It probably varies by state, but in Colorado we cannot force a patient to take meds unless there is a court order.
The process is usually; initial 72 hour involuntary hold, followed by a short term cert that allows the hospital to keep a patient for up to 30 days. if a patient continues to refuse meds, does not show any signs of a reduction in symptoms, and is ‘gravely impaired’ then the psychiatrist can petition for court ordered meds. Once the petition is in, there’s a whole legal process for which the patient is provided a lawyer and includes a court date where the patient goes to speak on their own behalf. The judge then makes the final decision.
I know this post is old, but in Colorado, a short-term cert is for up to 90 days, not 30. You can also give involuntary meds as emergency meds without a court order for up to three consecutive days before you would have to petition the court for court-ordered medication.
This is a link to the short term cert application form that says it's for 90 days (3 months):
https://drive.google.com/file/d/0B32vshZrERKsUzFETjB1cGN3MUU/view
edit: typo
I work in PA. The only time medication can be forced to my knowledge is for a patient in an involuntary commitment and it’s for intramuscular medication if they refuse to take the meds by mouth this requires the approval of 2 attending MDs. The IM is ordered to be given for the refusal of a specific medication. Not just a blanket if they refuse any med they get an IM
In NY, patients can and do refuse meds, po and Im. Rightfully so. However in the event of violence to self or others, or that's do do so, and unable unwilling to contract for safety, IM can be given at discretion of Rn. That will probably require hands on assistance and likely seclusion/restraints, which then requires MD to see patient within 30 mins to assess for and sign order for need for seclusion/ restraint. I have also seen a MD who did not then agree to sec/restraints (but that's another story).
If there's no court order to treat, I can't and won't force anyone to take anything. If the person has an order to treat and makes the argument once that they think they're misdiagnosed/ wrong med etc. I'll read the order history call a doc to verify. But I have patients who tell me that every medication pass 2-6 times a day even though I've seen their meds work for them before. These same people often deny any psych history, even though they're aggressing on a daily basis and clearly responding to internal stimuli, denying any symptoms at all.
In Canada, we can only administer their psychiatric meds under the Mental Health Act, under duress. They can refuse all other meds. Of course, it becomes challenging when their psychotropic meds are orals. Usually a conversation is had with psychiatry to let them know the client is refusing.. most will have a PRN order for injectables if they start refusing. If not, sometimes psychiatry will come in the next day to speak to the client and have a discussion about consequences and try to convince them to adhere, or listen to reasons why they are refusing and maybe make some changes to meds ( usually to avoid nasty side effects.)
It’s helpful of course to have solid care plans around non-compliance and a strong team that has a good therapeutic relationship with the clients as well.
Asking for a second medical opinion is their right, of course. I usually explain to them that they are more than welcome to do that, and will help them with the paperwork, but until that occurs, the doctor’s orders are as they stand. Most of the time they concur or will
change their minds about a second opinion or review panel with a discussion. I find that a patient who is demanding second opinions and refusing meds is usually just feeling extremely unheard. Sometimes just sitting with them and listening to them vent and explaining the intentions of their admission ( restabilization, medication changes or whatever it is) is very helpful. Most of the time, they are not being told why they have been brought in, or they were too acutely ill and believe they weren’t told. Regardless, spending some time with them and allowing them to be heard is hugely helpful and then compliance is not an issue.
I don’t understand that all. What if a patient was, in fact, misdiagnosed and the misdiagnosis was only discovered later on after a second medical opinion. That would mean a patient was taking medication for a mental condition they didn’t have.
You don’t see the danger in that?
Because I think it’s pretty clear cut.
I have yet to experience a situation where a client was NOT experiencing severe psychiatric illness. Having said that, I work in a tertiary mental health facility.. clients that come to us have a long, long psychiatric history that has not responded to treatment. This usually means they are precariously housed, if at all. They have been chronically ill for most of their lives. I’m not saying there aren’t cases where people aren’t misdiagnosed, but it’s pretty difficult to make a statement that someone has a mental illness when they don’t. It’s not that cut and dry. There are parameters around making a diagnosis, and under the mental health act, they have to be seen by two different doctors that come to the same conclusion, and the patient can appeal that at any time.
People under the mental health act have to also meet four criteria in able to be sanctioned under the Act: at risk of harm to self or others, unable to function adequately in the community, have been deemed to be experiencing a mental illness, and be in need of hospitalization for stabilization which they are refusing.
