Ch. 16 Ethical & Legal Issues

Question 1

criminal commitment

Answer 1

• individual with a psychological disorder is alleged to have committed a crime
• confines a person to a forensic or mental hospital either for:
  determination of competency to stand trial → understand what is going on and why they are on trial, orderly in court, contribute with lawyer capacity
  after acquittal by reason of insanity

Question 2

insanity defense

Answer 2

• “insanity” is a legal term
• defendant not responsible if knowing right from wrong is compromised
• fewer than 1% if cases; rarely successful
• usually requires assistance from psychiatrists or clinical psychologists

Question 3

compromised issues of right and wrong

Answer 3

existence of remorse; defect of reason at the time of the crime, having voices in their head saying this person was violent or bad

Question 4

fewer than 1% plead insane

Answer 4

• very difficult to establish the difference between right and wrong
• intellectual disability

Question 5

assistance from professionals

Answer 5

• reliability and validity
• jury does not understand content of topic being discussed by experts

Question 6

American Law Institute (ALI) Guidelines, 1962

Answer 6

• not responsible of criminal conduct if, at the time of conduct, there was mental disease/defect resulting in lack of capacity to appreciate criminality or of conforming to law
• “mental disease/ defect”–does not include abnormality manifested by repeated criminal/antisocial conduct
• solitary confinement, repeat offenses, drug use, alcohol abuse, DUIs

Question 7

Insanity Defense Reform Act, 1984

Answer 7

• eliminated irresistible impulse component
• changed ALIs “lacks substantial capacity…to appreciate” to “unable to appreciate” (more stringent)
• mental disease/defect must be “severe”
  passion or temporary insanity not included
• shift burden of proof from the prosecution to the defense
• first time insanity addressed at federal level

Question 8

Not Guilty by Reason of Insanity (NGRI)

Answer 8

• both sides agree that the person committed the crime
• at issue is responsibility for the crime
• indefinite commitment to a forensic/mental hospital until “recovered” → no real recovery, only rehabilitation
  John Hinckley → Reagan Assassination

Question 9

Guilty but Mentally Ill (GBMI)

Answer 9

• guilty and responsible; maximizes changes of incarceration
• mental illness plays a role in sentencing
  MH professional input
  committed to hospital until no longer mentally ill
  then sent to prison for remainder of sentence
• most are incarcerated; psychiatric care not guaranteed
• mitigating factor → lessening of sentence or charges

Question 10

Current Insanity Pleas

Answer 10

• most common: NGRI and GBMI
• 2020: US Supreme Court allows states to decide whether they wish to allow insanity defense
  Kansas, Montana, Idaho, Utah
• burden of proof rests with defendant

Question 11

competency to stand trial

Answer 11

• must be decided before responsibility is determined
• accused must be able to participate in defense
• trial is delayed; accused receives treatment to restore competency
• bail automatically denied
• determination of competency cannot last longer than maximal possible sentence
• if medication can produce rationality, trial can be held
  -forced medication to restore competency in very limited circumstances

Question 12

forced medication

Answer 12

alternative treatments fail; medication is likely effective, won’t interfere with right to defend self, government interest in prosecuting

Question 13

1960 supreme court decision

Answer 13

“…ability to consult with lawyer with reasonable degree of rational understanding”
“…has a rational as well as factual understanding of the proceedings against him”

Question 14

capital punishment

Answer 14

• legally sane at time of execution? → may not be at time due to years living in prison
• US Supreme Court 2002
  intellectual disability → cruel and unusual punishment
  definition of intellectual disability varies by state
  no federal oversight

Question 15

civil commitment

Answer 15

• in any state, an individual can be committed against will if:
  has a psychological disorder
  is danger to self or others
• formal (i.e., court order) or informal

Question 16

informal emergency commitment

Answer 16

• no court involvement initially
• physician certificate (PC) allows person to be detained without a court order
• 24 hours - 20 days
• supposed to be a psychiatric facility but can be a jail
• further detainment requires formal judicial commitment

Question 17

Preventative Detention and Predicting Dangerousness

Answer 17

• how do we decide about danger?
• 3% of violence in US linked to psychological disorders
• 90% of people with psychotic disorders are not violent (but this changes if they are unmedicated)

Question 18

predicting dangerousness

Answer 18

factors that influence accuracy
- history of violent acts
- return to environment of violent act
- “on the brink”
- failure to engage in treatment
- assisted outpatient treatment (mandated)
increase medication compliance

Question 19

protecting patient rights

Answer 19

• least restrictive alternative
• right to treatment
• right to refuse treatment

Question 20

least restrictive alternative

Answer 20

• hospitals are the most restrictive
• treatment restricting liberty handled very carefully

Question 21

right to treatment

Answer 21

• state provides after civic commitment
• requirements for mental hospitals
• civil commitment stats must be periodically reviewed

Question 22

right to refuse treatment

Answer 22

• unless harm is clear and imminent → who gets to decide?
• unless less intrusive interventions less likely to reduce danger

Question 23

deinstitutionalization

Answer 23

1950s: states discharged as many as possible and discouraged admission
- “treat them in the community”
- most cities lack sufficient community and health facilities
- inability to receive government assistance without established residency
- became vagrants and ended up in jail

Question 24

transinstitutionalization

Answer 24

• nursing homes, nonpsychiatric hospitals, prisons
• 17-30% in prison have serious psychological disorder
• police officers called on for the work of mental health professionals
• mental health courts, crisis intervention teams

Question 25

ethics

Answer 25

• ethical restraints avoid unnecessary harm, risk, humiliation, and invasion of privacy
• Institutional Review Board (IRB) approval necessary - researchers must be certified in research ethics

Question 26

informed consent

Answer 26

• sufficient information to make informed decision to participate
• freedom to withdraw without penalty
• examine each person individually for ability to consent

Question 27

confidentiality

Answer 27

nothing revealed to third party except for other professionals and those involved in treatment

Question 28

privileged communication

Answer 28

• protected by law; subpoena being denied

Question 29

research ethics

Answer 29

limits to right of privileged communication
- therapist accused of malpractice
- person under 16 and a victim of a crime
- person initiates therapy in hopes of evading the law
- patient is danger to self or others