Chapter 16: Mental Health Services: Legal and Ethical Issues

Comprehensive practice flashcards covering legal and ethical issues in mental health services, including civil and criminal commitment, the insanity defense, and patient rights.

Managing care for people with serious mental illness requires a balance between which three factors?

A patient’s rights as an individual, a patient's individual safety, and society’s right to safety and security.

What is the definition of civil commitment laws?

Laws that detail when a person can be legally declared to have a mental illness and be placed in a hospital for treatment.

What are the three general criteria for civil commitment?

The person has a mental illness and needs treatment, the person is dangerous to self or others, or the person is gravely disabled (unable to care for self).

Distinguish between police power and parens patriae in governmental authority over civil commitment.

Police power relates to the health, welfare, and safety of society, while parens patriae involves the state acting as a surrogate parent so a person receives care to prevent them from being in danger.

Who makes the final determination in the civil commitment process?

A judge makes the determination, informed by expert opinions.

How does the legal definition of mental illness typically differ from a psychological diagnosis?

It is defined as severe emotional or thought disturbances impacting health and safety, definitions vary by state, and they often exclude cognitive disability or substance-related disorders.

What is the reality regarding the relationship between mental illness and violence?

Having mental illness moderately increases the risk for dangerous behavior, often specifically when hallucinations, delusions, or personality disorders are present.

What is the PCL-R and how effective is it for predicting violence?

The Psychopathy Checklist-Revised is an assessment tool that is best at identifying persons at low risk of being violent, but it is not good at long-term prediction.

What restrictions has the Supreme Court placed on involuntary commitment?

A non-dangerous person cannot be involuntarily committed, and insufficient grounds include the need for treatment alone or being gravely disabled.

What is the difference between deinstitutionalization and transinstitutionalization?

Deinstitutionalization is the movement of people with mental illness out of institutions (often leading to homelessness), while transinstitutionalization is the movement from large mental hospitals to other institutions like prisons or nursing homes.

What defines criminal commitment?

Being accused of committing a crime and being detained in a mental health facility for an evaluation to determine fitness to stand trial.

What was the significance of the M'Naghten rule?

It is where the insanity defense originated, focusing on the inability to distinguish right from wrong.

How did the Durham rule define insanity?

It provided a more inclusive definition where the crime was the "product" of a mental illness.

What are the two components of the American Law Institute standard for insanity?

Knowledge of right vs. wrong and self-control (diminished capacity).

What is the "Guilty but mentally ill" (GBMI) verdict?

A change regarding the insanity defense that allows for both treatment and punishment.

What is therapeutic jurisprudence?

Using knowledge of behavior change to help those in trouble with the law, often through "problem solving" courts.

What two requirements must be met to be determined competent to stand trial?

An understanding of legal charges and the ability to assist in one’s own defense.

What legal duty was established by Tarasoff v. Regents of the University of California?

The Duty to Warn, which requires therapists to warn an individual if a client threatens to harm them.

According to Thompson v. County of Alameda, when must a threat be reported?

Threats must be specific.

What are the primary roles of an expert witness in court?

Assist in competency determinations, assist in making reliable DSM diagnoses, advise the court on psychological assessments, and assess for malingering (faking symptoms).

What is the patient’s right to the "least restrictive alternative"?

The right to receive treatment within the least confining and limiting setting possible.

What is the clinical efficacy axis in evidence-based practice?

A thorough consideration of scientific evidence to determine whether an intervention is effective compared to alternative treatment.