Chapter 16 Mental Health Services: Legal and Ethical Issues

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Chapter 16Mental Health Services Legal and
Ethical Issues
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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

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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

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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

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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

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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

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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

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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

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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
• MNaughten 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

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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 MNaughten-like standards
• Guilty but mentally ill (GBMI)
• Allows for treatment and punishment

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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

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Determination of Competence to Stand Trial

• Requirements for Competence
• Understanding of legal charges
• Ability to assist in ones 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

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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)

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Patients 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

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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

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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 Associations Practice
  Guidelines
• Standards for clinical efficacy research
• Standards for clinical utility (effectiveness)
  research

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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