Chapter 16 - Mental Health Services

Civil commitment laws

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

• invloves legal definition of mental illness.

• Vary by state.

Criteria for civil commitment

• person has a mental illness and needs treatment.

• person is dangerous to self or others (usually risk of suicide).

• Person is gravely disabled.

• Inability to care for self.

Parens Patriae

The state acts as a surrogate parent (a person reveives car to prevent them from being in danger).

Mental illness as a legal concept

Typically defined as severe emotional or thought disturbances that impact health and safety.

• vary by state

• often exclude cognitive disability and substance related disorders.

• not synonymous with having a psychological diagnosis.

Deinstitutionalization

Movement of people with mental illness out of institutions.

• led large numbers of ill people to become homeless.

Transinstitutionalization

People with mental illness have been moved out of large mental hospitals to other institutions, including prisons and nursing homes.

• currently in practice

Nature of the Insanity defense plea

The accused is not guilty because of insanity at the time of the crime.

• very rare

M’Naghten rule

Inability to distinguish right from wrong.

Durham rule

Crime was the product of a mental illness.

American Law Institute standard

Knowledge of right vs. wrong; self control; diminished capacity (reduced ability to understand their behavior).

Therapeutic Jurisprudence

Using knowledge of behavior chnage to help those in trouble with the law.

Requirements for competence (to stand trial)

Understadning of legal charges, ability to assist in one’s own defense, essential for trail or legal processes, the burden of prood is on the defense.

Tarasoff v. Regents of the University of California

Must warn individuals in danger. If your patient says they ahve intent to harm a specific person then you must warn that person.

Thompson v. County of Alameda

Threats must be specific. Cannot just be “I plan to hurt people”.

The right to treatment

Cannot be involuntarily committed without treatment.

• treatment → reduce symtoms and humane care.

The right to the least restrictive alternative

Treatment within the least confining and limiting setting.

The right to refuse treatment

Often in cases involving medical or drug treatment.

• a person cannot be forced to become competent for trial (ex. by taking medications)

Rights of a research participant

• the right to be informed

• the right to be treated with respect and dignity

• the right to be protected from phsyical and mental harm.

• the right to choose or to refuse participation.

• right to anonymity in the report of results.

• right to safeguarding records.

Clinical efficacy axis

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

Clinical utility axis

Is concerned with the effectiveness of the intervention in the practice setting. (i.e. are results generalizable to the real world)