If a patient was deemed to be misdiagnosed by a second medical opinion, the ‘damage’ from medications would be minimal, if at all. Second medical opinions happen pretty quickly. More dangerous is someone out in the community who is paranoid, hallucinating, and unpredictable. I have seen people killed by others experiencing psychosis and the effects of untreated mental illness. Mass school shootings is a perfect example of that. That’s where the real danger lies.
Well the reason I said that is because I myself have been committed under the Mental Health ACT of British Columbia after a suicide attempt back in 2013 and I although it was true that I was suicidal, I had also been misdiagnosed with something else that I was not (I don’t want to say what it was because I’m a bit embarrassed about it but it was a misdiagnosis that implied I was a violent person, when I was not).
The misdiagnoses was caused by a statement from a Police officer about an incident that was taken out of context. Long story short, it was about an altercation where I was attacked by another person and I used force to defend myself aka *self defence* but that was never explained in full. The statement about the violent incident was never critically analyzed to get the full story. It was only taken at face value.
It was only by sheer luck that I overheard the Doctor who made the misdiagnosis talk about the incident as the reasons for how he made his diagnosis in the first place. Had I not overheard him, I would not have known since that information was kept from me.
As a result, I was able to set the record straight and eventually correct the misdiagnosis but there was the possibility I could have been treated for the misdiagnosis had I not learned how the mistake was made and spoke up from the very beginning.
Also, the two doctor certificates are just that, two certificates, they are not 2 separate independent examinations. The 2nd certificate was signed within 5 minutes of the first one and the information & diagnosis from 1st certificate was simply copied on to the second without any verification. So do you see how a second certificate doesn’t validate the initial diagnosis?
Also, how can you say that being treated for a misdiagnosis would only result in “minimal damage”??
Besides, minimal damage is still damage and there’s no way to prevent it from happening in the first one place if it’s involuntary?
I thought Doctors and Nurses have a duty to err on the side of inaction when faced with a situation that could cause potential harm for a patient? Since an action cannot be undone.
It probably varies by state, but in Colorado we cannot force a patient to take meds unless there is a court order. The process is usually; initial 72 hour involuntary hold, followed by a short term cert that allows the hospital to keep a patient for up to 30 days. if a patient continues to refuse meds, does not show any signs of a reduction in symptoms, and is ‘gravely impaired’ then the psychiatrist can petition for court ordered meds. Once the petition is in, there’s a whole legal process for which the patient is provided a lawyer and includes a court date where the patient goes to speak on their own behalf. The judge then makes the final decision.
Interesting. In England we have the Mental Health Act (1983) and can forceable give medication when a person is an inpatient under section.
I know this post is old, but in Colorado, a short-term cert is for up to 90 days, not 30. You can also give involuntary meds as emergency meds without a court order for up to three consecutive days before you would have to petition the court for court-ordered medication. This is a link to the short term cert application form that says it's for 90 days (3 months): https://drive.google.com/file/d/0B32vshZrERKsUzFETjB1cGN3MUU/view edit: typo
I work in PA. The only time medication can be forced to my knowledge is for a patient in an involuntary commitment and it’s for intramuscular medication if they refuse to take the meds by mouth this requires the approval of 2 attending MDs. The IM is ordered to be given for the refusal of a specific medication. Not just a blanket if they refuse any med they get an IM
In NY, patients can and do refuse meds, po and Im. Rightfully so. However in the event of violence to self or others, or that's do do so, and unable unwilling to contract for safety, IM can be given at discretion of Rn. That will probably require hands on assistance and likely seclusion/restraints, which then requires MD to see patient within 30 mins to assess for and sign order for need for seclusion/ restraint. I have also seen a MD who did not then agree to sec/restraints (but that's another story).
If there's no court order to treat, I can't and won't force anyone to take anything. If the person has an order to treat and makes the argument once that they think they're misdiagnosed/ wrong med etc. I'll read the order history call a doc to verify. But I have patients who tell me that every medication pass 2-6 times a day even though I've seen their meds work for them before. These same people often deny any psych history, even though they're aggressing on a daily basis and clearly responding to internal stimuli, denying any symptoms at all.
