Involuntary treatment and Suicide risk assessment

Question 2

What is involuntary psychiatric treatment?

Answer 2

Involuntary psychiatric treatment is when patients are treated against their will in a psychiatric hospital under specific conditions.

Question 3

What must be ensured for involuntary treatment?

Answer 3

Patients must be treated in the least restrictive environment, and force can only be used when necessary with no alternatives.

Question 4

What are the laws that govern the limitations on patients’ rights during involuntary treatment based on?

Answer 4

The limitations of a patient’s fubdamental rights must be based on the Mental Health Act (mielenterveyslaki).

Question 5

Why might a patient’s self-determination be restricted?

Answer 5

The patient’s perception of reality may be so disturbed that their right to self-determination must be restricted to protect their own health as well as safety and public safety.

Question 6

What are the conditions for ordering involuntary treatment or treatment against a patient’s own will?

Answer 6

A person can be ordered to treatment in a psychiatric hospital against their will only if they are diagnosed as mentally ill,
if the person needs treatment for a mental illness which if not treated, would become considerably worse or severely endanger the person’s health or safety or the health or safety of others , and if other mental health services are inadequate or incapable.

Question 7

What does ‘mentally ill’ mean?

Answer 7

It refers to mental disorders involving a blurred sense of reality, often considered psychotic disorders, where the patient has a poor understanding of their disease or the need for treatment.

Question 8

Why must a psychotic person be treated involuntarily?

Answer 8

A psychotic person may be a danger to themselves or others, therapeutic cooperation with a person in a psychotic state is no longer possible, and they cannot control their symptoms and are driven by delusions, for example, to act violently.

It is important to remember though that a psychotic person may want treatment of their own free will.

Question 9

What forms are involved in the involuntary psychiatric treatment process?

Answer 9

The forms involved are M1 (referral to involuntary treatment), M2 (statement of observation), and M3 (involuntary treatment order(decision)).

Question 10

What must happen during the observation period?

Answer 10

Find the answers (Mental Health Act, chapter 2, sections 9 to
10)
The patient will be assessed how often?
* Observation period must be discontinued if apparent that the criteria is
what?
* Who is in charge must do a written statement (M2) no later than how many
days? after the admission.
* well-founded opinion whether the criteria is met

The patient’s condition must be assessed, and the observation period must be discontinued if it is apparent that the criteria for treatment are not met.

Question 11

Who makes the decision for involuntary treatment? Or facilitates ordering patient to involuntary treatment?

Answer 11

The decision (M3) is made by the chief physician in writing and it is based on the referral for observation, statement of observation, and case history.

It also must state whether the criteria is met or not and must be shown to the patient without a delay

Question 12

How many doctors’ opinions are required for the M1, M2, and M3 forms?

Answer 12

Opinions of at least three doctors are required, 1 for each, for M1 referral to hospital, M2 statement of observation, and M3 involuntary treatment (decision).

M1 - general doctor? Make an assessment on whether they might need a referral for psychiatric assessment, also determine whether the conditions for ordering a person to treatment are met.

M2- Psychiatrist? Performs psychiatric examination, Determines if involuntary treatment is necessary. must also consider the patients own opinion on the need for treatment

M3- Chief physician - Confirms the need for involuntary hospitalization and makes final decision based on previous evaluations and own assessment.

Question 13

How long will involuntary treatment last?

Answer 13

can last for up to six months at a time, with the possibility of renewal (often by a court) for further periods.

Read now: Mental Health Act —> chapter 2, sections, How many months?

Question 14

What limitation the law allows to make?

Answer 14

Chapter 4 a (1423/2001) Limitations on patients’ fundamental
rights during involuntary treatment and examination

Question 15

What limitations can be applied on a patients fundamental right during involuntary treatment?

Answer 15

can be applied to a patient under observation or in involuntary treatment (not voluntary patients).

Limitations can include restricting right to self-determination and other fundamental rights but only to the necessary extent, for example the right for the treatment of the illness, the person’s safety and the safety of others, and for safeguarding some other interest, but cannot be used as punishment.

Question 16

What are some specific limitations of freedom and self determination that can be imposed?

Answer 16

• Treatment of mental illness
• Treatment of physical illness
• Limitation of the freedom of movement
• Special limitations – Seclusion– Tying down
• Taking possession of personal property
• Checking a patient’s possessions and consignments to the patient
• Frisk and bodily search
• Limitation of contacts

Question 17

What is required for any limitations of freedom and self-determination?

Answer 17

Limitations always require a doctor’s order.

Question 18

What are suicidal thoughts?

Answer 18

A person questions their life, feels worthless, wants to be left alone and lacks a positive view of themselves or the future. These thoughts can increase during mentally challenging life events, changes, and stress.

Question 19

Characteristics of suicidal thoughts?

Answer 19

Can be a sign of an extremely distressing situation or agony that a person can’t handle.
Talking actively about suicide can be a sign of a premeditate plan.

Question 20

What is self-destruction?

Answer 20

An intention or behavior that aims to self-harm or presents a risk to a person’s life. It can be direct self- destruction which includes; suicidal thoughts, talking about suicide, suicide attempts, suicide.

