Emergency Department of a major Brisbane hospital

Hai is a 20-year-old male patient who arrives at the Emergency Department of a major Brisbane hospital. An ambulance transported Hai to the hospital after a bystander saw him jumping from the balcony of a first floor apartment. The paramedics called to the incident think that Hai has broken his arm as a result of falling over after he jumped. The circumstances surrounding the incident were not clear to the bystander, and the paramedics were not able to elicit any information from Hai about how the incident happened. Hai has remained very quiet since his admission to the hospital. Registered Nurse Mark Traves works at the Emergency Department of the hospital and is caring for Hai. Hai has not said much about the incident, but opens up to Mark and tells him more about himself, and what happened. Hai told Mark that he moved to Brisbane from far north Queensland, to attend university in Brisbane. Hai’s family all live up north, except his older brother, Tim, who is 24- years-old and is also studying/living in Brisbane. When Mark questioned Hai about what happened, he said “I had to jump off the balcony, so I could get away from the intruders in my apartment”. Mark tried to get more information about this from Hai, but he would not say anything further and instead shuts the conversation down. Mark established that Hai lives alone. After this conversation, Mark checks the records relating to Hai’s admission to the hospital. The paramedics made no mention of intruders at Hai’s apartment, so Mark seeks some further information about Hai’s medical history and background. Mark finds that Hai was recently undergoing psychiatric care at the same hospital. After speaking with a psychiatrist, Mark confirms that Hai experiences psychotic episodes which often result in hallucinations and/or delusions. The psychiatrist confirms that a diagnosis of delusional disorder was previously made, but that, at the time of treatment, Hai was not considered a risk to himself or others. After discovering this information, Mark discusses Hai’s circumstances with a colleague, Dr Chin. Dr Chin examines Hai and Hai tells her that she better be quick as the intruders are on their way, and that they are “going to get him”. Dr Chin thinks that the incident leading to Hai’s injuries resulted from a psychotic episode and that Hai is delusional. Dr Chin says to Mark that Hai should be treated for his mental illness so that he can then be treated for his physical injuries. Dr Chin asks Mark to take the steps necessary to treat Hai’s mental health. Mark returns to follow up with Hai’s care and says that the team want to help him get well. Mark tells Hai that he imagined the intruders at his apartment; that this is related to his hallucinations and delusions. Hai becomes agitated and denies the possibility that he imagined the intruders, saying that he has never experienced hallucinations before. Additionally, Hai tells Mark that he does not want any kind of antipsychotic medication and wants to be discharged from hospital. Hai is adamant that he is not delusional. Hai tells Mark that he has medical training that will enable him to take care of himself (which, in fact, he does not), and that there are no complications or risks associated with his injuries. Hai tells Mark that he is going to ask his friend to pick him up from the hospital. However, before that happens, Tim (Hai’s brother) arrives and asks that the health care team provide any necessary treatment that might help Hai’s psychological wellbeing. Apply the ethical and legal decision-making framework to this problem so that you can advise RN Mark Traves of any necessary steps to take that might enable the team to provide Hai with care for his mental illness. When considering legal principles, ensure that your answer addresses only the law outlined under the Mental Health Act 2016 (Qld) – do not consider the Mental Health Act 2000 (Qld) or the transitional provisions. You do not need to address the ethical and legal issues concerning the treatment of Hai’s physical injuries in your answer.

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