Contemporary Issues in Psychopathology: Legal and Ethical Notes
Module Overview and Forensic Psychology Foundations
Module Scope: The discussion focuses on the interaction between clinical psychology and the law, covering civil and criminal commitment, patient's rights, the therapist-client relationship, and the potential status of gaming as an addictive disorder.
Forensic Psychology/Psychiatry Definition: According to the American Psychological Association (APA), this field applies clinical psychology to the legal arena regarding assessment, treatment, and evaluation. * It incorporates research from other subfields, including cognitive and social psychology. * Required training involves both law and forensic psychology, supported by strong clinical skills.
Roles of a Forensic Psychologist: The APA identifies several specific tasks, including: * Performing threat assessments for schools. * Conducting child custody evaluations. * Performing competency evaluations for criminal defendants and the elderly. * Providing counseling services to victims of crime. * Managing death notification procedures. * Screening and selecting law enforcement applicants. * Assessing post-traumatic stress disorder (). * Delivering and evaluating intervention and treatment programs for juvenile and adult offenders.
Key Judicial Concept: Forensic psychologists investigate mens rea (guilty mind) or the insanity plea.
Civil Commitment and Dangerousness
Civil Commitment Definition: This is the involuntary commitment of an individual with a mental illness to a hospital or mental health facility when they behave in erratic or dangerous ways to themselves or others.
Parens Patriae: Meaning “father of the country” or “country as parent,” this is the legal principle under which the government has the responsibility to act to protect an individual and express concern for their well-being, similar to a parent's role.
Voluntary vs. Involuntary Admission: An individual may admit themselves voluntarily. In this case, staff determine if an extended stay or treatment is necessary.
Criteria for Civil Commitment: While criteria vary by state, common requirements include: * The individual presents a clear danger to self or others. * The individual is unable to care for themselves or make decisions regarding the necessity of treatment/hospitalization. * The individual believes they are about to lose control and requires facility-based care.
Dangerousness Assessment: Defined as a person’s capacity or likelihood of harming themselves or others. * Public Perception vs. Reality: Public belief often incorrectly associates mental illness with higher degrees of dangerousness, particularly among self-reported conservatives or those exhibiting Right-Wing Authoritarianism () (Gonzales, Chan, & Yanos, 2017). * Media Impact: McGinty et al. (2014) found that of news coverage regarding serious mental illness () and gun violence between 1997 and 2012 focused on extreme specific events and shootings by persons with . Most news stories failed to mention that most people with are not violent. * Statistics and Risk Factors: Mental illness is a weak risk factor for violence (Rozel & Mulvey, 2017). Approximately of criminal violence is attributed to the mentally ill (Metzl & MacLeish, 2015). Conversely, those with mental illness are times more likely to be targets of violence rather than perpetrators (Choe et al., 2008).
Challenges in Predicting Dangerousness: * Definitions are vague (e.g., does it include psychological abuse or property destruction?). * Past criminal activity is a good predictor but often inadmissible in court. * Context is critical; a person may only react with rage in specific frustrating circumstances (e.g., long DMV lines).
Civil Commitment Procedures and Legal Standards
Standard Process: 1. Request: A family member, mental health professional, or primary care practitioner requests a court-ordered examination. 2. Examination: If the judge agrees, two appointed professionals (physicians or mental health experts) examine the person's psychological condition, self-care ability, and likelihood of harm. 3. Formal Hearing: Examiners, family, friends, and the individual provide testimony. 4. Judgment: The judge determines if confinement is necessary and the duration.
Confinement Duration: Typically ranges from months to year, though an indefinite period with periodic reviews is possible.
Emergency Short-term Commitment: Can be enacted without full procedures if the person is an imminent threat.
Legal Proof Disparity: Criminal trials require proof “beyond a reasonable doubt.” Civil commitment only requires “clear and convincing” proof, which the U.S. Supreme Court defines as certainty. This means a mentally ill person can be incarcerated without having committed a crime based on potential dangerousness.
Criminal Commitment and the Insanity Defense
Criminal Commitment Definition: Occurs when persons accused of crimes are found mentally unstable and sent to an institution for treatment.
NGRI (Not Guilty by Reason of Insanity): The defendant acknowledges the crime reached the standard of actus rea (guilty act) but claims they are not guilty because they lacked mens rea (guilty mind) due to mental illness at the time of the act.
