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RP is a 30 y/o female baker-acted to the hospital after an attempt to overdose on Tylenol. She was medically cleared from the ER and sent to the psychiatric hospital for an inpatient evaluation. She reported that she has been depressed and hopeless about a relationship she had just gotten broken up. She felt there was no reason to live. As an adult, they will see the psychiatrist and be evaluated for competency. Once deemed competent they will have the ability to sign a voluntary form. Being competent allows them to make their own decisions about treatment options. Patient was started on Lexapro 10 mg daily and Vistaril 50 mg at bedtime to help her sleep. Group therapy and therapeutic milieu ordered. Upon discharge she was set up with out- patient services such as therapy and follow-up with a psychiatrist to monitor her medication. She gave consent for her treatment and medications.
A child would have been treated the same way, but the parent or guardian would be more involved in the decisions for the child. The medication choice would be started at a lower dose or a different antidepressant. The child would be medically cleared before sending to psych. Because this is a minor, parents need to be involved in every aspect of the transaction. A child is considered vulnerable as opposed to a competent adult. Another difference is the separation of adults and children in a psychiatric facility. There is no blending of the two. Chapter 36 of the Code of Practice to the Mental Health Act specifies that children and adolescents receiving in-patient care for mental illness should have: appropriate physical facilities; staff with the right training, skills and knowledge to understand and address their needs as children and young people; a hospital routine that will allow their personal, social and educational development to continue as normally as possible; and equal access to educational opportunities as their peers, in so far as that is consistent with their ability to make use of them, considering their mental state (Hazel, Sprague, & Sharpe, 2016) .
Decision-making in child and adolescent psychiatry brings with it a variety of challenges for children, parents/guardians, and child and adolescent psychiatrists. It relies on the concepts of assent and consent by proxy, which is the focus of Principle IV of the AACAP Code of Ethics (2014). Assent recognizes that minors might not, due to their developmental level, be capable of giving completely reasoned consent; however, minors might be capable of having preferences and communicating their preference. Assent recognizes the importance of the involvement of minors in the decision-making process, while also recognizing that a minor’s level of participation is less than completely competent. Parents/guardians and child and adolescent psychiatrists should not exclude minors from decision-making without clear and convincing reasons (“American Academy of Child and Adolescent Psychiatry,” 2020). Some feel that the baker-act is being abused when it comes to children and adolescents. “They want to use (the) Baker Act for any behavioral problem — anything that they don’t like,” Hilary Caskey said. “If you have any kind of outburst, if you have any kind of emotion whatsoever and you are not just an order-following automaton, they will Baker Act you.” Law enforcement officers, who have limited training in mental health issues, are usually the ones deciding whether a child should be sent to a psychiatric facility for an evaluation. This is especially true in the schools, which may or may not have an on-site psychologist (Gluck, 2019). So, for an adult to be baker-acted, it is straight forward. For a child to be baker-acted is a bit more complicated as they typically get baker-acted from school and the parents may not get notified which they are the guardians of the child. Some schools averaged multiple Baker Acts a month per school year. Many happen even at the elementary school level. The rule for the schools needs to be followed. A parent or guardian must be contacted before the baker act process.
Ethical Issues in Clinical Practice. (2020). Retrieved from https://www.aacap.org/AACAP/Member_Resources/Ethics/Ethics_Committee/Ethical_Issues_in_Clinical_Practice.aspx
Gluck, F. (2019). Florida kids are getting sent to psychiatric units under the Baker Act in record numbers. Retrieved from https://www.news-press.com/in-depth/news/2019/08/21/florida-children-baker-act-record-numbers-mental-health/3247904002/
Hazel, P., Sprague, T., & Sharpe, J. (2016, January 8, 2016). Psychiatric hospital treatment of children and adolescents in New South Wales, Australia: 12-year trends. US National Library of Medicine, 1-5. https://doi.org/ doi: 10.1192/bjpo.bp.115.000
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