Gerald, a 22-year-old black man, has a diagnosis of schizoaffective disorder. Gerald has been living at home, but this afternoon he had a physical fight with the neighbors and set a fire in their garage to burn their house.

QUESTION

Case Study, Mohr

CHAPTER 5, Legal and Ethical Aspects: In completing the case study, students will be addressing the following learning objectives: Identify the basic rights of people with mental illness. Describe the different types of commitments and states of competency.

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Gerald, a 22-year-old black man, has a diagnosis of schizoaffective disorder. Gerald has been living at home, but this afternoon he had a physical fight with the neighbors and set a fire in their garage to burn their house.
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1. Gerald, a 22-year-old black man, has a diagnosis of schizoaffective disorder. Gerald has been living at home, but this afternoon he had a physical fight with the neighbors and set a fire in their garage to burn their house. His father took him to the local psychiatric hospital and said that he wants an involuntary commitment for Gerald since he will not agree to the hospitalization. The father expressed concern over Gerald’s legal rights. The psychiatric nurse practitioner recommends to the father that he commit Gerald on involuntarily for emergency care for a period of 72 hours since he is clearly a danger to others. The nurse explains that Gerald will be evaluated to determine if he needs involuntary detention for observation and treatment for a longer period of time. The nurse explains that Gerald will be periodically evaluated, and that when it is determined that he is no longer a danger to others or himself, Gerald will be released from the hospital.

(Learning Objectives: 4, 5)

a. What basic legal rights does Gerald have at the time of this illness?

b. Why can Gerald not make the decision for himself about being an involuntary emergency commitment to the hospital?

ANSWER

Legal Rights and Involuntary Commitment: A Case Study of Gerald with Schizoaffective Disorder

Gerald has several basic legal rights at the time of his illness, despite being diagnosed with schizoaffective disorder. These rights include:

Right to Due Process: Gerald has the right to receive fair and lawful treatment throughout the commitment process. This means that his father and the hospital staff must follow the appropriate legal procedures when initiating and executing the involuntary commitment.

Right to Confidentiality: Gerald’s personal and medical information must be kept confidential by the healthcare professionals involved in his care (National Academies Press (US), 1994). They cannot disclose this information without his consent, except in specific circumstances where disclosure is required by law (e.g., when there is a threat to his safety or the safety of others).

Right to Treatment: Gerald has the right to receive appropriate medical and psychiatric treatment while in the hospital. This includes access to medication, therapy, and other interventions necessary for managing his condition and ensuring his well-being.

Right to Least Restrictive Treatment: Healthcare providers must strive to provide treatment that is the least restrictive to Gerald’s personal freedom and autonomy. This means that involuntary commitment should only be used when absolutely necessary, and efforts should be made to explore alternative options before resorting to confinement.

Right to Appeal: If Gerald or his father disagrees with the decision to involuntarily commit him, they have the right to appeal the decision through the appropriate legal channels. This allows them to challenge the commitment and present their case for why Gerald should not be detained against his will.

Gerald cannot make the decision for himself about being involuntarily committed to the hospital

This is due to several factors related to his condition and the potential danger he poses to others. Schizoaffective disorder is a serious mental illness that can significantly impair a person’s judgment, insight, and decision-making abilities. In Gerald’s case, his recent actions of engaging in a physical fight and setting a fire in the neighbors’ garage demonstrate a clear danger to others.

When an individual’s mental illness poses a risk to their own safety or the safety of others, it may be necessary to override their autonomy temporarily through an involuntary commitment (Bergamin et al., 2022). In Gerald’s situation, his father has expressed concern and sought help for him, indicating that Gerald is unable to make rational decisions in his current state.

Involuntary emergency commitment is a legal mechanism designed to ensure the protection of individuals who are unable to recognize their own need for treatment or pose a risk to themselves or others (Saya et al., 2019). In Gerald’s case, he is unable to appreciate the severity of his actions and the potential consequences, which justifies his father’s request for an involuntary commitment.

The decision to involuntarily commit Gerald is made based on the principle of balancing individual rights and public safety. While it temporarily restricts Gerald’s autonomy, it aims to prevent harm and provide the necessary treatment and care to stabilize his condition. The periodic evaluations mentioned by the nurse practitioner allow for ongoing assessment of Gerald’s mental state and progress, ensuring that his rights are respected and that his release from the hospital occurs when it is determined that he no longer poses a danger to himself or others.

Overall, Gerald’s inability to make the decision for himself about being involuntarily committed stems from the serious nature of his condition and the immediate threat he poses. The decision to pursue involuntary commitment is made in his best interest and in consideration of public safety, while still respecting his legal rights to due process and appropriate treatment.

References

Bergamin, J., Luigjes, J., Kiverstein, J., Bockting, C. L. H., & Denys, D. (2022). Defining Autonomy in Psychiatry. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.801415 

National Academies Press (US). (1994). Confidentiality and Privacy of Personal Data. Health Data in the Information Age – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK236546/ 

Saya, A., Brugnoli, C., Piazzi, G., Liberato, D., Di Ciaccia, G., Niolu, C., & Siracusano, A. (2019). Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00271 

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