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Chapter 16 Mental Health Services: Legal and Ethical Issues. Mental Health and the Legal System: An Overview. Mental Health and the Legal System Guided by ethical principles and state and federal laws Shifting Perspectives on Mental Health Law; Two Eras

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mental health and the legal system an overview
Mental Health and the Legal System: An Overview
  • Mental Health and the Legal System
    • Guided by ethical principles and state and federal laws
  • Shifting Perspectives on Mental Health Law; Two Eras
    • Liberal (1960 to 1980) – Rights of mentally ill dominated
    • Neo-conservative (1980-onwards) – Limit rights of patients
  • The Issues
    • The nature of civil vs. criminal commitment
    • Balancing ethical considerations vs. legal considerations
    • The role of psychologists in legal matters
    • Rights of patients and research subjects
    • Practice standards and the evolution of mental health care
civil commitment overview criteria and oversight authority
Civil Commitment: Overview, Criteria,and Oversight Authority
  • Civil Commitment Laws
    • Legal declaration of mental illness
    • When can a person be placed in a hospital for treatment?
    • Such laws and definitions of mental illness vary by state
  • General Criteria for Civil Commitment
    • Person has a mental illness and needs treatment
    • Person is dangerous to self or others
    • Grave disability – Inability to care for self
  • Governmental Authority Over Civil Commitment
    • Police power – Health, welfare, and safety of society
    • Parens patriae – State acts a surrogate parent
the civil commitment process
The Civil Commitment Process
  • Initial Stages
    • Person fails to seek help
    • Others feel that help is needed
    • Petition is made to a judge on the behalf of the person
    • Individual must be notified of the commitment process
  • Subsequent Stages
    • Involve normal legal proceedings in most cases
    • Should a person be committed?
    • This determination is made by a judge
the concept of mental illness in civil commitment proceedings
The Concept of Mental Illness inCivil Commitment Proceedings
  • Defining Mental Illness
    • A legal concept – Severe disturbances
    • Not synonymous with a psychological disorder
    • Definitions of mental illness vary by state
    • Often excluded conditions include
      • Mental retardation and substance-related disorders
  • Dangerousness to Self or Others
    • Central to commitment proceedings
    • Assessing dangerousness
      • The role of mental health professionals
    • Knowns and unknowns about violence and mental illness
problems with the process of civil commitment
Problems with the Process of Civil Commitment
  • Early Supreme Court Rulings
    • Restrictions on involuntary commitment
    • A non-dangerous person cannot be committed
    • Need for treatment alone is not enough
    • Having a grave disability is insufficient
  • Consequences of Supreme Court Rulings
    • Criminalization of the mentally ill
    • Increase in homelessness
    • Deinstitutionalization – Large psychiatric hospitals closed
    • Transinstitutionalization – Mentally ill to community care
  • Liberal Changes in Civil Commitment Procedures Followed
subsequent modification to civil commitment procedures
Subsequent Modification to Civil Commitment Procedures
  • Civil Commitment Criteria Were Broadened
    • Involuntary commitment
      • For dangerous and non-dangerous persons
      • For persons in need of treatment
  • National Alliance of the Mentally Ill
    • Argued for further reforms
criminal commitment an overview
Criminal Commitment: An Overview
  • Nature of Criminal Commitment
    • Accused of committing a crime
    • Detainment in a mental health facility for evaluation
    • Focus on fitness to stand trial
    • Found guilty or not guilty by reason of insanity
the insanity defense
The Insanity Defense
  • Nature of the Insanity Defense Plea – A Legal Statement
    • Accused of not guilty because of insanity at time of crime
    • Defendant sent to a treatment facility rather than prison
    • Diagnosis of a disorder is not the same as insanity
  • Definitions of Insanity
    • M’Naughten rule – Insanity defense originated here
    • Durham rule – More inclusive definition
      • Mental disease or defect
    • American Law Institute Standard
      • Knowledge of right vs. wrong
      • Self-control
      • Diminished capacity
consequences of the insanity defense
Consequences of the Insanity Defense
  • Public Misperceptions and Outrage
    • John Hinckley Jr. found not guilty by reason of insanity
    • 50% of states – Moved to abolish the insanity defense
    • Public views – Insanity defense is a legal loophole
  • Facts About the Insanity Defense
    • Used in less than 1% of criminal cases
    • Spend more time in mental hospitals than in jail
  • Changes Regarding the Insanity Defense
    • Insanity defense reform act
      • Movement back to M’Naughten-like standards
    • Guilty but mentally ill (GBMI)
      • Allows for treatment and punishment
therapeutic jurisprudence
Therapeutic Jurisprudence
  • Overview
    • Using knowledge of behavior change
      • To help those in trouble with the law
  • “Problem Solving” Courts
    • Address unique needs of people with specific problems
    • Examples include delayed sentencing under the condition the individual holds a job for six months
determination of competence to stand trial
Determination of Competence to Stand Trial
  • Requirements for Competence
    • Understanding of legal charges
    • Ability to assist in one’s own defense
    • Essential for trial or legal processes
    • Burden of proof is on the defense
  • Consequences of a Determination of Incompetence
    • Loss of decision-making authority
    • Results in commitment, but with limitations
the role of expert witness in civil and criminal proceedings
The Role of Expert Witness inCivil and Criminal Proceedings
  • The Expert Witness: Psychologists’ Roles
    • Person with specialized knowledge and expertise
    • Assist in competency determinations
    • Assist in making reliable DSM diagnoses
    • Advise the court
      • Regarding psychological assessment and diagnosis
    • Assess malingering (i.e., faking symptoms)
patient s rights an overview
Patient’s Rights: An Overview
  • The Right to Treatment
    • Cannot be involuntarily committed without treatment
    • Treatment – Reduce symptoms and humane care
  • The Right to the Least Restrictive Alternative
    • Treatment within the least confining and limiting setting
  • The Right to Refuse Treatment
    • Often in cases involving medical or drug treatment
    • Persons cannot be forced to become competent for trial
  • The Right to Confidentiality vs. Duty to Warn
    • Confidentiality – Protect disclosure of information
    • Tarasoff and the Duty to Warn – Limits on confidentiality
research participant rights an overview
Research Participant Rights: An Overview
  • The Right to be Informed About the Research
    • Involves informed consent, not simply consent alone
  • The Right to Privacy
  • Right to be Treated with Respect and Dignity
  • Right to be Protected from Physical and Mental Harm
  • Right to Chose or to Refuse to Participate in Research
  • Right to Anonymity in Report of Study Findings
  • Right to Safeguarding of Records
clinical practice guidelines and standards
Clinical Practice Guidelines and Standards
  • Agency for Health Care Policy and Research
    • Efficient and cost-effective mental health services
    • Dissemination of relevant state-of-the-art information
      • To practitioners and the general public
    • Establish clinical practice guidelines
      • For assessment and treatment
  • American Psychological Association’s Practice Guidelines
    • Standards for clinical efficacy research
    • Standards for clinical utility (effectiveness) research
summary of ethical and legal issues in mental health services
Summary of Ethical and Legal Issuesin Mental Health Services
  • Societal Views and Laws About Mental Illness
    • Have changed over time
  • Mental Illness Is a Legal Term, Not a Psychological Term
  • Civil Commitment Is a Legal Processes
    • Involves involuntary commitment
  • Criminal Commitment
    • Involves criminal behavior and mental illness
    • Involves competence, insanity, and criminal culpability
  • Role of Mental Health Professionals in Legal Matters
  • Rights of Patients and Research Subjects
  • The Future of Mental Health Care