Chapter Nineteen: Law, Society, and the Mental Health Profession

Law and Mental Health

• Forensic Psychology: The branch of psychology concerned with intersections between psychological practice and research and the judicial system

Psychology in Law: How Do Clinicians Influence the Criminal Justice System?

• Courts need to know whether defendants are responsible for the crimes they commit and capable of defending themselves in court
• Criminal Commitment: A legal process by which people accused of a crime are instead judged mentally unstable and sent to a treatment facility
  • Not guilty by reason of Insanity: A verdict stating that defendants are not guilty of a crime because they were mentally unstable at the time of their crimes
  • Another form - people are judged mentally unstable at the time of their trial
  • Committed for treatment until they’re competent to stand trial
• Criminal Commitment and Insanity During Commission of a Crime
  • Defense’s burden is to prove that defendants are insane
  • Insanity is a legal term
  • M’Naghten Test: A legal test that holds people to be insane at the time they committed crime if, because of a mental disorder, they didn’t know the nature of the act or didn’t know right from wrong
  • Irresistible Impulse Test: A legal test that hold people to be insane at the time they committed a crime if they were driven to do so by an uncontrollable “fit of passion”
  • Durham Test: A legal test that holds people to be insane at the time they committed a crime if their act was the result of a mental disorder
  • American Law Institute test: A legal test that combines aspects of the M’Naghten, irresistible impulse, and Durham tests
  • More than 80% of defendants who are acquitted of a crime by reason of insanity qualify for a diagnosis of schizophrenia or another form of psychosis
  • Concerns raised by the Insanity Defense
  • Legal definitions of insanity and responsibility will differ from those suggested by clinical research
  • Lack of professional agreement about abnormal behavior
  • Clinicians can never be entirely certain that their assessments of mental instability at the time of the crime are accurate
  • Allows criminals to escape punishment
    • Public dramatically overestimates the percentage of defendants who plead insanity
    • Only a minority of defendants fake or exaggerate their psychological symptoms
  • Offenders are being released earlier and earlier
    • Increasing effectiveness of drug therapy and other treatments
    • Growing reaction against extended institutionalization
    • More emphasis on patients’ rights
    • Outpatient Commitment: A way of maintaining control over offenders even after their release using community treatment, patient monitoring, and rehospitalization if necessary
  • Other Verdicts Available
  • Guilty but Mentally Ill: A verdict stating that defendants are guilty of committing a crime but are also suffering from a mental illness that should be treated during their imprisonment
    • Hasn’t reduced the number of not guilty by reason of insanity verdicts
    • Often confuses jurors
    • Appropriate mental health care is supposed to be available to all prisoners anyway
  • Guilty with Diminished Capacity: A defendant’s mental dysfunction is viewed as an extenuating circumstance that the court should take into consideration in determining the precise crime of which they are guilty
    • Because of mental dysfunction, the defendant couldn’t have intended to commit a particular crime
    • Can be found guilty of a lesser crime
    • Eliminated in some states
  • Sex-Offender Statutes
  • Mentally Disordered Sex Offenders: Some sex offenders who are repeatedly found guilty of sex crimes have a mental disorder
  • Sent to a mental health facility instead of a prison
  • Most states have been changing or abolishing these laws
    • In order to be classified as a mentally disordered sex offender, the person must be a good candidate for treatment
    • Difficult judgment to make
    • Racial bias often affects the use of the classification
    • Considered an attractive alternative to imprisonment
    • State legislatures and courts are now less concerned than they used to be about the rights and needs of sex offenders
  • Sexually Violent Predator Laws: Laws that call for certain sex offenders who’ve been convicted of sex crimes and have served their sentence in prison to be removed from prison before their release and committed involuntarily to a mental hospital
    • Requires both treatment and imprisonment
• Criminal Commitment and Incompetence to Stand Trial
  • Mentally Incompetence: A state of mental instability that leaves defendants unable to understand the legal charges and proceedings they are facing and unable to prepare an adequate defense with their attorney
  • Psychological evaluation on an inpatient basis
  • If declared incompetent, they will be assigned to a mental health facility until competent to stand trial
  • Majority of criminals currently institutionalized for psychological treatment in the US are convicted inmates whose psychological problems have led prison officials to decide they need treatment
  • An incompetent defendant can’t be indefinitely committed
  • Found competent and tried
  • Set free
  • Transferred to a mental health facility under civil commitment procedures
  • Jail Diversion: When defendants with relatively minor charges are treated on an outpatient basis

Law in Psychology: How Do the Legislative and Judicial Systems Influence Mental Health Care?

