Ch14 Terms: Legal & Ethical Issues

Civil commitment (laws) 🧑‍⚖

legal proceedings determining a person’s mentally disordered and may be hospitalized, even involuntarily

Parens patriae

• Government’s legal authority: state serves as ‘surrogate’ parent (+ police power)

• state or country as the parent power; applied when citizens aren’t likely to act in their own best interest

• ex: to commit people with severe mental illness to mental health facilities when it’s believed they might be harmed because they’re unable to secure basic necessities of life, like food and shelter (grave disability), or because they don’t recognize their need for treatment)

Due process 👂

hearing that allows mental health professionals to argue for the merits of medication use and the patient to provide a counterargument

5150

number of the section of the Welfare and Institutions Code, which allows an adult who is experiencing a mental health crisis to be involuntarily detained for a 72- hour psychiatric hospitalization when evaluated to be a danger to others, or to himself or herself, or gravely disabled.

Involuntary commitment ❌

• Legally being admitted to a psychiatric unit for care of a severe mental health condition against your wishes

• General criteria: severe mental illness OR critical need for mental health care, danger to self or others

• Grave disability: unable to care for self

De-institutionalization ❌

• Systematic removal of people with severe mental illness or intellectual disability from institutions like psychiatric hospitals

• 1963: Community Mental Health Act (President Kennedy) created community preventive and treatment programs. Unfortunately, there weren’t enough funds or trained mental health staff to serve needs.

• 1967 Medicaid: incentives to increase nursing homes and general hospitals. Little funding for ‘institutions for mental disease’.

• 1960s Closing of state psychiatric hospitals: lawsuits against states due to mistreatment of clients and old/decaying facilities.

  • Inpatient beds decreased: 559k (1955) to 36,150 (in 2023)

Trans-institutionalization ▶

Movement of people with severe mental illness from large psychiatric hospitals to smaller group residences

• Transition: community-based programs, creation of small group and nursing homes – but limited funds for mental illness 

• Increased mental illness in jails/prisons or homeless: 66% are homeless with mental illness or drug problems. 45-64% are in prisons/jails with mental illness. 

• 1996 Mental Health Parity & 2008 MHP/Addiction Equity: can’t set limits to mental health care less than health care. HMOs and insurance failed to follow strict guidelines; weren’t serving the needs of those with mental health disorders. 

• Recession and mental health funding: down $43.5 billion in mental health funds 🔽

Criminal Commitment

Legal procedure by which a person found not guilty of a crime by reason of insanity must be confined in a psychiatric hospital

• Person is charged with a criminal act: must determine if mental illness played a role in criminal act  

• Determine competency to stand trial through psychiatric evaluation: 3 major criteria to determine competence  

• Mental health professional provides expert testimony: expertise in psychological testing, forensic background

Insanity Defense

for more than 100 years, was used to determine culpability when a person’s mental state was in question

M’Naghten Rule, 1843

it must be clearly proved that at the time of committing the act, the party accused was:

• laboring under such a defect of reason, from disease of the mind, as to not know the nature and quality of the act he was doing

• or if he did know it, that he did not know he was doing what was wrong

Durham Rule, 1954

an accused isn’t criminally responsible if his unlawful act was the product of mental disease or mental defect

American Law Institute rule, 1962

• A person’s not responsible for criminal conduct if at the time – as a result of mental disease or defect – he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law

• As used in the Article, the terms “mental disease or defect” don’t include an abnormality manifested only by repeated criminal or otherwise antisocial conduct.

Diminished capacity, 1978

Evidence of an abnormal mental condition in people that causes criminal charges against them, requiring intent or knowledge to be reduced to lesser offenses requiring only reckless or criminal neglect.

Insanity defense reform act 1984

A person charged with a criminal offense should be found not guilty by reason of insanity if it’s shown that, as a result of mental disease or mental retardation, he was unable to appreciate the wrongfulness of his conduct at the time of his offense.

Not Guilty by Reason of Insanity (NGRI)

Court determines the person was not able to tell right from wrong due to their mental state at the time of the offense.

• % of Insanity defenses in criminal cases: less than 1% 

• Incarceration time: Mental health facilities compared to Jails/Prisons 

  • Hinckley Jr: spent 35 years in a mental health facility, another 6 years under court supervision (41 years total). Served more time than in prison if found guilty of crime. A sentence is normally 20 to life, eligible for parole after a minimum of 20 years.  

  • Jones v US (1983): Prison sentence if found guilty has no bearing on the length of time in commitment at a mental health facility  

Guilty but Mentally Ill (GBMI) Verdict

a person is found legally guilty of a crime, but the court also recognizes that they were mentally ill at the time the crime was committed.

Mental competence 🧠✅

ability of legal defendants to participate in their own defense and understand the charges and roles of the trial participants

Duty to warn ⚠

Mental health professional’s responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened

Least restrictive alternative 🦺

wherever possible, people should be provided with care and treatment in the least confining and limiting environment possible

Privacy 🤫

anything you say to your therapist is confidential and must be kept private between you and the therapist

Confidentiality 🔒

Professional ethics requiring providers of mental health care to limit the disclosure of a patient’s identity, their condition/treatment, any data entrusted to them during assessment, diagnosis, treatment

Privileged communication 👮❌

even if authorities want the info the therapist has receive from the patient, they can’t have access to it without expressed consent of the patient