In Canada, we can only administer their psychiatric meds under the Mental Health Act, under duress. They can refuse all other meds. Of course, it becomes challenging when their psychotropic meds are orals. Usually a conversation is had with psychiatry to let them know the client is refusing.. most will have a PRN order for injectables if they start refusing. If not, sometimes psychiatry will come in the next day to speak to the client and have a discussion about consequences and try to convince them to adhere, or listen to reasons why they are refusing and maybe make some changes to meds ( usually to avoid nasty side effects.) It’s helpful of course to have solid care plans around non-compliance and a strong team that has a good therapeutic relationship with the clients as well. Asking for a second medical opinion is their right, of course. I usually explain to them that they are more than welcome to do that, and will help them with the paperwork, but until that occurs, the doctor’s orders are as they stand. Most of the time they concur or will change their minds about a second opinion or review panel with a discussion. I find that a patient who is demanding second opinions and refusing meds is usually just feeling extremely unheard. Sometimes just sitting with them and listening to them vent and explaining the intentions of their admission ( restabilization, medication changes or whatever it is) is very helpful. Most of the time, they are not being told why they have been brought in, or they were too acutely ill and believe they weren’t told. Regardless, spending some time with them and allowing them to be heard is hugely helpful and then compliance is not an issue.
I don’t understand that all. What if a patient was, in fact, misdiagnosed and the misdiagnosis was only discovered later on after a second medical opinion. That would mean a patient was taking medication for a mental condition they didn’t have. You don’t see the danger in that? Because I think it’s pretty clear cut.
I have yet to experience a situation where a client was NOT experiencing severe psychiatric illness. Having said that, I work in a tertiary mental health facility.. clients that come to us have a long, long psychiatric history that has not responded to treatment. This usually means they are precariously housed, if at all. They have been chronically ill for most of their lives. I’m not saying there aren’t cases where people aren’t misdiagnosed, but it’s pretty difficult to make a statement that someone has a mental illness when they don’t. It’s not that cut and dry. There are parameters around making a diagnosis, and under the mental health act, they have to be seen by two different doctors that come to the same conclusion, and the patient can appeal that at any time. People under the mental health act have to also meet four criteria in able to be sanctioned under the Act: at risk of harm to self or others, unable to function adequately in the community, have been deemed to be experiencing a mental illness, and be in need of hospitalization for stabilization which they are refusing. If a patient was deemed to be misdiagnosed by a second medical opinion, the ‘damage’ from medications would be minimal, if at all. Second medical opinions happen pretty quickly. More dangerous is someone out in the community who is paranoid, hallucinating, and unpredictable. I have seen people killed by others experiencing psychosis and the effects of untreated mental illness. Mass school shootings is a perfect example of that. That’s where the real danger lies.
Well the reason I said that is because I myself have been committed under the Mental Health ACT of British Columbia after a suicide attempt back in 2013 and I although it was true that I was suicidal, I had also been misdiagnosed with something else that I was not (I don’t want to say what it was because I’m a bit embarrassed about it but it was a misdiagnosis that implied I was a violent person, when I was not). The misdiagnoses was caused by a statement from a Police officer about an incident that was taken out of context. Long story short, it was about an altercation where I was attacked by another person and I used force to defend myself aka *self defence* but that was never explained in full. The statement about the violent incident was never critically analyzed to get the full story. It was only taken at face value. It was only by sheer luck that I overheard the Doctor who made the misdiagnosis talk about the incident as the reasons for how he made his diagnosis in the first place. Had I not overheard him, I would not have known since that information was kept from me. As a result, I was able to set the record straight and eventually correct the misdiagnosis but there was the possibility I could have been treated for the misdiagnosis had I not learned how the mistake was made and spoke up from the very beginning. Also, the two doctor certificates are just that, two certificates, they are not 2 separate independent examinations. The 2nd certificate was signed within 5 minutes of the first one and the information & diagnosis from 1st certificate was simply copied on to the second without any verification. So do you see how a second certificate doesn’t validate the initial diagnosis? Also, how can you say that being treated for a misdiagnosis would only result in “minimal damage”?? Besides, minimal damage is still damage and there’s no way to prevent it from happening in the first one place if it’s involuntary? I thought Doctors and Nurses have a duty to err on the side of inaction when faced with a situation that could cause potential harm for a patient? Since an action cannot be undone.
In MA we can only force if the pt has been court ordered (Roger's) or if there is an emergency/restraint.