Legal Concerns

1
Legal Concerns

• Defining Mental Illness
• Mental Illness is a Legal Concept
• Varies by State
• Not the Same as Psychological Disorder
• Responsible for Actions?
• How do you determine this?

2
Legal Concerns

• Insanity Defense
• Less than 1 of all cases
• Even fewer succeed
• Often spend more time locked in hospital than
  would be in prison
• Twinkie Defense
• Guilty But Mentally Ill
• Competent to Stand Trial
• Understand Charges
• Assist in Own Defense

3
Civil Commitment

• Should People Be Committed to a Psychiatric
  Institution Against Their Will?
• Criteria for Civil Commitment
• Person has a Mental Illness
• Needs Treatment
• Is Dangerous (self or others)
• Is Unable to Care for Self
• Right to Refuse Treatment?

4
Clients Rights

• To Refuse Treatment
• To Obtain Treatment
• To Confidentiality
• Therapeutic Effect
• Limits
• Imminent Harm to Self or Others
• Duty to Warn (Tarasoff)
• Suspicion of Child Abuse
• Least Restrictive Environment

5
Deinstitutionalization

• Made Possible Largely Due to Medications for
  Severe Disorders
• Intended Shift of Treatment to Community Mental
  Health Centers
• Largely a Failure
• Greyhound Therapy
• Other care facilities
• Nursing and group homes

6
Antipsychotic Drugs and Inpatient Treatment
7
Cost-effectiveness and Accountability

• Managed Mental Health Care
• Fewer Hospitalizations
• Briefer Treatments
• Fewer psychiatrists, and now psychologists,
  providing psychotherapy
• Greater use of medications
• Movement Toward Practice Guidelines
• Manualized treatments
• EVTs, ESTs, and narrowing treatments
• Treatment is in many cases very good, but some
  areas not very good

8
Social Aspects of Mental Illness

• Social Stigma
• The Myth of Mental Illness
• Szasz
• Mental illness is an invention not a discovery
• Power of Mental Health Professions
• On Being Sane in Insane Places
• Rosenhan