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Chapter%2014%20%28For%20BB%29 - Chapter 16 Chapter Mental...

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Unformatted text preview: Chapter 16 Chapter Mental Health Services: Legal and Mental Ethical Issues Ethical Mental Health and the Legal System Mental Mental Health and the Legal System – Guided by ethical principles & state/federal laws Two Perspectives on Mental Health Law – Liberal (1960 to 1980) – Rights of mentally ill dominated – Neo-conservative (1980-onwards) – Limit rights of patients Neo-conservative The Issues The – – – – – 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 Practice Civil Commitment Civil Civil Commitment Laws – Legal declaration of mental illness – When can a person be placed in a hospital for treatment? When – 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 Governmental – Police power – Health, welfare, and safety of society – Parens patriae – State acts a surrogate parent The Civil Commitment Process The 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 Individual Involve normal legal proceedings in most cases Should a person be committed? This determination is made by a judge This Subsequent Stages The Concept of Mental Illness The 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 Mental Dangerousness to Self or Others Dangerousness – Central to commitment proceedings – Assessing dangerousness The role of mental health professionals – Knowns/unknowns about violence and mental illness Problems with Civil Commitment Problems Early Supreme Court Rulings – – – – – – – – Restrictions on involuntary commitment Restrictions A non-dangerous person cannot be committed non-dangerous Need for treatment alone is not enough Need Having a grave disability is insufficient Having Criminalization of the mentally ill Increase in homelessness Deinstitutionalization – Large psychiatric hospitals closed Transinstitutionalization – Mentally ill to community care Consequences of Supreme Court Rulings Consequences Liberal Changes in CC Procedures Followed Subsequent Modifications Subsequent 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 Criminal 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 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 M’Naughten rule – Insanity defense originated here M’Naughten Durham rule – More inclusive definition Mental disease or defect Definitions of Insanity – American Law Institute Standard Knowledge of right vs. wrong Self-control Diminished capacity Consequences Consequences 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 Overview – Using knowledge of behavior change To help those in trouble with the law “Problem Solving” Courts – Address unique needs of people with specific Address problems problems – Examples include delayed sentencing under the Examples condition the individual holds a job for six months condition Competence to Stand Trial Competence Requirements for Competence – – – – Understanding of legal charges Understanding 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 Results The Role of Expert Witnesses The The Expert Witness: Psychologists’ Roles – – – – Person with specialized knowledge and expertise Assist in competency determinations Assist in making reliable DSM diagnoses Advise the court Advise Regarding psychological assessment and diagnosis Regarding – Assess malingering (i.e., faking symptoms) Patient’s Rights Patient’s 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 Treatment The Right to Refuse Treatment The – 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 Research The Right to be Informed About the Research The – 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/Refuse to Participate in Research Right to Anonymity in Report of Study Findings Right to Safeguarding of Records ...
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