PSYC 300 - Module 11

Legal + Ethics

Criminal Commitment 

Federal legislature (same across all provinces). 2 ways mental illness can be taken into account: 

1. Not Criminally Responsible on account of Mental Disorder (NCRMD)

2. Judgement of Competency to Stand Trial 

Not Criminally Responsible on account of Mental Disorder (NCRMD) 

• Used to be called "insanity defense” 

• Mental illness that indicates they should not be held responsible for crime committed

• When crime was committed, not capable of understanding nature + quality of act 

• Did not have ability to know right from wrong at that time 

  • Can understand why it was wrong at time of trial (competent to stand trial), but at time of crime they did not 

• Specific assessments done to assess different components→ extensive interviews, tests, administrations which is then presented to judge, judge makes ultimate decision about status 

  • Tests for malingering (not making it up) 

  • Very difficult to be deemed NCRMD

Controversy around NCRMD 

Highly criticized. In reality: 

• Rarely applied + successful (extremely rare) 

• Typically placed into psychiatric forensic hospital, sentence is much longer than if they had gone to jail for same crime 

• Must not have risk of going back to mental illness state when they committed crime 

  • For chronic illness, could mean a lifetime (incredibly restricted freedom) 

Controversy: Whether people should be required to take medication to be competent enough to  stand trial 

• Judge could do that! Must weight benefits and costs, as well as individual’s ability to choose their own treatment 

Judgement of Competency to Stand Trial 

Competency to stand trial is determined by present condition. Accused must be able to: 

1. Understand the nature of the legal proceedings (how the court system works) 

2. Understand the consequences if they were found guilty 

3. Consult with council to participate in his/her defence 

• Possible that they understood what they were doing at time of the crime, but not when standing trial

How is Fitness Assessed?

Fitness Interview Test Revised (FIT-R) → Making sure they are not faking ill 

1. Understand nature + purpose of legal proceedings 

2. Understands possible/likely consequences

3. Capable of communicating with lawyers (to the extent they can actively participate in defense) 

Controversy: Synthetic Sanity 

If medication can produce rationality, trial can be held, even if discontinuation of drug would render the defendant incompetent (ex. They know they will no longer continue meds + mental illness symptoms return) 

• Decisions made by mental health professionals presented to judge for final verdict 

• Community treatment order: Judge says they are required to get treatment 

• Specifies treatment conditions to be released, as long as they comply with treatment. If don't comply to treatment, must go back to hospital

What if defendant is not judged competent to stand trial?

• Trial typically delayed until adequate mental functioning is established (in forensic hospital setting)

• Competency should be made before trial moves forward

• Severe consequences: 

  • Bail is automatically denied 

  • Accused person must receive treatment to render them competent to stand trial; 

  • May lose employment 

NCRMD Cases

1. Irresistible impulse (1834)

2. M’Naghten Rule (1843)

3. Durham Test (1954)

4. American Law Institute Guidelines (1962)

5. Insanity Defense Reform Act (1984) 

6. Guilty by Mentally Ill (1975) 

Irresistible impulse (1834)

Impulse could not be controlled, drove person to commit crime

M’Naghten Rule (1843)

• Person did not know the nature/quality of criminal act they engaged in

• If they did know, the person did not know what they were doing was wrong 

Durham Test (1954)

The person’s criminal act is a product of mental disease/defect

American Law Institute Guidelines (1962)

• The person’s criminal act is a result of mental disease/defect that results in person’s not appreciating the wrongfulness of act/person’s inability to behave according to law (combination of irresistible impulse+ M’Naghten rule) 

• Mental disease/defect does not include abnormalities manifested by repeated criminal/antisocial conduct 

Insanity Defense Reform Act (1984)

• Criminal act os result of severe mental illness/defect that prevents person from understanding nature of their crime 

• Burden of proof shifted from prosecution to defense; defense must prove the person is insane 

• Person released from forensic/prison hospital only after being judged to be no longer dangerous + recovered mental illness (can be longer than imprisonment if convicted) 

Guilty by Mentally Ill (1975)

• Person can be found legally guilty of crime, and person’s mental illness plays role in sentence 

• Even seriously ill person can be held morally/legally responsible, but then committed to prison hospital/psychiatric treatment rather than regular prison for punishment 

Civil Commitment 

• Provincial legislature, duty to protect citizens from harm (pretty consistent across Canada) 

• Procedure that confines person in mental/forensic hospital for either determination of competency to stand trial/after acquittal by reason of insanity

Individual can be committed to psychiatric hospital against their wishes if?

1. Person is mentally ill, AND

• Has nothing to do with whether they broke a law or not, this is for at-risk individuals (prevention) 

2. Is a danger to themself or others  

• More broad than suicide → includes inability to provide for basic needs 

• Includes homicidal + suicidal 

Protection of Patient Rights 

Balance between patient rights + right of the public to be protected 

• Must establish that there is an imminent threat to themselves or others 

• Cant restrict freedom just because they have mental illness 

Psychologists must breach confidentiality under certain circumstances: 

1. Imminent threat to self or others

• Not required to let know patient that you've broken confidentiality → consider potential harm/risk if letting them know

2. To protect a child/vulnerable adult (mental disability/incapable of making own decisions/dependant) 

3. Extended protection: Must warn if there’s a specific victim

• ex. Tarasoff case, warned police but not Tanya -→ shifted laws

• Responsibility of psychologists to protect others as well. If there is no identifiable victim, just tell the police. If there is identifiable victim, let them know as well 

• must make reasonable effort to contact target

Protections for those with Psychological Disorders 

1. Principle of Least Restrictive Alternative 

• Mental health professionals have to provide the treatment that restricts the person’s liberty to the least possible degree while remaining workable

• Ex. cannot confine someone who is non-dangerous/capable of living alone/with support 

2. Right to Treatment 

3. Right to Refuse Treatment 

Psychologist Code of Conduct: Ethical Principles (in order of priority)

1. Respect for dignity of persons + people 

• Consent + confidentiality!

• Emphasizes inherent worth, non-discrimination, moral rights, and distributive, social and natural justice

2. Responsible Caring

• Competence (need to be well informed + trained on treating individual), maximization of benefit, minimization of harm  

• If only person who can provide care, prioritize treatment but let them know! Some care is better than no care 

3. Integrity in Relationships 

• Advertise honestly, objective + straightforward 

• Avoid conflict of interest (family, friends, peers) 

• Maximize boundaries with people  

• Recognize that at times, respecting dignity of others must be more important than being open + candid with them 

4. Responsibility to society 

• Greater good of society, not just the needs of the individual 

• Promote welfare of all human beings in society 

• Takes priority if you feel patient would harm others 

If a client says they’ve stolen a car and you choose not to tell anyone, which ethical principles are being held?

Respect for dignity of persons + people

• Prioritized confidentiality

• Must be fear/imminence of harming others to break confidentiality!

if a client reveals a credible plan to hurt someone, which ethical principle should be followed?

Responsibility to society

• break confidentiality to protect potential target 

Anosognosia

Neurological and psychiatric condition causing a person to be unaware of their own mental or physical impairments, often mistakenly viewed as denial

• result of brain damage (alzheimer’s, schizophrenia, strokes)