Evolution of Insanity Rules: * M’Naghten Rule (1843): Originating from the murder trial of Daniel M’Naghten in England (who attempted to assassinate Prime Minister Robert Peel). It states that having a disorder is insufficient; the person must also be unable to know right from wrong or comprehend the act was wrong. * Irresistible Impulse Test (1887): Adopted by some U.S. courts, it focuses on the inability to control behaviors. The challenge is distinguishing between an inability to control vs. choosing not to exert control. * Durham Test/Products Test (1954): Derived from Durham v. United States, stating the person is not responsible if the crime was a “product” of mental illness. It was abandoned for being too vague. * American Law Institute (ALI) Standard (1962): A compromise stating individuals are not responsible if a mental disorder prevented them from distinguishing right from wrong and obeying the law.
Post-1982 Shifts: Following John Hinckley’s NGRI verdict for the attempted assassination of Ronald Reagan, public outcry led the American Psychiatric Association to revert to the M'Naghten standard (focusing only on knowing right from wrong).
Federal Insanity Defense Reform Act (IDRA) of 1984: * Placed burden of proof on the defendant (clear and convincing evidence). * Limited expert testimony on ultimate legal issues. * Eliminated diminished capacity defense. * Created “not guilty only by reason of insanity” verdict. * Provided for commitment of those found insane after conviction or during prison.
Current Status: Half of all state courts and all federal courts use this standard. Idaho, Kansas, Montana, and Utah have abolished the insanity plea.
Guilty But Mentally Ill (GBMI): A verdict acknowledging a disorder existed but was not responsible for the crime. Accused are convicted but may receive treatment. Critics argue it is a “guilty verdict in name only” since all prisoners have access to mental health care.
Competency to Stand Trial
Definition: Refers to the defendant's mental state at the time of psychiatric examination after arrest and before the trial.
Federal Requirements for Competency: * Must have a rational and factual understanding of the proceedings. * Must be able to rationally consult with counsel for their defense.
Outcome: If found unfit/incompetent, the defendant is hospitalized until their state improves.
Patient's Rights and Landmark Cases
Right to Treatment: * Rouse v. Cameron (1966): Defined the right to treatment as a constitutional right; insufficient resources cannot justify failure to provide it. * Wyatt v. Stickney (1972): Ruled Alabama was constitutionally obligated to provide adequate treatment, including more therapists, privacy, exercise, and better living conditions. * O’Connor v. Donaldson (1975): Ruled that patient cases must be reviewed periodically for release. Patients must be released if they are not dangerous and can survive alone or with help.
Right to Refuse Treatment: Includes the right to refuse biological treatments, psychotropic medications (Riggins v. Nevada, 1992), and electroconvulsive therapy.
Right to Less Restrictive Treatment: Dixon v. Weinberger (1975) established that individuals have the right to treatment in facilities less restrictive than mental institutions. Only those unable to care for themselves should be hospitalized.
Right to Live in a Community: Staf v. Miller (1974) ruled that state mental hospital patients have the right to live in adult homes within their communities.
The Therapist-Client Relationship: Ethical and Legal Obligations
Confidentiality: An ethical principle ensuring information is not shared without consent (applies to both research subjects and patients).
Privileged Communication: A legal principle stating confidential communications cannot be disseminated without permission. * Exceptions: Client under , dependent elderly crime victims, or danger to self/others.
Duty to Warn: * Tarasoff v. the Board of Regents of the University of California (1976): Following the death of Tatiana Tarasoff (killed by Prosenjit Poddar in 1969), the court ruled that confidentiality ends when there is public danger. Therapists are obligated to warn potential victims. * Thompson v. County of Alameda (1980): Ruled that the duty to warn does not apply if the threat is nonspecific.
Internet Gaming Disorder
Diagnostic Status: Listed in the DSM-5-TR as a “condition for further study.” It is officially included in the ICD-11 as “gaming disorder.”
Symptoms of Internet Gaming Disorder: * Preoccupation with Internet games. * Withdrawal symptoms when not playing. * Failed attempts to stop or curb playing. * Need to spend increasing amounts of time gaming. * Continued overuse despite knowledge of negative life impacts. * Use of games to relieve anxiety, guilt, or for escape. * Loss of interest in previous hobbies and entertainment.
Statistics: * The average prevalence is approximately globally. * Prevalence is similar across Asian and Western countries. * More common in males than females. * Comorbidity: Often occurs with Major Depressive Disorder (), Obsessive-Compulsive Disorder (), and Attention-Deficit/Hyperactivity Disorder ().