Involuntary admission commitment status supercedes admission criteria until the consumer can be evaluated and the involuntary status is removed or expires
·
The consumer must have a diagnosed or suspected
mental illness. Mental illness is as defined
in AS 47.30.915 (12): “means an organic, mental, or emotional impairment that
has substantial adverse effects on an individual’s ability to exercise
conscious control of the individual’s actions or ability to perceive reality or
to reason or understand; mental
retardation, epilepsy, drug addiction, and alcoholism do not per se constitute
mental illness, although persons suffering from these conditions may also be
suffering from mental illness,” anddefined
as a psychiatric disorder identified with appropriate DSM IV codes on all
applicable axes, I-V.
·
Criteria A, B, or C, must be met.
·
Criteria A, B or C must be met:
(A) The consumer is likely to cause
serious harm to themselves or others as defined in AS
47.30.915(10):
“means a person who
(1) poses a substantial
risk of bodily harm to that person’s self as manifested by recent behavior
causing, attempting, or threatening that harm, or
(2) poses substantial
risk of harm to others as manifested by recent behavior causing attempting
threatening harm, and is likely in the near future to cause physical injury,
physical abuse, or substantial property damage to another person, or
(3) manifests a current intent to
carry out plans of serious harm to that persons self or another.”
(B) and/or is
“gravely disabled” as defined in AS 47.30.915 (7): “means
a condition in which a person as a result of mental illness
(1) is in danger of
physical harm arising from such complete neglect of basic needs
for food, clothing, shelter, or personal safety as to render serious accident,
illness or death highly probably if care by another is not taken; or
(2) will, if not treated,
suffer or continue to suffer severe and abnormal mental, emotional, or physical
distress, and this distress is associated with significant impairment of
judgement, reason, or behavior causing a substantial deterioration of the
person’s previous ability to function independently.”
(C) and cannot be served in
a less restrictive treatment alternative within the community.
Voluntary persons may be admitted to API if they do
not meet definitions of “likely
to cause serious harm to themselves or others” or
being “gravely disabled” on
a case by case basis. However, whenever possible,
these persons will be referred to a less-restrictive treatment
program.
A.demonstrates
dangerousness to self by any of the following aspects ,1-5.
1.Current plan,
pervasive and continual suicidal ideation or intent to seriously harm self with
an available and lethal method.
2.0.A recent lethal
attempt to harm self with continued risk as demonstrated by any of the
following
a. .poor impulse control
b. .an inability to
reliably contract for safety
c. .shared reasonable
suspicion by evaluative staff that the consumer will imminently self-harm again
despite denial of intent of the ability to contract for safety
3.0.Gravely
disabled. Inability to adequately care
for one’s own physical needs due to delusions, hallucinations, severe disorganized
thought patterns, and/or grossly disorganized or catatonic behavior.
4.0.Shared reasonable
suspicion by the evaluation staff which is supported by collateral contact information that the
consumer will imminently self-harm despite denial of intent or the ability to
contract for safety
5.0.Available lower
levels of care are clearly not able to maintain safety due to lack of staff and
physical structure
B. .The consumer
demonstrates imminent serious harm to others by any of the following aspects,
1-5.
1.0.Current plan,
pervasive and continual homicidal ideation, or intent to harm others with an
available and lethal method.
2.0.A recent action to
harm others with continued imminent risk to repeat violent behavior as
demonstrated by poor impulse control or an inability to plan reliably for
safety.
3.0.Uncontrolled violent
behavior that represents an imminent serious risk of harm to others or their
property.
4.0.Shared reasonable
suspicion by the evaluation staff which is supported by collateral contact information that the
consumer will imminently harm others despite denial of intent or the ability to
contract for safety.
C. .As a result of a
medical or psychiatric intervention complication, there is a high risk of
serious, imminent and dangerous deterioration of the consumer’s medical and/or
mental health requiring secure observation.
III. Exclusionary
Criteria
Although API has a family practice physician
(Medical Officer) as well as Physician's Assistants on staff to help manage the
medical problems of API patients, API is not able to provide continuous
physician presence in the hospital and thus must examine with scrutiny the
appropriateness of a patient with suspected or identified medical problems to
be safely managed and cared for at API.
A, Medical Illness
Management
API is classified
under JCAHO as a "Level 4" facility in terms of its ability to care
for patients with emergent medical (includes surgical, neurologic,
etc.) problems. Likewise, API is not
equipped nor is its staff trained to manage many typically non-ambulatory medical
interventions such as intravenous fluids / medications, infusion pumps, and
other such interventions. This is a
JCAHO competency issue.
Thus, API cannot
accept patients who require intravenous fluids or medications, infusion pump
treatment, and so on, unless the referring agency is willing to supply trained
and certified competent personnel to be with the patient at all times during
the API hospitalization, to monitor the specialized medical treatment.
The standard is
generally that API cannot care for patients whose medical care would otherwise
require medical hospitalization. Even
with this standard, though, there are some interventions (such as infusion
pumps treatment) that may be used in ambulatory settings, but that JCAHO
specifically will not allow in a setting like API without certified competent
staff (e.g. for that particular brand of infusion pump) standing by at all
times monitoring the patient's medical treatment.
Disputes as to
whether API can manage a particular medical problem should be reviewed at the
API Medical Director level, with consultation by the API Medical Officer.
B. Medical Instability
New onset of an
altered mental status should alert caregivers to the possibility of medical
(includes neurologic / trauma, etc.) instability. This is especially true of older patients, as
severe psychiatric illnesses generally declare themselves prior to onset of
middle-age.
API on-call
psychiatrists may ask for more extensive diagnostic testing to rule-out medical
instability, prior to accepting a patient for transfer to API. The Medical Officer may be asked to consult
with the Emergency Room physician to discuss the problems in more detail, prior
to psychiatrist acceptance of transfer.
Disputes should be reviewed with the API Medical Director.
C. Primary diagnosis of dementia
Persons with
dementia, with or without previous history of psychiatric problems, can
occasionally become aggressive or suicidal.
API will admit patients whose primary diagnosis is
dementia. However, API attempts to make
this a last-resort placement for these patients. This is primarily a best-practice utilization
strategy: dementia patients typically require long-term, though not usually
intensive, treatment. If admitted to
API, then, they tend to unnecessarily tie up a high acuity bed for an extended
period.
All
options for crisis stabilization, including admission to a medical ward with
sitter and psychiatric consultation, or transfer to a private psychiatric unit,
should be explored before referral is made to API.
D. Intoxication
Acute intoxication
causing psychiatric symptoms or complaints should attempt to be managed in the
emergency room setting, as these symptoms or complaints will often resolve with
increased sobriety.
Intoxication
is ultimately a clinical impression, though is guided by legal standards, e.g.
breath or serum alcohol levels, or by urine drug screen. Generally, an alcohol level should be less
than 0.150 mg/dl prior to transfer to API. API may take alcohol levels higher than
0.150 mg/dl with discussion with the API on-call M.D.
Acute
intoxication can lead to medical instability, e.g.
seizures, cardiovascular collapse, respiratory arrest, cardiac arrhythmias,
aspiration, and other complications
that cannot be safely managed at API.
·
Criteria A or B must be met
A. The admission criteria must
continue to be met, or
B. The current treatment plan
requires inpatient care. Any one of the following aspects must be met.
1. Acute symptoms of the
disorder(s) which caused the admission still remain and the consumer’s safety
would be compromised if a lower level of care is utilized.
2. New problems have developed that require continued inpatient care to re-stabilize, consolidate treatment gains and integrate the consumer back into the community.
3. Medications adjustments require inpatient care for monitoring.