Abnormal Psychology An Integrative Approach 4 th Edition

Abnormal Psychology: An Integrative Approach, 4 th Edition, David H. Barlow Chapter 16: Mental Health Services: Legal and Ethical Issues Chapter 16 Mental Health Services: Legal and Ethical Issues

Abnormal Psychology: An Integrative Approach, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow Chapter 16: Mental Health Services: Legal and Ethical Issues Britain Bedlam

Abnormal Psychology: An Integrative Approach, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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, 4 th Edition, David H. Barlow 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