Initiating Committal Proceedings “Just In Case” with Voluntary Patients: A Critique of Nursing Practice
Tony L. Farrow, RCpN, MHSc (Hons). Senior Lecturer, School of Nursing, Christchurch Polytechnic Institute of Technology, Christchurch Brian G. McKenna, RCpN, MHSc (Hons). Senior Lecturer, Division of Nursing, University of Auckland, Auckland; and Nurse Advisor, Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland
Anthony J. O’Brien, RGN, RPN, MPhil (Hons). Lecturer, Division of Nursing, University of Auckland, Auckland
Farrow, T. L., McKenna B. G., & O’Brien, A. J. (2002). Initiating committal proceedings “just in case” with voluntary patients: A critique of nursing practice. Nursing Praxis in New Zealand, 18(2), 15- 23.
Voluntary patients entering mental health units retain the right to accept or refuse treatment, including ongoing admission, as they see fit. However the nature of acute mental distress means that some patients have fluctuations in their mental status and competency to make informed decisions. Inpatient mental health nurses face the ongoing challenge of practising in a way that balances the requirement to support and promote the autonomy of voluntary patients with the need, occasionally, to take actions which although they may appear paternalistic are needed to protect those patients or other people. Anecdotal evidence together with a clinical audit undertaken by the authors suggest that the practice of nurses requesting that doctors sign medical certificates which are then placed on patients’ files ‘just in case’ they are needed has become a mechanism by which a minority of nurses deal with such challenges. A conceptual analysis of these issues indicates that such a practice is both legally questionable and ethically inappropriate. We suggest an alternative framework for practice that is legally and ethically preferable for both nurses and patients.
Key Words: Inpatient mental health/psychiatric nursing, Mental Health Act, mental health law, mental health ethics
Voluntary admission of mentally ill persons to acute mental health units can present a challenge for clinicians entrusted with their care. Nurses in these units often face the difficult task of balancing the patient’s right to hospital of their own volition, against awareness that fluctuating mental status, competency and risk to self and others during the hospital stay may require compulsory assessment and treatment to be considered. Although nurses usually negotiate the need for changes in legal status as they arise, we have anecdotal evidence of instances where, at the request of nurses, some doctors complete section 8B medical certificates at the time of admission of a voluntary patient. These certificates are held on file in anticipation of a change in clinical presentation, a practice known colloquially as “section 8 just in case”. The aims of this paper are to present the findings of a clinical audit that verifies this practice; to critique the practice on legal and ethical grounds; and to make recommendations for alternative practice.