chapter 14 - mental health services: legal and ethical issues

civil commitment laws

legal proceeding that determines a person is mentally disordered and may be hospitalized, even involuntarily

mental illness

term formerly used to mean psychological disorder but less preferred because it implies that the causes of the disorder can be found in a medical disease process

dangerousness

tendency to violence that, contrary to popular opinion, is not more likely among mental patients

parens patriae power

state or country as the parent

deinstitutionalization

systematic removal of people with severe mental illness or intellectual disability from institutions like psychiatric hospitals

transinstitutionilization

movement of people with severe mental illness from large psychiatric hospitals to smaller group residences

criminal commitment

legal procedure by which a person found not guilty of a crime by reason of insanity must be confined in a psychiatric hospital

diminished capacity

mental disorder could lessen person’s ability to understand criminal behavior and to form criminal intent

mens rea

theory of criminal intent / mental state / having a “guilty mind”

actus rea

proof of a physical act

GBMI

guilty but mentally ill

NGRI

not guilty by reason of insanity

competence

ability of legal defendants to participate in their own defense and understand the charges and the roles of the trial participants

duty to warn

mental health professional’s responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened

expert witnesses

person who because of special training and experience is allowed to offer an opinion testimony in legal trials

malingering

faking or grossly exaggerating symptoms, usually to be free from blame

informed consent

formal agreement by the subject to participate after being fully apprised of all important aspects of the study, including any possibility of harm

quantified clinical observations/clinical replication series

collecting data from large sets on outcomes of patients to find out how many are cured/how many somewhat improve/how many fail to respond to intervention

method to determine clinical efficacy

clinical efficacy axis

one of a proposed set of guidelines for evaluating clinical interventions on the evidence of their effectiveness

clinical utility axis

one of a proposed set of guidelines for evaluating clinical interventions by whether they can be applied effectively and cost effectively in real clinical settings

what is it called when a person with severe mental illness can live in community but as a condition, must receive treatment

assisted outpatient tx

formal process of civil commitment

when an ill person requests help themselves and then this happens, going through a legal process to guarantee they are not being committed against will and truly need to go

3 criteria for involuntary commitment to inpatient

1. person has mental illness; needs tx

2. person is danger to self or others

3. unable to care for themselves

2 types of authority that permit government to take actions against person’s will to inpatient

police power

parens patriae

police power goal

protecting public

power of state goal

protecting person who cannot make decisions in their best

many states exclude what type of disorders from definition of mental illness? (2)

cognitive disability

substance-related disorders

evidence points to a ____ ____ rate of violence among people with mental illness

moderately increased

what assessment is used to decide if someone is likely to be dangerous to society?

psychopathy checklist-revised

PCL-R

2 goals of deinstitutionalization

1. eliminate large state mental hospitals

2. create network of mental health centers where released individuals can be treated

was deinstitutionalization a success or failure

failure - people just ended up in jails or SNFs where services = bad

people with severe mental illness are increasingly being placed in ___ rather than facilities

jails

problem-solving courts

courts where judges can make specialized deals related to substance abuse, mental illness, etc.

M’Naghten rule

person could not distinguish between right and wrong at the time of the crime

ALI rule

person not responsible for crime if unable to appreciate wrongfulness of behavior caused by mental disease or defect

durham rule

person not responsible for crime if it was result of mental disease or defect

since 1960s mental health in US has followed what pattern

commitment to protecting individual, followed by a shift in emphasis to protecting society