Mental Health Services: Legal and Ethics Issues

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Mental Health Services Legal and Ethics Issues

• Chapter 16 Barlow and Durand

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Civil Commitment

• Each state
• Legally declared mentally ill and placed in a
  hospital for treatment
• Criteria Before

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Civil Commitment

• A person can voluntarily request treatment
• After evaluation he/she may be accepted for Tx
• A petition can be made by a relative or mental
  health professional
• The person undergoes evaluation
• The judge contemplates
• Person must be aware such proceedings are
  occurring and participate in trail with
  representation

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Civil Commitment

• But usually CC is in emergency cases
• Person is in immediate danger
• Short term commitment can be made without the
  formal proceedings
• A family member or police officer certifies the
  person is of clear and present danger to self or
  others

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Civil Commitment

• Then evaluated
• Certified by a mental health professional
• Signed by a state official
• Committed
• Definitions of mental health vary from state to
  state

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Assessing Dangerousness

• Critical determinant for civil commitment must
  watch biases in determination
• Mental illness does not equal violent
• Women are often found violent when compared to
  the aggressiveness of men

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Assessing Dangerousness

• Women homeless are more likely to be hospitalized
  even in warm climates
• More black males are perceived as dangerous when
  compared to white males

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Assessing Dangerousness

• Mental health professionals can determine if a
  group of people are at greater risk of violence
• IE previous violence Hx, drug/alcohol abuse
• Can so advise the court but can not predict an
  individuals violence potential

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Civil Commitment

• It is good that commitments are tightened to
  dangerousness so as to not take freedom away from
  just anyone
• But then many MI were not getting the help and Tx
  they needed and were ending up in jail were
  appropriate Tx is not always available nor
  adequate

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Deinstitutionalization

• The movement of people with severe MI out of
  institutions in the 70s and 80s
• Homelessness increased dramatically

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Transinstitutionalization

• Since the large hospitals were closed and not
  enough community centers were created
• Severe MI were moved to nursing homes/group
  residences/jails/prisons
• Marginal care was provided in these places

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Criminal Commitment

• The process by which people are held because

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The Insanity Defense

• Beginning

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The Insanity Defense

• Durham Rule
• ALI (American Law Institute) Rule

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The Insanity Defense

• Diminished Capacity
• Mens rea

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Reactions to the Insanity Defense

• Criticisms
• Supporters
• lt1 actually use it
• Publics perception is 37 use it
• Hospitalizations are often longer than jail
  sentences
• The person does not go free if NGRI

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Insanity Defense Reform Act

• 1984
• A person charged with a criminal offense should
  be found NGRI if it is shown that . . .
• As a result of mental disease or mental
  retardation he/she was unable to appreciate the
  wrongfulness of his/her actions at the time of
  the offense
• AT THE TIME OF THE OFFENSE

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Guilty But Mentally Ill (GBMI)

• Consequences are different than NGRI
• The person is given a prison term just as if
  guilty with no question of MI
• Goes to Tx facility until recovered and then back
  to jail to finish their given term
• Or the person goes to jail just the same as if
  found guilty and if mental health resources are
  available in jail they are to receive them

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Competence to Stand Trail

• Before people can be tried for a criminal offense
  they must be able to understand the charges
  against them and to assist with their own defense
• The length of stay in MH facility is the time it
  takes the person to regain competence (6 month
  checks)
• Courts have stated it cannot be indefinite and
  that after a reasonable amount of time a person
  must be found competent, set free, or civilly
  committed

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Duty to Warn

• Tarasoff Case
• Grad student killed by person with paranoid
  schizophrenia
• University therapist had contacted the police but
  not the victim
• Family sued and won
• Duty to warn was born
• Duty to warn our clients potential victims
  threats must be specific

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Expert Witnesses

• Providing information on a persons dangerousness
• Providing information on clients ability to
  understand court proceedings
• Malingering
• Opinions are mixed on the reliable nature of this
  testimony
• Loftus false memory research

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Patients Rights
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Patients Rights

• 3. Research Participation Rights

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Clinical Practice Guidelines

• Psychosocial Tx must meet . . .
• Clinical efficiency
• Clinical utility