Psychiatric patients, whether voluntary or involuntary, must give informed consent prior to receiving treatment with antipsychotic medications. Informed Consent includes a signed consent form, which facilities are authorized to develop, which must be completed before antipsychotic medications may be administered. The signed consent form is to be kept in the patient's record. The information that a patient receives must include:
- The nature of the patient's mental condition.
- The reasons for taking such medication, including the likelihood of improving or not improving without such medication.
- The fact that consent, once given, may be withdrawn at any time by stating such intention to any member of the treating staff.
- The reasonable alternative treatments available, if any.
- The type, range, frequency and amount (including use of PRN orders), method (oral or injection), and duration of taking the medications.
- The probable side effects of these drugs known to commonly occur, and any particular side effects likely to occur with the particular patient.
- The possible additional side effects which may occur to patients taking such medications beyond three months. The patient shall be advised that such side effects may include persistent movement of the face or mouth and might at times include similar movement of the hands and feet, and that these symptoms of tardive dyskinesia are potentially irreversible and may appear after medications have been discontinued.
Recent legislation (SB 665) extends to involuntary patients, as well as voluntary patients, the right to refuse antipsychotic medications. As part of the Informed Consent process patients must be notified of this right.
The exceptions to this are emergency administration of medications or a court determination of a patient's lack of capacity to give informed consent and/or refuse antipsychotic medications. An emergency is defined in WIC 5208 (m) as:
"A situation in which action to impose treatment over the person's objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment."
State law (SB 665) makes provisions for capacity hearings wherein a doctor may file a petition to the court for permission to administer antipsychotic medications to involuntary patients over their objections. This pertains to involuntary patients under WIC 5150, 5250, and 5260. The capacity hearing is conducted by a court-appointed hearing officer and is attended by the patient (who may choose to waive his or her presence), the treating physician, and the patient's representative - a Patients' Rights Advocate. Both doctor and patient can file for an appeal to take the case before superior court should they wish to dispute the findings of this hearing. Patients on conservatorship should have a determination regarding capacity to refuse medications as part of the conservatorship orders. Due to complexities that make detailed explanation impracticable for purposes of this manual, patients on conservatorship who wish to appeal court or conservatorship decisions should be encouraged to contact the Patients' Rights Advocacy Office for assistance.