Learning Objectives Students will: Evaluate clients for voluntary commitment Evaluate clients for involuntary commitment based on state laws Recommend actions for supporting parents of clients not eligible for involuntary commitment Recommend actions for treating clients not eligible for involuntary commitment To Prepare for this Practicum: Review the Learning Resources concerning voluntary and involuntary commitment. Read the Week 7 Scenario in your Learning Resources. Research your state’s laws concerning voluntary and involuntary commitment. The Assignment (2–3 pages): Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not? Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not. Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain. If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment. If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client. Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.


Why I Would Not Recommend the Client to Be Voluntarily Committed

Voluntary commitment requires a patient to freely consent and agree to undergo treatment. This decision is made at a personal level followed by admission to a psychiatric unit or a mental health facility. The client, however, has the freedom to leave a psychiatric unit against medical advice following a notice period (Jendreyschak, Illes, Hoffmann, 2014). Based on the client’s presentation, agreeing to voluntary commitment means that the chances of the client receiving inadequate treatment and presenting some days later with similar complaints is high. To prevent this, I would highly recommend that the client be involuntarily committed.

The criterion for involuntary commitment is set out in the Mental Health act to provide guidelines on how individuals can be admitted in hospital against their will. The first criterion is that the person should be mentally disordered and has no other less restrictive care in the forms of family support or voluntary commitment (Zhang, Mellsop, Brink, 2015). In this context, being mentally disordered refers to having a mental illness with a serious likelihood of causing serious immediate harm to other people or oneself. Based on the client’s history and presenting complaints of suicidal ideation it is evident that the client has a high likelihood of causing serious harm to himself or others who may be against his thoughts, ideas, and feelings, leaving involuntary commitment the best option.

In this case, the involuntary commitment would require a thorough assessment of the patient by a psychiatrist or a mental healthcare provider to illustrate that he is mentally ill. Following this observation, the client can also be reviewed by the review tribunal of mental health to be admitted for more than three days (Smith, Roche, O’Loughlin, 2014). The suicidal thoughts experienced by the client have higher chances of recurring and might force him to act on the impulses once more, thus endangering himself. This means that involuntary commitment will enhance the patient’s safety since he will be able to progress with treatment for good health outcomes as compared to voluntary commitment. NURS6660 Week 7 Assignment 1 Paper

Whether The Client Would Be Eligible for Involuntary Commitment Based On State Laws

According to New Jersey state laws, involuntary commitment is recommended in cases where evidence is clear and convincing. One of the required evidence according to the New Jersey Act is for the patient in this context to be 214 years or older. It is also expected that the mental illness should be the major contributor to a client endangering himself, endangering others or even property (Wang, Chiu, Yang, 2015). Besides, the client should be unwilling for admission to a mental health facility for voluntary mental health care.

Lastly, the patient should be needing care at a psychiatric unit since other services present cannot meet the patient’s needs.  Based on the scenario presented in this case, it was clear that the client, who was 14 years old, was not willing to be admitted following a suicide attempt through overdosing with prescription drugs (Røtvold & Wynn, 2015). Thus behavior indirectly posed danger to his loved ones and directly to himself.  As a result, based on the laws of New Jersey, the client would fully be eligible for involuntary commitment.

Whether Understanding of the State Laws Challenged/Confirmed Initial Recommendation of Involuntary Commitment

In reference to the New Jersey State law on involuntary and voluntary commitment, it is evident that my decision to settle on involuntary commitment is in line with the law. Conversely, the initial recommendation is supported by the New Jersey State law because the state of my client was in compliance with the descriptions provided in this state law to be used as the qualifications to determine whether a patient qualifies for involuntary commitments (Wang, Chiu, Yang, 2015). The fact that my client present signs of serious mental illness with a high likelihood of posing danger to himself and other patients, then he met the descriptions of the New Jersey States laws and was rightly admitted involuntarily. NURS6660 Week 7 Assignment 1 Paper

How I Would Convince the Patient’s Parents against Voluntary Commitment In Case the Patient Didn’t Meet the Criteria to Be Admitted Involuntary Commitment

Although the client is protected by the New Jersey State law to provide a written consent declaring not a commitment to the involuntary session within 72 hours, there is still an opportunity to convince the parents that involuntary commitment is the best option. Consequently, I would utilize the 72 hour window period to explain to the parents of the clients the danger that the client faces, having attempted suicide (Smith, Roche, O’Loughlin, 2014). I would make it known to the parents that the patient’s life is at risk and can only be saved by subjecting the client to an involuntary commitment. I will request the parents of the client to seek the assistance of a qualified mental health professional to conduct an emergency evacuation on the client (Zhang, Mellsop, Brink 2015). The evaluation report would serve as additional documents to justify why the client requires the involuntary commitment.


The First Step to Initiate Treatment for the Client Who Does Not Qualify For Involuntary Commitment

In case the client is not qualified for involuntary commitment, then the first step in the treatment plan would be to subject the patient to a patent education process to help the client understand the benefit of going through the commitment (Røtvold & Wynn, 2015). Perhaps this step would require the application of psychiatric advance to obtain the client’s consent to voluntary commitment and subject implement the involuntary commitment with the guidance of the psychiatrist. Thereafter, the client would be requested to sign a 201 form to facilitate the development of an effective treatment plan.


Jendreyschak, J., Illes, F., Hoffmann, K., Holtmann, M., Haas, C. R., Burchard, F., … & Juckel, G. (2014). Voluntary versus involuntary hospital admission in child and adolescent psychiatry: a German sample. European child & adolescent psychiatry23(3), 151-161.

Røtvold, K., & Wynn, R. (2015). Involuntary psychiatric admission: characteristics of the referring doctors and the doctors’ experiences of being pressured. Nordic Journal of Psychiatry69(5), 373-379.

Smith, D., Roche, E., O’Loughlin, K., Brennan, D., Madigan, K., Lyne, J., … & O’Donoghue, B. (2014). Satisfaction with services following voluntary and involuntary admission. Journal of Mental Health23(1), 38-45.

Wang, J. P., Chiu, C. C., Yang, T. H., Liu, T. H., Wu, C. Y., & Chou, P. (2015). The low proportion and associated factors of involuntary admission in the psychiatric emergency service in Taiwan. PloS one10(6), e0129204.

Wexler, D. B. (2018). Mental Health Law and the Seeds of Therapeutic Jurisprudence. The Roots of Modern Psychology and Law: A Narrative History, 78

Zhang, S., Mellsop, G., Brink, J., & Wang, X. (2015). Involuntary admission and treatment of patients with mental disorder. Neuroscience Bulletin31(1), 99-112. NURS6660 Week 7 Assignment 1 Paper


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