The Benefits of Voluntary Inpatient Psychiatric Hospitalization: Myth or Reality?

Throughout the United States, mentally ill persons are confined against their will in psychiatric hospitals as a result of being accused of dangerous behavior. Some are committed involuntarily by a judge after an administrative hearing during which they are afforded legal representation, a right to be present, and important due process protections, including the right to cross-examine witnesses and present one\u27s own witnesses. However, a significant number of individuals, initially confined in psychiatric institutions for allegedly posing a danger to life or safety, never see an impartial judge, lawyer, or even a family member. These mentally ill individuals are not involuntarily committed. They are committed, without any benefit of due process protections, as voluntary patients. The legal and medical implications of imposing voluntary status to a patient being admitted to a psychiatric hospital are of paramount importance. This Article focuses primarily on the specific criteria to be used in determining whether a patient\u27s admission into a psychiatric hospital is voluntary. The questions it seeks to answer include: should psychiatrists be required to administer a mental status exam? Should witnesses be present at the time the person is voluntarily admitted and what, if any, documentation should be required? Should the mental disorder diagnosis of the patient be a major factor in determining competence to give voluntary consent? Should periodic review be required to determine whether the person continues to meet the criteria for voluntary admission? This Article will make specific recommendations as to when a psychiatric hospital will be permitted to accept and treat a mentally ill person as a voluntary patient and will ask what the legal significance is of the phrase knowingly and competently as used in defining consent to hospitalization. Related to its primary focus, this Article examines the process through which a mentally ill person is voluntarily confined to a psychiatric hospital. It reviews diagnostic methods in order to help identify the existence of patient coercion. It discusses the need for a waiting period before the time the hospital assigns patient status and the time a patient signs an admission form. It also discusses the relevance of the proximity between the time a patient signs the form and his initial confinement involuntary civil commitment hearing. In particular, the Article explores whether there are certain time periods during the initial observation status of a patient in which there is more likely to be stress, anxiety, misunderstanding, coercion, or clear understanding as to the significance of the voluntary status. A further aspect of the article is an exploration of the legal issues surrounding voluntary confinement. The questions addressed in this regard include: should a legal guardian or power of attorney be permitted to voluntarily admit a person into a psychiatric facility? What are the legal implications of an advanced medical directive or living will? Should an attorney be consulted by the patient prior to any voluntary admission, and should a judge review the voluntary admission to ensure that the patient is legally competent to be voluntarily admitted? What is the relevance of a prior court determination of the patient to being found legally incompetent? Voluntary psychiatric hospitalization should be the result of a competent and informed decision arrived at within a non-coercive environment. Hospitalization based on anything less is not only involuntary, but it is an infringement of personal liberty. Because of the uncertainties surrounding voluntary patient status-uncertainties exacerbated by the absence of due process protections-the criteria and procedures of voluntary admission demand careful and thorough scrutiny. By ensuring that voluntary admission is in fact voluntary, such scrutiny is the first step in protecting a mentally ill patient\u27s personal liberty

The Dangers of Psychotropic Medication for Mentally Ill Children: Where Is the Child’s Voice in Consenting to Medication? An Empirical Study

When a child with a mental illness is being prescribed psychotropic medication. who decides whether the child should take the medication — the parent or the child? What if the child is sixteen years of age? What if the child is in foster care: Should the parent or social service agency decide? Prior to administering psychotropic medication, what specific information should be provided to the person authorized to consent on behalf of the child? Should children be permitted to refuse psychotropic medications? If so, at what age should a child he able to refuse such medication What procedures should be put in place to forcibly medicate a child with psychotropic medication? There are numerous reports indicating that children in foster care are overmedicated as compared to children not in foster care. What are the reasons for this occurrence? Are there abuses within the foster care system? Should the state mental health agency monitor psychotropic medications for children, require oversight or a second opinion, or monitor abuse? What authority should a state agency have to stop prescribing psychotropic medication to children? This article will explore the overmedication of children with mental illness, with a specific emphasis on foster care children. Part I will examine the use of psychotropic medication on children, from the viewpoint of psychiatrists, pediatricians, parents, and children. Part II will explore the reasons why foster children receive psychotropic medications at a higher rate than children under their parents\u27 care. Part IIl will provide an explanation of the consent procedures for children, and a critical inquiry into the manner psychiatrists and psychiatric hospitals undertake to address a minor\u27s refusal to take psychotropic medication. Additionally, Part I will analyze various states\u27 responses to addressing both the overmedicating of children as well as consent and refusal issues that ultimate]y result from the medication of children. It will offer recommendations for a model consent form to be utilized by psychiatrists and in-patient psychiatric hospitals. It will present the rights of children to refuse psychotropic medication as recommended and the procedure for overriding such refusal. Finally, Part III will analyze a survey of psychiatrists and pediatricians on the use of psychotropic medications to understand the existing consent procedures governing a minor\u27s refusal to take psychotropic medications. The survey\u27s design allows for a better understanding of the reasons behind the overmedication of foster children. The analysis will highlight the best practices and offer recommendations that provide for a state reporting and monitoring system

The Disabled Lawyers Have Arrived; Have They Been Welcomed with Open Arms into the Profession? An Empirical Study of the Disabled Lawyer

This Article proceeds in seven parts. Part I briefly outlines the ADA\u27s position on reasonable accommodations. Part II addresses how law firms are reacting and responding to the fact that they employ lawyers with mood disorders, such as depression or bipolar disorder, attorneys with learning disabilities, and individuals with alcohol or drug addiction. What disabilities are most often represented? Are lawyers with disabilities apt to receive work modifications to accommodate their disability? Are attorneys with mental illness provided with less stressful case assignments? Are lawyers with substance use disorders and alcohol or drug addiction assigned co-counsel to monitor or offer support to the disabled individual? Part III of this Article outlines the annual ABA report on lawyers with disabilities, which includes recommendations as to how employers should accommodate disabled persons from the hiring process through employment. A fundamental concern underlying the provision of reasonable accommodations within the law firm is the potentially negative impact on client representation. Part IV of this Article analyzes the balancing act of providing reasonable accommodations to the disabled lawyer and the importance of providing competent representation to the client. Part V examines attorney disciplinary proceedings pursuant to the Model Rules of Professional Conduct in order to shed light on the issues related to the disabled lawyer. Part VI discusses and analyzes court decisions in the area of reasonable accommodations in the workplace to note the impact of the ADA and the direction in which courts are heading as they tackle this challenging and significant area of law. Empirical data contained in this Article serves as a backdrop for purposes of elaboration and comparison of these and other questions. Attorneys from fifty law firms in nine states were surveyed to obtain data and their opinions on questions relating to employment accommodations by law firms. Because of the significant number of disabled lawyers entering the workforce and seeking modifications and accommodations, such an inquiry is well warranted. Law firms are beginning to grapple with the disabled lawyer\u27s claim for fair and equitable treatment, while still serving their clients to the best of their ability. Part VII presents and analyzes this empirical data. In conclusion, this Article offers recommendations regarding fair and equitable reasonable accommodations for disabled lawyers in the workplace

Pre-Employment Inquiries: Drug Testing, Alcohol Screening, Physical Exams, Honesty Testing, Genetics Screening - Do They Discriminate? An Empirical Study

Statistics serve as a reminder that many disabled people continue to face obstacles in gaining access into the employment arena. This Article will reveal how disabled persons are at greater risk when employers increase their screening and testing arsenal in the job selection area