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Home 动态 Info. 研究动态 Research Info. 专家解读:SAFE Act中的精神病患报告程序 Expert's Reflection: SAFE Act Reporting Requirement

专家解读:SAFE Act中的精神病患报告程序 Expert's Reflection: SAFE Act Reporting Requirement

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专家简介:Eric D. Caine医学博士为美国罗彻斯特大学医疗中心精神病学系主任,自杀研究和预防中心副主任。

We are fast approaching the implementation date of the NYS Safe Act. I have attached a set of explanatory slides, which coincide with how we want to approach the demands of the new law.

In many ways, this is 'old news' for all of us, in terms of patient care though not in terms of the reporting requirements. 

So, let's first consider the patient care issues. If you have an outpatient that you consider potentially dangerous to self or others due to his/her clinical condition, do what you always have done---talk with you supervisor and send the patient to CPEP. Given that we have many patients who may at times require emergency evaluation, this is a procedure that is well-established.

Obviously, by sending the person to CPEP, you are indicating that you see a high risk of dangerousness, even as this is a difficult-to-predict situation. CPEP is useful as it provides, a] a second opinion from people who are skilled in these assessments; b] time for the appraisal to be done more carefully, with the patient in a controlled environment; and c] if

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confirmed, direct access to the inpatient service. 

We are very clear that it is not appropriate to decide that someone is dangerous, and thus, reportable, but not send that person to CPEP. The person may be escorted by you, by clinical staff including a case manager, by Mobile Crisis team members, by security with you and clinical staff, or on occasion, by the police after a MHA. Safety is paramount. Once there is an initial decision that referral is necessary, it is not acceptable to leave the person on his/her 'own' to get to CPEP.

Once in CPEP, the appropriate assessment will be conducted. If the person is not deemed dangerous, s/he will likely not be admitted [certainly, not admitted involuntarily] and will be discharged with follow-up care plans well laid.  No reporting is needed or required. However, if CPEP staff consider discharge, it is essential that there must be well-considered communication between the outpatient providers and the CPEP staff before the actual fact of discharge!  Clearly, our outpatient folks [or others in the community] decided to refer someone to CPEP because there was a strong view of dangerousness; resolving clinical impressions and developing a coordinated plan is a key element of integrated care that will be most important for care providers, patients, and their families [and their living settings, if they are in a group home or other similar location].

If the patient is deemed dangerous due to a mental disorder or defect [as they say in these legislatively crafted directives], s/he will be admitted. It is important to remember that it is not required that this person comes in under the auspice of a

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9.39 or 9.27; voluntary admissions are an important option, and it always is possible [should someone want to leave] to implement commitment while someone is an inpatient.

All involuntary admissions must be reported to DOH; SAFE Act reporting uses a separate form that is an OMH function. These are separate processes. If, hypothetically, someone who is deemed dangerous after evaluation in CPEP agrees to a voluntary admission, SAFE Act mandated reporting is required. If someone is admitted on 9.39 or 9.27 status [much more likely], then two reports are required.

We are working now on clarifying who will do the reporting for DOH and OMH related forms. Given the 'flow' of the work process, it is likely that someone will collect data from the inpatient floors on a regular basis daily and serve as the designated reporter of both agencies.

 

This is an extract from his email to his department.

 

最后更新 ( 2016-07-22 19:53 )