Or Indirect self-destruction: risk behaviour that doesn’t include a purpose or
intent to self harm or commit suicide, neglecting own well being (alcohol or
substance abuse, neglecting treatment of a physical condition).
→icreases the risk of suicide

Question 21

What should be done if a patient is acutely suicidal?

Answer 21

Refer them directly to a doctor for assessment and ensure they get there. If the situation is serious, call 112!

Question 22

What is a suicide attempt?

Answer 22

A person takes suicidal thoughts and plans into action, expressing inability to cope, find other solutions (ways out), hopelessness and a need for help.

Must be seen as an important, meaningful and dangerous event.

Question 23

What should be done in the case of an interrupted suicide attempt?

Answer 23

The patient should always be transported to the emergency room, even if there are no somatic consequences.

Question 24

What is a somatic evaluation?

Answer 24

is a medical assessment focused on the physical (bodily) health of a person, especially when they are being treated for mental health issues.

Question 25

What does psychiatric evaluation (Doctor) involve? Possible treatments as well

Answer 25

The patient is interviewed with open questions to clarify the chain of events leading to the attempted suicide, history of previous attempts, and confirm whether the attempted suicide was accompanied by a desire to die.

Question 26

What should a patient be instructed if psychiatric care is not necessary?

Answer 26

They should be given instructions on where and how to contact if suicidal thoughts become a crisis.

Question 27

What are some risk factors for suicide?

Answer 27

Previous suicide attempts, mental health disorders(especially depression, schizophrenia, bipolar disorder), substance abuse problem, current and previous negative life events, physical illness severe pain conditions, low socio-economic status, loss of work, finance or social relationships, social isolation(loneliness), unstable and impulsive personality, and being part of a sexual or gender minority.

Question 28

More risk factors and protective factors.

Answer 28

Question 29

How should a nurse encounter a suicidal patient?

Answer 29

Show empathy and be respectful * Avoid judgmental interaction Take patient’s condition into consideration Give the patient time to explain their situation in their own words, allow them to convey their experience, and you can help them identify events and experiences prior to the suicide attempt. Tell them that you want to help and ask what kind of help they would benefit from Ask about self-harm directly. - Talking about suicidal thoughts is safe and does not increase then risk of suicide. Questions like, do you have suicidal thoughts or suicidal ideation? What are your suicidal thoughts like?

Question 30

What should be included in risk assessment?

Answer 30

Check medical history (helps to identify the risk of suicide), ask about current stressors (open-ended questions), let the patient tell and listen, ask about substance abuse, and directly inquire about self-harm thoughts and plans, e.g. “Have you thought about harming your self in any way? If so, what do you plan to do? Do you have the means to carry out this plan?” For example, has the patient sought information on how to commit suicide, or does he or she have the tools to commit suicide? Ask about previous suicide attempts.

Question 31

What are open ended questions? Give some examples for suicidal patients?

Answer 31

Can you tell me how you’ve been feeling lately? What’s been going through your mind when you feel overwhelmed? Have you been having any thoughts about hurting yourself? When you think about not wanting to be here, what do you imagine? Who do you feel comfortable talking to when you're feeling low? What has helped you feel better in the past? Is there anything that gives you hope right now?

Question 32

What is a no-suicide contract?

Answer 32

A no-suicide contract (also called a safety contract or no-harm agreement) is a written or verbal agreement between a patient and a healthcare provider where the patient promises not to harm or kill themselves and to seek help if suicidal thoughts occur.

Question 33

What is the purpose of a safety plan?

Answer 33

To prevent suicide attempts and have an action plan ready for possible self-harm situations. A safety plan is always implemented as soon as the patient's condition allows it. Contains steps that a person can follow as self-destructiveness increases.

Question 34

How can hope be created for a suicidal patient?

Answer 34

Identify stressors - help to find appropriate assistance for these. e.g. a consultation with a social worker or debt counselling. Help the patient to identify coping behaviors previously used * are they still effective, could we find new ones? * It is important to identify client’s strengths and encourage the use of them Help client identify areas of life situation that are under own control. * emotional condition may interfere with ability to problem-solve. * help the patient to help the patient find and learn new problem-solving skills. * Identify together sources that client may use after discharge when crises occur or feelings of hopelessness and possible suicidal ideation prevail. * safety plan * local support services —> involve family members, activate support work

Question 35

What should be done if the suicide risk is high?

Answer 35

Provide treatment in an inpatient unit, ensure continuous observation (frequent rounds to patient's room), remove self-harm items, assess the possibility to do a no-suicide contract with a patient, and treat any mental health illness.

Question 36

Treatments for suicidal patients.

Answer 36

If the suicide risk is high → treatment in an inpatient unit. * Continuing observation if needed * Remove items that could be use to self harm. Assess the possibility to do a no-suicide contract with a patient. Treatment of a possible mental health illness. Alleviate agony and create hope. Involve family members and activate support network. Acknowledge good coping skills. Make a concrete safety plan for future in partnership with a patient.