Psych 257 - Ch. 17 Mental Health and the Law

civil commitment laws

• laws under the provincial and territorial Mental Health Acts that detail when ppl can be legally detained in a psychiatric institution, even against their will.

• each province and territory has its own ones

• in arthurs case (german embassy psychotic break), these laws protected him from involuntary commitment, but they also put him and others at risk by not compelling him to get help.

criteria for civil commitment

1. individuals have a mental disorder

2. they are a danger to themselves or others

3. they are in need of treatmnet

all require the 2nd, and some require first and third as well

are there differences in how strictly dangerousness is defined across jurisdictions?

yes!! BC says they require hospitalization but Ontario is very strict, saying that the mental disorder will likely result in serious bodily harm or seirous physical impairment to the person

some have argued that less strict definitions of dangerousness are actually in the patients best interest (BC FTW)

why do some say less strict definiitons of dangerousness better for the patient?

because if the law requires dangerousness, then progonisis is worse cause they lsot treatmnet time but they also have legal issues to deal wth because htey actully hurt someone

why do some say more strict deficintions are better?

• bcz less strict ones can compromise patient’s autonomy

• ex. a psychiatrist might detain a patient cuse they refuse to take theri meds, even if the patient is not activley dangerous to others

which safeguards are built into the civil commitment process to guarantee no one is involuntarily ocmmitted to a psychiatric facility for illegit reasons

• does patient have right to refuse treatment?

• right to be ifnoremd of reasons ofor the hospital detention?

• right to apply to a refview panel so they can get a discharge fromt the hospital?

• right to legal counsel?

what two types of authroity permit the government o take actions against a citizen’s will?

• police power

• and parens patriae (state as the parent) power

what is police power

• governmetn takes responsibiliy for protecting public health, safety, and welfare

• create laws and regulations to ensure this protection

• offenderrs are held in custody

• so this one’s focus is government

what is parens patriae power

• provinces and territories apply this

• its in situations where citizens are not likely to act in their own best itnerest, so they act as the “parent”

  • don’t have that candy kid itll rot your teeht!!

• ex. committing indivudals with severe mental illnesses to facilities when its bleieved they may be harmed cause htey cant get food or shelter because htey dont see that they need treatment

• gov acts as surrogate parent in best interests of ppl who need help

can ppl voluntarily admit themselves?

yes!! they can!! tehy just have to be evaluated by a professional, then tehy can be accepted for treatment. civil commitment is initiated when indivdal doesn’t voluntarily seek help but others feel that treatment or protection is necessary

what are CCTs + necessary criteria for CCT

• compulsory community treatments

• for pppl who are deemed suitable for commitment but not necessarily a hospital

• point of these is to be less restrictive and prevent relapse

• in australia, this is first form f treatment

• in canada its not permitted until inpaitnets already happened

• must satisfy 1 of 2 necessary critiera:

  • must have some risk of increased mental deterioration

  • ORRRR pose harm to themselves or others

mental illness as a legal concept

• severe meotional or thought disturbances that negatively affect an individual’s health and safety

• a good definitoin sepcifies effect of illlness on patine’ts thoughts and behaivours —> functional definition

• not synonhymous with psychologcial disorder

• even if someone has a dsm diagnosis, doesnt mean that they are legally mentally ill

• the flexibility of this helps when ur making case by case decisions, but bias can colour it now

what is dangerousness

• whether people are a danger to themselves or others

• ppl who have a mental illness are acc not more dangerous than those who don’t have one on average

• theres a small increased rate of violence among ppl with mental illness, bcz sreious mental illness does icnrease likelihood of future, specifier FACTORS are what are responsible for icnreased risk (ex. high anger predisposition, recent stressors, substance use)

• presence of these risk factors may predict recorruance of violent crimes amongst those with mental illness

• BUT!! INMATES WITH SERIOUS MENTAL ILLNESSES ARE LESS LIEKELY TO COMMIT NEW VIOLENT OFFENSE ON RELEASE!!

how to assess dangerousness?

• early psychologists weer acc kinda bad at that

• but now, we have accurate assessments

• rating scale based on important predictors of violence can predict violence happening again among men who have aleady been violent

  • ex. psychopathy, age at first arrest, failure on pror conditional release

• clinical judgment is required but past statistical analyses make them more reliable (and acc actuarial in nature)

• assessing risk for suicidal behaviour

how is self harm implicated in civil commitment?

