Legal and Ethical Issues

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Legal and Ethical Issues

• I. Civil Commitment

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Civil Commitment

• Civil commitment in U.S. dates back to late 19th
  century
• Prior to this, family and community cared for
  mentally ill (or left to care for self)
• Creation of large hospitals ? unexpected social
  problem committing people for reasons other than
  mental disorders (e.g., political beliefs)

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A. Mental Illness

• Mental illness a legal concept referring to
  severe emotional or thought disturbance that
  negatively affects an individuals health and
  safety
• Legal term ? every state has its own definition
• Many states exclude mental retardation and
  substance use disorders from the definition

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B. Criteria for Civil Commitment

• Rules vary by state
• Historically, person could be committed when one
  of the following conditions was met
• Person has a mental illness and is in need of
  treatment
• Person is dangerous to himself or others
• Person is unable to care for himself (grave
  disability)

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B. Criteria for Civil Commitment (cont.)

• Commitment process
• petition by relative or mental health
  professional to a judge
• Judge orders evaluation
• Hearing held in court (protects patients
  rights)
• Judge or jury (depending on state law) can hear
  and decide commitment case

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B. Criteria for Civil Commitment (cont.)

• Commitment process is similar to a trial
• Must notify person of the proceedings
• Person must be present at the hearing
• Person must be given legal representation
• Person can examine witnesses

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B. Criteria for Civil Commitment (cont.)

• In an emergency (person is a danger to
  self/others), temporary commitment can be made
  without a hearing 72-hour hold
• Longer commitment term would require a formal
  hearing

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C. Special Cases of Civil Commitment

• Many states (e.g., FL) have adopted special cases
  of civil commitment
• Sexual predator laws are civil commitment laws
• Allow for civil commitment of criminals who have
  served their prison term for a sexual offense
• Commitment is until the offender is deemed no
  longer a threat to others (which may be never)

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A few questions

• What is the purpose of civil commitment for
  society?
• What is the purpose of civil commitment for the
  person who is committed?

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D. Deinstitutionalization

• Recalldeinstitutionalization movement of
  people with severe mental illness out of
  institutions
• Goals
• Decrease number of people in state hospitals to
  reduce number of state hospitals
• Accomplished large reduction in number of state
  hospitals by 1980s

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Goals (cont.)

• Provide community care for mentally ill
• Failed community care did not materialize for
  majority of patients removed from institutions
• Transinstitutionalization moving people from
  mental hospitals to other types of institutions
  (jails, nursing homes)
• Care for mentally ill marginal

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D. Deinstitutionalization (cont.)

• Resulted in increased homelessness
• But, not all homeless are mentally ill
• 20-30 of homeless have a history of
  psychological problems/disorder

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Legal and Ethical Issues

• II. Criminal Commitment

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A. Criteria for Criminal Commitment

• Criminal commitment laws vary by state
• Most states hold people in prison or mental
  hospitals under either of two conditions
• Person has been accused of a crime and must be
  assessed for fitness to stand trial
• Pre-trial, but not necessarily a brief period of
  time
• Must demonstrate competency to stand trial be
  able to understand proceedings and participate in
  the defense
• Burden of proof is on the defense to show
  competency
• Law prohibits indefinite commitment, but language
  of law usually gives judges ability to commit for
  years

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Commitment conditions (cont.)

• Person found not guilty by reason of insanity
• Rare ? less than 1 of felony cases use insanity
  defense
• 26 of those result in a not guilty by reason of
  insanity verdict
• 15 of those are set free without any period of
  criminal commitment

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B. Duty to Warn

• Tarasoff vs. Regents of the University of
  California (1974, 1976)
• basis of duty to warn rule
• Graduate student (paranoid Sz) indicated to 2
  therapists at the university his intention to
  kill Tatiana Tarasoff (fellow student)
• Therapists called police ? investigated, got
  assurances that he would not harm Tarasoff
• Shot and stabbed Tarasoff a few weeks later
• Her parents sued said someone should have
  warned Tarasoff of the danger
• Therapists must now warn a person against whom a
  patient has made a serious threat

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Legal and Ethical Issues

• III. Ethical Treatment in Practice and Research

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A. APA Ethics Code

• American Psychological Association (APA) provides
  ethics code for members
• Psychological research
• Therapy
• Several (e.g., do not have sex with clients)
• General
• Several for example
• Do not hold multiple relationships if they will
  impact objectivity, effectiveness, or competence
• Confidentiality limits legal limits such as
  duty to warn

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Summary

• Civil commitment mental illness danger to
  self/others
• Deinstitutionalization
• Criminal commitment competency not guilty by
  reason of insanity
• Duty to warn
• APA ethics code