• Civil Commitment: A legal process by which a person can be forced to undergo mental health treatment
  • Why Commit?
  • Individuals are considered to be in need of treatment and dangerous to themselves or others
  • Parens Patriae: The state can take action to protect patients from self-harm, including through involuntarily hospitalizing them
  • Police Power: The state can take steps to protect society from a person who is dangerous
  • Procedures for Civil Commitment
  • Family members often begin commitment proceedings
  • For minors, a hearing isn’t necessary, as long as a qualified mental health professional considers commitment necessary
  • For adults
    • Mental examination
    • Clear and convincing proof that they are mentally ill and have met the state’s criteria for involuntary commitment
    • Can contest the commitment in court
  • Emergency Commitment
  • Clinicians have the right to certify that certain patients need temporary commitment and medication
  • States require certification by two physicians
  • Length varies from state to state
  • Usually three days
  • Who is Dangerous?
  • 90% of ppl w/ mental disorders aren’t violent or dangerous
  • People with severe mental disorders are somewhat more likely than the general population to perform violent behaviors
    • Severe substance use disorder
    • Impulse control disorder
    • Antisocial personality disorder
    • Psychotic disorders
  • Psychiatrists and psychologists are often wrong when they make long-term predictions of violence
    • Overestimate the likelihood that a patient will eventually be violent
  • Short-term predictions tend to be more accurate
  • Problems with Civil Commitment?
  • Difficulty in assessing a person’s dangerousness
  • Legal definitions of “mental illness” and “dangerousness” are vague
  • Many people committed involuntarily don’t respond well to therapy
  • Risk assessment
• Protecting Patient’s Rights
  • How is the Right to Treatment Protected?
  • Right to Treatment: State is constitutionally obligated to provide adequate treatment to all people committed involuntarily
  • Institutions must review patients’ cases periodically
  • State cannot continue to institutionalize ppl against their will if they aren’t dangerous and are capable of surviving on their own
  • Protection and advocacy systems
  • How is the Right to Refuse Treatment Protected?
  • Right to Refuse Treatment: The legal right of patients to refuse certain forms of treatment
  • Consistently granted patients the right to refuse psychosurgery
  • Acknowledged the right to refuse ECT
    • Patient must be informed fully
    • Patient must give written consent
    • Can still be forced on committed patients in some states
  • Some states have granted patients the right to refuse medication
  • What other rights do patients have?
  • Patients who work in mental institutions are guaranteed to at least a minimum wage
  • Patients released from state mental hospitals have a right to aftercare and to an appropriate community residence
  • People with psychological disorders should receive treatment in the least restrictive facility available
  • The “Rights” Debate
  • Patients’ rights rulings and laws may unintentionally deprive patients of opportunities for recovery
  • Clinical field hasn’t always done an effective job of protecting patients’ rights

In What Other Ways Do the Clinical and Legal Fields Interact

• Malpractice Suits: A lawsuit charging a therapist with improper conduct in the course of treatment
  • Patient’s attempted suicide, sexual activity with a patient, failure to obtain informed consent for a treatment, etc etc
  • Fear of malpractice suits can have significant effects on clinical decisions and practice
• Professional Boundaries
  • More authority given to psychologists
  • Blurred the lines that once separated psychiatry from psychology
  • Psychologists are allowed to pursue extensive educational and training programs in prescription services and receive certification to prescribe meds if they pass
• Jury Specialists: A subsect of clinical specialists who advise lawyers about which potential jurors are likely to favor their side and which strategies are likely to win jurors’ support during trials
  • Might not be more valid than a lawyer’s instincts
  • Judgments aren’t particularly accurate
• Psychological Research of Legal Topics
  • Eyewitness Testimony
  • 70% of wrongful convictions were based on mistaken eyewitness testimony
  • Eyewitnesses sometimes hold subtle biases
  • Most crimes are unexpected and fleeting and therefore can’t be remembered well
  • It’s easy to fool participants by introducing misinformation
  • Accuracy is heavily influenced by the method used in identification
  • Patterns of Criminality
  • Psychological profiles aren’t nearly as revealing or influential as thought to be
  • Criminal Minds lied 🙁
  • Perpetrators of particular kinds of crimes frequently share a number of traits and background features

What Ethical Principles Guide Mental Health Professionals?

• Code of ethics: A body of principles and rules for ethical behavior, designed to guide decisions and actions by members of a profession
• Confidentiality: The principle that certain professionals will not divulge the information they obtain from a client
• Duty to Protect: The principle that therapists must break confidentiality in order to protect a person who may be the intended victim of a client

Mental Health, Business, and Economics

Bringing Mental Health Services to the Workplace

• Over 40% of workers find their jobs very stressful and believe them to be bad for their mental health and general wealth
• Stress affects home life and personal functioning of employees as well as performance and productivity in the workplace
• Employee Assistance Programs: Mental health services made available by a place of business
  • Can be run by mental health professionals who work directly for a company
  • Can be run by outside mental health agencies
• Stress Reduction Programs: Workshops or group sessions in which mental health professionals teach employees techniques for coping, solving problems, and handling and reducing stress

The Economics of Mental Health

• Government funding for services to people with psychological disorders has risen sharply over the past five decades
• Government funding for mental health services is insufficient
• Managed Care Programs: The insurance company determines which therapists clients may choose from, the cost of sessions, and the number of sessions for which a client may be reimbursed
• Many therapists and clients dislike managed care programs and peer reviews
  • Breaches confidentiality
  • Importance of therapy is difficult to convey in a brief report
  • Priorities of these programs shorten therapy
  • Favors short-term treatments over long-term improvement
  • Reimbursements for mental disorders are lower than those for physical disorders

Technology and Mental Health

• Digital world provides new triggers for the expression of abnormal behavior

  • ex: those with gambling disorder can now gamble online
  • Constant internet browsing may shorten people’s attention spans

• Today’s technology is helping to produce new psychological disorders

  • Internet Use Disorder

• Even everyday social networking can contribute to psychological dysfunction

  • Peer pressure
  • Social anxiety
  • May lead shy or socially anxious ppl to withdraw from irl relationships

• Telemental Health: The use of various technologies to deliver mental health services without the therapist being physically present

• There is a lack of quality control - some websites for mental health info offer misinformation

• As many as 84% of therapists report having been in therapy at least once