Legal & Ethical Issues in Psychopathology

1
Legal Ethical Issues in Psychopathology
2
Current Legal/Ethical Issues

• Legal Issues
• Civil Commitment
• Criminal Commitment
• Duty to Warn

• Ethical Issues (in Treatment)
• Confidentiality
• Competence
• Dual Relationships

3
Legal Issues
4
Legal Issues

• Rights of patients vs. rights of public
• Few laws govern therapy
• Required to be competent
• To have a license
• Can use collection agencies if clients fail to
  pay
• Several unique legal issues with therapy
• Complex questions
• Burden therapist, state, others

5
Civil Commitment

• Most hospitalizations are voluntary
• Voluntary is in best interest b/c can check out
• In some cases, patients are involuntarily
  hospitalized
• Danger to oneself (suicidality)
• Danger to others (homocidality)
• Majority of commitments are male schizophrenics

6
Civil Commitment

• Judge hears case decides
• Hearing is requested by police, mental health
  provider
• Civil commitment must legally be lifted when
  patient is no longer dangerous
• Requirements protect patients - historically,
  anyone could have someone committed
• But, goals are re danger, not helping

7
The Right to Treatment

• Established 1972 by Wyatt v. Stickney
• Rationale for commitment treatment
• Thus, if hospital is unwilling or unable to
  provide, patient can petition for commitment
  overruled
• Why suspend a patients rights unless there is a
  benefit?
• First attempt to have minimum criteria for mental
  health treatment

8
The Right to Treatment

• Staffing levels, of bathrooms, size of
  facility, variables that impact quality of life
• Rulings required states to provide facilities
  that met minimal requirements
• State provides most treatment for the severely
  and chronically mentally ill

9
The Insanity Defense

• Based up on premise that people cannot be held
  responsible for crimes if they were unaware of
  the nature of their actions or were unable to
  control their actions
• We have free will to commit or not commit crime
• Legal insanity is a very narrow definition
• Psychological insanity products of antecedents
  (a disorder is not something we choose)

10
Insanity Defense Reform Act (1984)

• Made it more difficult to prove insanity
• Unable to appreciate wrongfulness as result of
  severe mental illness
• Defense now has burden of proof
• Previously, prosecution had to prove sanity
• Reduced advantages of pleading insanity
• Fixed minimum periods of incarceration
• Eliminated automatic release following reduction
  of danger

11
Guilty But Mentally Ill

• Individual will be incarcerated, but acknowledges
  presence of mental illness
• Suggests that treatment is needed during
  incarceration

12
Public Opinions of Insanity Pleas

• 90 of the public believes that
• The insanity defense is used too much
• Lots of guilty people get to go free
• Public estimates of how many felony cases involve
  insanity pleas 33
• Actual number lt1
• Public estimates of success 50
• Actual number 25

13
Public Opinions of Insanity Pleas

• Public estimate of how many insane people are
  released 50
• Actual number 15 (minor offenses that do not
  result in incarceration anyway)
• Public also tends to believe successful insanity
  pleas short time in hospital
• They actually spend 50 longer in hospital then
  they would have in prison if guilty

14
Competency to Stand Trial

• Is the person capable of understanding the
  charges and helping attorney to prepare the case?
• This is independent from sanity at the time of
  crime
• Trial is postponed defendant is held for
  treatment
• Protects public from possible danger

15
The Right to Refuse Treatment

• Can usually refuse treatment if desired
• Unless refusal is based on psychosis or delusions
• Before all commitments, independent evaluation is
  required (not connected to the hospital)

16
Therapists Duty to Warn

• Tarasoff v. Regents of the U. of CA (1974, 1976)
• Therapists have a legal responsibility to warn
  potential victims when they may be at risk from a
  client
• 1969 Tatiana Tarasoff is murdered by a grad
  student who suggested, in therapy, that he was
  going to kill her
• Therapist informed police, who told grad student
  they were aware of his threats
• Grad student assured police he had no intentions
  of murder

17
Therapists Duty to Warn

• Therapists are required to warn/protect potential
  victims
• By telling the police
• By committing the client
• By informing the potential victim
• Involves breaking a clients confidentiality

18
Ethical Issues
19
Ethical Issues in Treatment

• Competence
• Integrity
• Professional Scientific Responsibility
• Respect for Peoples Rights Dignity
• Concern for Others Welfare
• Social Responsibility

20
Confidentiality

• Therapy is a protected relationship - information
  is not shared without explicit permission
• Exceptions
• Knowledge of child abuse
• Threats to others (Tarasoff)
• Threat to self
• Can consult with other therapists openly

21
Competence

• Maintain the highest standards of competence
• Recognize respect the limits of competence
• Provide only those services we are qualified to
  provide
• Competence is a combination of education,
  training, experience

22
Competence

• E.g. Conducting a neuropsyc assessment without
  training
• Be familiar with culture, gender, other
  differences how those differences will effect
  ones work
• Remain current in the field on research and
  professional information

23
Record Keeping

• Maintain records of client contact to facilitate
  document treatment
• Provide a basis for decisions
• Covers the therapist in case of legal action
• E.g. decisions regarding suicidality
• Records are often requested by insurance
  companies to determine if more services are needed

24
Who is the Client? (Esp. Children)

• Psychologists may work with more than one person
• Especially with children, who have parents
  teachers, and other providers
• Ethics do not offer a clear line in this case
• Avoid multiple roles
• Clarify roles if they are ambiguous
• Often ask parents for childs confidentiality

25
What if No Treatment Exists?

• Experimentation is required to further the field
• Clients should be informed of experimentation
• Clients also should be informed of other options
  that are established
• Often try experimental tx if an EST has been
  tried and failed (in clinical work)
• Design based on available science

26
Dual Relationships

• When therapist/client relationship exists at the
  same time as another
• E.g. friend/friend or boss/employee
• Should therapists treat their friends?
• Should therapists treat/listen to their students?

27
Some Practical Issues - Science vs. Pseudoscience
28
The Widening Gap

• Between academic psychology popular psychology
• Between research and general public knowledge

29
Characteristics of Pseudoscience

• Overuse of ad hoc hypotheses to escape refutation
• Emphasis on confirmation, not refutation
• Absence of self-correction
• Reversed burden of proof
• Overreliance on anecdotal evidence
• Use of obscurantist language
• Absence of connectivity with other disciplines

30
Pseudoscience in Psychopathology

• Explosion of unvalidated tx for trauma
• Use of demonstrably ineffective tx for autism
• Continued use of inadequate assessments
• Widespread use of herbal tx w/o testing
• Subliminal self-help tapes
• Explosion of self-help books and programs
• Suggestive techniques for memory recovery

31
Why Should We Care?

• Why should we monitor the general public? Cant
  they use whatever they want to buy?
• Techniques may be harmful to the public
• Consumers waste time they could use in
  therapy
• Damage to our reputation integrity
• Our ethical guidelines of social responsibility

32
What Should Psychologists Do?

• Actively study debunk pseudoscience
• Evaluate self-help materials
• Standardize training programs
• Popularize our findings methods to the general
  public, convey our scientific excitement to
  outsiders show the successful applications of
  it
• The general public is often unaware of what is
  proven, and what is not