Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Position Statement on an Act Relating to Involuntary Treatment and Medication (S-287) Vermont Organization of Nurse Leaders (VONL) Executive Committee February 2014 OVERVIEW The Vermont Organization of Nurse Leaders believes that every person deserves access to the timely treatment of severe mental illness, including psychiatric medication. The population that the proposed act is intended to serve is a very small percentage of those Vermonters that have mental health issues and who, by virtue of their acute or chronic symptoms of mental illness, lack the capacity to assess the benefits and risks of taking and refusing medications and have proven to be dangerous to either themselves or members of the community based on the clinical assessment of a trained psychiatrist. VONL realizes that society has an obligation to respect an individual’s liberty and right to self-determination. VONL also realizes that there is a small percentage of the population of persons with severe mental illness who because they lack capacity, and because of shortcomings in the involuntary mediation system, suffer long delays between when they are admitted to a psychiatric inpatient facility and when the court rules they can be medicated. Although this delay may be intended to be a protective measure to ensure individual liberty it actually prolongs the length of time of inpatient hospitalization as these patients are not safe to be discharged prior to the onset of psychotropic treatment. This often extends the periods of time that they spend away from family members, their home and their community as well as increasing the risk of assaultive behaviors resulting in harm to themselves or caregivers. The time spent waiting also equates to time in which an illness remains untreated and is allowed to progress. All existing studies show that the prognosis of individuals that remain psychotic for extended periods of time is poorer than those that receive timely treatment. Extended periods of prolonged psychosis are associated with increased assaultive behavior, restraints and seclusion (Russ & John, 2013). BACKGROUND According to the Vermont Department of Mental Health, some patients who refuse medication after involuntary commitment to a psychiatric treatment facility have experienced anywhere from 15-253 days waiting for judicial decisions to authorize or deny the involuntary medication of these patients. These delays are associated with staff and patient injuries, compromised patient flow throughout the facility, increased length of stay and downstream delays for patients in emergency departments throughout the state who are awaiting treatment placement. S287 seeks to streamline the current system for involuntary treatment and medication of psychiatric patients. Specifically, the act proposes to: substitute a mandatory probable cause hearing for the current voluntary hearing create an expedited application for involuntary treatment and petitions for involuntary medication enable joint filings of certain applications for involuntary treatment eliminate “automatic stays” and “automatic stays pending appeal” for orders of involuntary medication. Vermont is the only state that does not have mandatory probable cause hearings for patients who are involuntarily admitted. Although there is international consensus among mental health professionals that deprivation of liberty should be an extreme mode of crisis intervention (Kuosmanen, et al 2007) the following points should be noted: The act does not address the appropriateness of involuntary medication for the mentally ill patient The act does not define mental illness, nor does it seek to deny the patient the right to refuse treatment or medication. The act also does not address the treatment of behavioral health patients in the outpatient or emergency department setting. VONL POSITION Therefore, it is the position of VONL to support the legislation of S287 to focus on the judicial review portion of the process. Furthermore, VONL recommends continued research, literature review and and dialogue about the medico-legal approaches to managing cases of psychotropic medication refusal (Jarrett, Bowers & Simpson, 2008). VONL advocates for the continued assessment of involuntary patients’ satisfaction with treatment and perceptions of coercive measures associated with their care. Patients’ feelings of coercion may depend less on the use of specific coercive measures and more on the way such treatment is explained, negotiated, and delivered. (Katsakou et al, 2010). VONL also advocates for involving the stabilized patient in a Psychiatric Advanced Directive process to be used in the event that they return to a state where they are psychotic and lack capacity. VONL encourages a “rights-driven” approach. The rights-driven model addresses the treating provider’s judgment about the need for treatment and the patient’s competency to refuse treatment. There is some evidence that a rights-driven approach may result in fewer instances of involuntary medication (Russ & John, 2013). REFERENCES: Jarrett, M., Bowers, L., Simpson, A. (2008). Coerced medication in psychiatric inpatient care: literature review. Journal of Advanced Nursing, Dec; 64(6): 538-48. Katsakou, C., Bowers, L., Amos, T., Morris,R., Rose,D., Wykes,T., Priebe,S. (2010). Coercion and treatment satisfaction among involuntary patients. Psychiatric Services, 61(5). www.ps.psychiatryonline.org. Kuosmanen, L., Hatonen, H., Malkavaara, H., Kylma, J., Valimaki, M. (2007). Deprivation of liberty in psychiatric hospital care: the patient’s perspective. Nursing Ethics, 14; 597 doi:10.1177/0969833997080205. Russ, M.J.,John, M. (2013). Outcomes associated with court-ordered treatment over objection in an acute psychiatric hospital. The Journal of the American Academy of Psychiatry and the Law., 41: 236-44.