Health care risk management assignment week 5

Chapter 13: Risk Management in Psychiatry

Psychiatric Care

• Healthcare and treatment of persons with

acute and/or chronic mental illness

• Provided in various types of healthcare

settings

– Specialty facilities

– Special unit in a hospital

– Ambulatory centers

– Private offices

Informed Consent

• Psychiatric patients have the right to select their treatment (as do all patient) unless deemed incompetent.

• For the patient to be considered competent to consent to treatment, they must be able to:

– Communicate a choice

– Understand information about the treatment

– Recognize the clinical situation

– Manipulate information rationally

Informed Consent and Research

• Research guidelines must adhere to the general informed consent requirements

• The National Bioethics Advisory Commission issued a report entitled “Ethical and Policy Issues in Research Involving Human Participants” which outlines basic principles for research studies

• The Office for Human Research is another resource for guidelines on obtaining consent, especially for children

Right to Treatment

• Right to the Least Restrictive Alternative

• Closure of Psychiatric Facilities

• Involuntary Outpatient Treatment

• Medical Necessity

• Insurance Coverage

• Psychiatric Advanced Directives (PAD)

Right to Refuse Treatment

All patients have the right to refuse

treatment, even patients with mental illness.

• Psychotropic Medications

• Involuntary Hospitalization

• Involuntary Outpatient Treatment

Clinical Risks

• Psychopharmacology and Side Effects

• Electroconvulsive Therapy

• Suicide

• Discharge and Aftercare Planning

• Seclusion and Restraint

• Elopement and Wandering

• Child and Adolescent Psychiatry

Confidentiality and Stigma

• Public view of mental illness

• Privileged Communication

• Duty to Protect/Warn

High Risk Incidents

• Violence and Mental Illness

• Violence in the Institution

• Availability of Illicit Substances

• Professional Sexual Misconduct

• Staff-Patient Sexual Misconduct

Other Areas of Concern

• Fraud and Abuse

• Public Safety

• Noncompliance with treatment regimen

Summary

• Patients with mental illness have the same

rights as all patients unless deemed

incompetent.

• There are additional risk management

concerns involved in treating patients with

mental illness.