• well risk for self-harm is a common critier afor it, so psyhcologists acc assess risk for suicidal behaviour

• patients who reported suicidal thoughts, verbal and physical aggression, history of self-harm, and suicide attempt within 2 weeks before being committed were most likely to harm themselves while in hospital

• SRAS (Suicide Risk Assessment Scale)

deinstitutionalization

the movement of people with severe mental illness out of institutions

THIS HAS LED TO WAY MORE HOMELESSNESS!! AND LOTS OF EMERGENCY ROOM VISITS!!

most of them have some sort of mental illness, addiction , or are survivors of abuse or trauma

the goals: to downsize psychiatric hospitals, create network of commmunity mental health services where released ppl could be treated

BUT THEY ONLY DOWNSIZED!! THEY DIDNT PROVIDE ALTERANTIVE COMMUNITY CARE!!!!!!

transinstitutionalization

ppl with severe mental illness moved from psyhciatric hopistals to nursing homes or JAILS AND PRISONS which dont have nearly as many services available!!

while community care is a good idea in theory, the supports for this don’t exist yet!!! the different agencies nad services aren’t working welll togehter, and community is essenitally not integrated well.

battered woman syndrome

• not in the dsm

• its a state of learned helplessness or post-traumatic stress that results from being in an abusive relationship!!!

• accused may be under reasonable apprehension of death even if the threat is not immediate WHEN SHE CHOOSES TO PROTECT HERSELF. if he always says hes gonna kill her nad he hits her, she has the right to self defense even if hes not actively doing these tings at the time

• this is an extension of the self-defence legal defense for those who were defending themselvs for murder in a way that we think of usually

criminal commitmnet

• the process by which ppl are held bcz

• 1. have been accused of commiting a crime, and are detained in mental health facility until someone syas theyre fit enough to particpate in legal proceedings

• ORRR they are held there because they are NCRMD (not criminal responsible on account of mental disorder)

m’naghten rule

• that if they dont know what theyre doing or if they dont know what tehyre dong is wrong, they are not responsible for their actions

• this is the first way the insanity defense started

• but now its been modfiied bcz ppl think that simply relying on accused person’s knoweldge of right or wrong is too limiting

• ex. ppl with compulsions may know what theyre doing is wrong BUT TEHY CANT RESIST THE COMPULSION. should they be jailed then?

canadian criminal code

• if found not guilty by reason of insanity you would be in a psyhciatric hopsital untl you’re wlel enough to be relesed

• this protected the public, and helped them recover

• BUT are they acc getting the right treatment?

• so now we have NCRMD defense:

  • no person is criminally resposnibel for act committed while suffering from mental disorder that made them incapble of APPRECIATING THE NATURE AND QUALITY OF THE ACT OR OF KNOWING IT WAS WRONG

NGRI (not guilty by reaosn of insanity) vs NCRMD (not criminally responsible on account of mental disorder)

1. insanity, is not mental disorder

2. not criminally responsible instead of not guilty (so they may actually have commiteed the crime, but theyre not responsibile for it bcz of mental disoder)

3. NCRMD can be made if peson is incapble of knwoing if their actions were either legally OR MORALLY wrong, while NGRI was just legally.

do ppl acc get away with the NCRMD defense?

NO ACUTALLY!! ITS USED VERY SPARINGLY BCZ AS SOON AS U USE IT, IF IT DONES’T PAN OUT, YOU’RE GONG STRAIGHT TO JIAL. ITS UR ONLY OPTION!!

also those who declare NCRMD and are high risk are not more likely to commit new crime than NCRMD who are not high risk.

ppl in community must be aware of community-based programs for NCRMD ppl and be educated bout risk indviduals pose and insist there should be high levels of monitoring, assessment of antisocial traits and routine use of validated riks assessment tools

fitness to stand trial 3 questions to answer + what being unfit means

3 questions to answer:

1. is the accused able to assist in a defense?

2. does the accused understnd their role in the proceedings?

3. does the accused understand the nature or oject of the proceedings?

being unfit:

a. undersatnd the nature or object of hte proceedings (ex. do u undestand the arrest process? the pleas available? teh court procedures?

b. understand the possible consequences of the proceedings (ex. do u undersatnd the range of possible penalties, the legal defenses available?)

c. communicate with counsel (ex. can you acc have a conversaiton with ur lawyer about this, and plan a legal strategy)

if ur not fit to stand trial, you cant make decisions anymore and ur gonna be committed.

