Involuntary Psychiatric Treatment

Please respond to the discussion post below
In what ways are the positions similar? In what ways do they differ? How do they compare to the legal requirements in your intended state of practice?
The American Psychiatric Associations (APA), position statement directs key goal for individuals to improve in treatment adherence to decrease relapses, hospitalizations, and incarceration. Involuntary treatments can be a useful tool in treatment of individuals with severe mental illness with frequent relapses and hospitalizations. Initial push to encourage voluntary treatment plans and when fails to consider involuntary (APA, 2020).
Mental Health America (MHA), position statement directs their primary goal to increase each individuals own autonomy and dignity by protecting human rights in terms of treatment of mental health disorders. Truly encouraging mental health treatments being voluntary. Reserving involuntary treatments to only those at serious risk to themselves or others with frequent checks and safeguards to ensure it is needed (MHA, 2020).
After reviewing each position statement, the APA seems to encourage the use of involuntary commitments more than MHA. It seemed that they saw it more as a benefit for the patient to work towards treatment adherence when requiring medication and psychotherapy services more closely monitoring the patient. The APA briefly discusses maintaining non-maleficence throughout involuntary treatments. Where MHA, wants to have more checks on the continued need for involuntary commitment. APA recommended better outcomes with a extended involuntary period. I believe the state of Iowa has more APA direction when it comes to involuntary substance and mental health condition treatment policy and regulations. Requiring an individual to have serious mental impairment, likely be a safety risk to themselves or others. Unable to care for themselves as well as prior history of non-adherence and need for hospitalizations (Iowa Judicial Branch, 2023).
After reading the position statements, with which statement do you find yourself more philosophically aligned? Explain why.
I have a hard time only relating to one of the position statements. I can see values in myself that are highlighted by both the Mental Health America and American Psychiatric Associations. I do see the value in placing highest encouragement in having individuals voluntarily seek treatment. In my own practice I have seen the importance of a patients will on their treatment outcomes. If they do truly want to get better, they usually do. If someone never wants to improve no matter the treatment or provider usually therapies will fail. I also know the extreme burden that severe mental health and substance abuse has on our human service agencies including police, criminal courts, jails and prisons, emergency personnel, healthcare facilities, social services, and other public assistance programs. Having individuals that are involuntary committed to services either mental health or substance abuse treatments can hopefully help them enough to the point that they want to better themselves and continue with sobriety or their own mental wellness.
What legal recourse do clients have if they disagree with involuntary treatment decisions in your intended state of practice?
In the state of Iowa there can be a court hearing if there are legal concerns as well where there will be a court appointed attorney to represent them. If needed a mental health advocate can also be appointed. If the individual wants to appeal the decision to be placed in involuntary treatment the individual has 10 days to file with the district court. Rights for a individual after commitment includes regular medical checks, where paperwork is filed if care needs to be continued, the individual can request to be released at any time as well as any change in placement is made. If there is serious mental impairment and they want to appeal commitment they should be directed to the mental health advocate (Iowa Judicial Branch, 2023).
At times, providers may experience moral distress when ordering involuntary treatment. What type of situation might create moral distress for you? What resources exist for providers experiencing moral distress?
Two situations that might crease moral distress in regards to involuntary commitment are opposite of each other. Either not placing an involuntary commitment on a patient that should have been and a resulting negative outcome happened to that patient including overdose, suicide attempt or success, other medical or legal problems. Or placing one then the patient completely losing all trust and confident in your ability to care for them resulting in even worse treatment adherence and openness in appointments. Hopefully, within the department or in the facility each provider can have a strong support behind them and the decisions they make, with regards to inclusivity, fairness, and open communication (Epstein, Haizlip, Liaschenko, Zhao, Bennett, & Marshall, 2020).
In what ways might your perspective about involuntary psychiatric treatment impact the choices you make in practice?
After experiencing a few involuntary psychiatric treatment patients in my past practicum experiences I am not afraid of them as a daunting legal mess of paperwork. I can see have there is benefit that does come from implementing them. My preceptor has a few patients that she has had for years that are under commitments and those patients are almost always the ones with the best outcomes and most stable. I also understand how addressing concerns with a patient in regards to their wellbeing, personal safety and safety of those around them may be deciding factors if a committal is made. Having as open communication as possible to help patients see that the underlying driving factor is wanting to help them be stable and safe.
References
American Psychiatric Association (APA), (2020). Position statement on involuntary outpatient commitment and related programs of assisted outpatient treatment. American Psychiatric Association. https://www(dot)psychiatry(dot)org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Involuntary-Outpatient-Commitment.pdfLinks to an external site.
Epstein, E. G., Haizlip, J., Liaschenko, J., Zhao, D., Bennett, R., & Marshall, M. F. (2020). Moral distress, mattering, and secondary traumatic stress in provider burnout: A call for moral community. AACN Advanced Critical Care, 31(2), 146-157.
Iowa Judicial Branch. (2023). Commitments. Iowa Judicial Branch. https://www(dot)iowacourts(dot)gov/for-the-public/representing-yourself/committments
Mental Health America. (2020). Position statement 22: Involuntary mental health treatment. Mental Health America MHA. https://www(dot)mhanational(dot)org/issues/position-statement-22-involuntary-mental-health-treatment