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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
Chapter 16
Mental Health Services: Legal and Ethical Issues
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
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
 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
The Concept of Mental Illness in
Civil 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
The Role of Expert Witness in
Civil 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)
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 16: Mental Health Services: Legal and Ethical Issues
Summary of Ethical and Legal Issues
in 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