FORENSIC PSYCHOLOGISTS SHOULD BE DOING THIS, NOT PSYCHIATRISTS?

whether you have to pass all 3 or not is dependent on jurisdiction i think.

what happens if someone is found unfit?

go to a review board! review board has 3 options.

1. conditionally discharged

2. detain in hospital

3. or order they receive treatment

if found fit after inital assessment, court proceedings can resume.

CONCEPT CHECK 17.1

1. mental disorder

2. danger

3. help

2 reasons people are committed criminally

• they are waiting to see if they are determiend fit to stand trila

• or they are found NCRMD

duty to warn

• duty of therapist to warn a client’s potential victims

• still difficult for therapists to know exact responibilities to protect third parties

• also have code of ethics to tell them what to do

• limits to confidentialist —> when psychologists break confidentiality to protect third parties from harm. also child abuse. also suicidal risk

• 1. harm to others (murder)

• 2. harm to self (suicide)

• 3. child abuse

expert witnesses

• inudivudals with specilaized knowledge

• some see them as goodo to educate jury, other see them as hired guns, biased towards whoever pays them more

• psychologists are expert witnesses!!

• mental illness isnt in dsm,so its what the court says

• psycholoigists can identify malingering + competence

  • ex. were tehy actaully hallucinating at the time? MMPI has scales that reveal if they actually are. (valiidty sacales) aslo helpful in knowing whether they’re faking PTSD or not

• but biases and opinions of individuals will colour what their opinion will be/how tehy present their findings

• who hires you plays a bit of a factor, as htose retained by prosectuion rated offenders are mosrre psyhcopathic while those retained by defense rated htem less psychopathic

ethics and treatmnet of mental illness

• boundary issues (conflict of interests!! can’t exploit relationship established with them as psychologists to further their own interests. i dont think jean should be seeing aimee. she should refer her)

• do no harm (applies to clearness in reports and records, making referrals, DO NOT HAVE SEX WITH YOUR CLIENTS)

• recognitizing limits of competence

  • neuropsychologist would not treat ppl with substance use disorders unless they had the training

  • bcz neuropsychologists work in a different area. if they wanted to wrok with those with substance use issues, they’d have to obtain speicalized training in this area.

patients rights

1. right to treatment

   1. right to treatmnet in the least restrictive setting possible (ex. if someone with an intellectual disability needs to be mvoed to less structured living, smaller facilies, smaller living units, indivudal residences, integrated into community and integrated into independent livign YOU MUST MAKE THAT HAPPEN)

2. the right to refuse treatment

   1. ex. u committed suicide? you nderstand risks and benefits but wanna refuse it? you shouuld be abllowed to. some ppl disagree and agree.

3. the rights of research participants

   1. protect their autonomy, fully informed about risks (informed consent), minimized possiblity of harm, burden and benefits of research must be distributed across population)

concept check 17.2

1. expert witness, malingering (c,e)

2. deinstitutionalization (d)

3. duty to warn (b)

4. informed consent (a)

clincal efficacy

• an axis that is a throogh consideration of scientific evidence to dtermine whether interveintion is efeective or not

• is treatmnet effective when compared with alt treatment or no treatment in a controlled clinical research context?

• to determine this, expeiremnts must establish that the intervention is better tahn no therapy, nonspecific therapy, or alt therapy

• systematic data helps us find this out

what is clinical utility axis

• the effectivness of hte interveniton in the practice setting its applied in

• ex. it has proven efficcacy in research, will that also be there in clinical settings?

• ex. experiments often only have ppl with that one disease, but what about those that are comorbid? so we dontknow how itll work on ppl who are comorbid in clinical settings

• EXTERNAL VALIDITY!! CONCERNED ABOUT EXTERNAL VALIDITY!!

• worry about feasibility, (like ECT is effective in theory, but like are clients gonna do it? its scary and needs sophisticated machines)

• GENERALIZABILITY: to different ages, backgrounds, sexes, in inpatient, outpatinet, community care and different therapists. can be effective in reserch with one group of patients, but not generalizable across dfiferent ethnic gorups.