Chapter 16: Mental Health Services: Legal and Ethical Issues

Civil Commitment Laws

Legal statutes that detail the conditions under which a person can be declared to have a mental illness and involuntarily placed in a hospital for treatment

Civil Commitment Criteria

The conditions typically required for involuntary commitment: a person has a mental illness and needs treatment, is dangerous to self/others, or is gravely disabled (unable to care for self)

Mental Illness (Legal Concept)

A legal term (not synonymous with DSM diagnosis) usually meaning severe emotional or thought disturbances that negatively affect an individual’s health and safety

Deinstitutionalization

The movement of people with severe mental illness out of large psychiatric institutions (largely unsuccessful because community support was often inadequate)

Transinstitutionalization

The practice of moving individuals with severe mental illness from large hospitals to other marginal institutions, such as nursing homes, jails, or prisons, following deinstitutionalization

Criminal Commitment

The process where individuals are detained in a mental health facility either because they are found Not Guilty by Reason of Insanity (NGRI) or are awaiting trial to determine competence

M’Naghten Rule

The foundational definition of the insanity defense: a person is not responsible for criminal behavior if, at the time of the act, they could not distinguish between right and wrong

American Law Institute (ALI) Standard

Modern standard for the insanity defense; a person is not responsible if mental disease/defect leaves them unable to appreciate the wrongfulness of their conduct OR unable to conform their conduct to the law

Diminished Capacity

A legal concept allowing mental illness evidence to show that a person lacked the necessary criminal intent (mens rea) for the degree of crime with which they were charged

Competence to Stand Trial

The legal requirement that a defendant must be able to understand the charges and assist with their own defense before standing trial

duty to warn

The legal standard (established by Tarasoff v. Regents) mandating that a therapist must warn an identifiable individual if a client makes specific threats to hurt or kill them

informed consent

The ethical and legal requirement that research participants/patients must be fully informed of all aspects, risks, and benefits of a study or treatment before formally agreeing to participate

Clinical Efficacy Axis

One part of clinical practice guidelines that focuses on the internal validity of an intervention: whether the treatment is effective compared to alternative/no treatment in a controlled, scientific context

Clinical Utility Axis

One part of clinical practice guidelines that focuses on the external validity of an intervention: whether the treatment is effective, feasible, cost-effective, and generalizable in real-world practice settings

Insanity Defense Fact vs. Perception

The insanity defense is used in less than 1% of criminal cases and acquittees typically spend more time confined in mental hospitals than they would have spent in jail

Goal of Deinstitutionalization

While the closing of large state psychiatric hospitals has largely been accomplished, the goal of creating a network of community mental health centers has largely failed

Right to Refuse Treatment Challenge

The right to refuse treatment becomes highly controversial when a patient is deemed unable to make decisions in their own best interest (e.g., refusing medication that would restore competence or stop severe symptoms)

Expert Witness Role

Mental health professionals act as expert witnesses primarily to assist the court with objective information regarding competence, diagnosis, and malingering, but they struggle with accurate long-term predictions of dangerousness

Which set of criteria applies to the insanity defense: "He could not distinguish between right and wrong at the time of the crime"?

M’Naghten Rule

In contrast to public perceptions, the length of time a person spends confined to a hospital after being judged NGRI (Not Guilty by Reason of Insanity) is typically:

Longer than the time they would otherwise have spent in jail

Which of the following is a critical determinant of the civil commitment process?

Dangerousness (A person must be a danger to themselves or others)

The clinical researcher knows the potential for harm of the participants is slight but is nevertheless careful to tell them about it and asks them whether they agree to give their..

informed consent

The legal concept holding that a mental disorder could lessen a person’s ability to understand criminal behavior and to form criminal intent is called:

diminished capacity