Ch.17, Legal/Ethical Issues of Psyc Flashcards
Universal interventions: Thes
These efforts are targeted at the general public or a whole population group. Such efforts might involve legal restrictions on the age at which alcohol or cigarettes can be purchased, advertising campaigns, or school-based programs designed to teach children how to manage conflict. Other examples here would include school-based efforts directed at preventing drug use.
(1) alter conditions that can cause or contribute to mental disorders (risk factors) and (2) establish conditions that foster positive mental health (protective factors). Epidemiologic studies help investigators obtain information about the incidence and distribution of various maladaptive behaviors
=Virtually any effort that is aimed at improving the human condition would be considered a part of universal prevention of mental disorder.
Selective interventions:
These efforts are aimed at a specific subgroup of the population whose risk of developing a mental health problem is thought to be significantly higher than average—for example, certain groups of adolescents or ethnic minorities (Coie et al., 2000). Prevention efforts aimed at young girls who are engaging in unhealthy dieting behaviors would be another relevant example of a selective intervention. In this case, the focus would be on reducing risk for eating disorders.
Indicated interventions:
These efforts are directed toward high-risk individuals who are identified as having minimal but detectable symptoms of mental disorder but who do not meet criteria for clinical diagnosis. Examples here might include individuals who have recently experienced a traumatic event such as having been forced from their homes by a flood or some other disaster
Intervention Programs for High-Risk Populations
This research strategy involves identifying high-risk individuals and providing special approaches to circumvent their problems; for example, identifying adolescents at risk for abusing alcohol or committing suicide and implementing a program to prevent the problem behavior.
universal biological strategies
Biologically based universal strategies for prevention begin with promoting adaptive lifestyles. Many of the goals of health psychology can be viewed as universal prevention strategies. Efforts geared toward improving diet, establishing a routine of physical exercise, and developing overall good health habits can do much to improve physical well-being (Martins et al., 2010). Physical illness always produces some sort of psychological stress that can result in such problems as depression, so with respect to good mental health, maintaining good physical health is prevention.
universal Psychosocial Strategies
The first requirement for psychosocial health is that a person develops the skills needed for effective problem solving, for expressing emotions constructively, and for engaging in satisfying relationships with others. Failure to develop these protective skills places the individual at a serious disadvantage in coping with stress and may increase risk of developing a mental disorder.
The second requirement for psychosocial well-being involves having a healthy context for identity development. When people’s assumptions about themselves or their world are inaccurate their behavior is likely to be maladaptive. Consider, for example, the possible consequences that might result when a young woman believes that she has to be thin to be happy or when adolescents believe they are worthless and unlovable.
A third requirement for psychosocial health is that a person be prepared for the types of problems they are likely to encounter at various stages of their lives. For example, young people who want to marry and have children must be prepared for the challenges associated with building a mutually satisfying relationship and helping children develop their abilities. At a later stage of life, older adults need to be prepared for problems that might arise during retirement and old age.
universal sociocultural strageties
Without a supportive community, individual development can be stifled. At the same time, without responsible, psychologically healthy individuals, the community will not thrive and, in turn, cannot be supportive. Individuals with psychosocial impairments as a result of exposure to disorganized communities lack the wherewithal to create better communities. As such, they cannot nurture and sustain the psychological health of those who come after them, and a persistently unprotective environment results. Sociocultural efforts toward universal prevention are focused on making the community as safe and attractive as possible for the individuals within it. Included here are a broad spectrum of approaches—ranging from public education and Social Security to economic planning, environmental protections, and legislation directed at ensuring adequate health care for all.
why might selective interventions be more effective?
. Attempts to effect psychologically desirable social change are also likely to involve ideological and political issues that may inspire powerful opposition, including opposition from government itself. Efforts to bring about change through targeting a smaller segment of the population can have more effective results. For example, a review of the research in reducing depression in children concludes that selective intervention programs are more effective than universal programs (Horowitz & Garber, 2006) in reducing the extent of depressive disorders.
behavioural therapy and alcohol and drug use prevention ads
The most promising alcohol and drug use prevention curricula are based on behavioral theory; they target the risk (e.g., peer pressure, mass-media messages) and protective (e.g., alcohol-free activities, messages supporting “no use” norms) factors associated with adolescent use; include developmentally appropriate information about alcohol and other drugs; are skill based and interactive; and emphasize normative education that increases the awareness that most students do not drink alcohol, smoke, or use other drugs
ulticomponent programs
. Prevention efforts that combine two or more effective approaches (e.g., family-based and school-based programs) can be more effective than a single approach (Hawkins et al., 2009). Typically, classroom curricula are used as the core component. Other strategies (e.g., parent programs, mass media, extracurricular activities, and community strategies to reduce access to alcohol via enforcement of age of drinking laws) can then be added
Indicated Interventions
Indicated interventions emphasize the detection and treatment of maladaptive thoughts, feelings, or behaviors that already are detectable but before a disorder is present. For example, a program that screens school children for symptoms of depression and anxiety and provides a group-based intervention program to children with elevated symptoms that teaches them strategies for decreasing these symptoms is an example of an indicated intervention (Patras et al., 2016). Another example would be a program that identifies high-risk teenagers who have developed problematic alcohol use and that attempts to circumvent their further use of alcohol or transition to other potentially dangerous drugs (Hawkins et al., 2004). In other words, the focus is on identifying and helping adolescents before their alcohol or drug problems become entrenched
milieu therapy
In creating a therapeutic community, all the ongoing activities of the hospital are brought into the total treatment program, and the environment, or milieu, is a crucial aspect of the therapy. This approach is thus often referred to as milieu therapy (Petti, 2010; Zimmerman, 2004). Three general therapeutic principles guide this approach to treatment:
Staff expectations are clearly communicated to patients. Both positive and negative feedback are used to encourage appropriate verbalizations and actions by patients. Patients are encouraged to become involved in all decisions made, and in all actions taken, concerning them. A self-care, do-it-yourself attitude prevails. All patients belong to social groups on the unit. The group cohesiveness that results gives the patients support and encouragement, and the related process of group pressure helps shape their behavior in positive ways.
deinstitutionalization, w
a persistent concern about hospitalization is that the mental hospital may become a permanent refuge from the world. As noted in Chapter 2, during the past four decades, considerable effort has been devoted to reducing the population of inpatients by closing hospitals and treating patients who have mental disorders as outpatients. This effort, which is often referred to as deinstitutionalization, was initiated to prevent the negative effects, for many psychiatric patients, of being confined to a mental hospital for long periods of time as well as to lower health care costs. The rise of the biological therapies described in Chapter 16 has also meant that many patients can be discharged within a few weeks, or at most a few months.
Aftercare Programs
now referred to as aftercare programs, are live-in facilities that serve as a home base for former patients as they make the transition back to adequate functioning in the community. Typically, community-based facilities are run not by professional mental health personnel but by the residents themselves. Aftercare programs can help smooth the transition from institutional to community life and reduce the number of relapses. However, some individuals do not function well in aftercare programs. Clients who hold unskilled employment, have nonpsychotic symptoms, have committed a crime, or are more transient tend to be less compliant in aftercare programs
civil commitment
Individuals with psychological problems or behaviors that are so extreme and severe as to pose a threat to themselves or others may require protective confinement. Those who commit crimes, whether or not they have a psychological disorder, are dealt with primarily through the judicial system. They are arrested, sent for a court trial, and, if convicted, may be faced with confinement in a penal institution. People who have not committed crimes but who are judged to be potentially dangerous because of their psychological state may, after civil commitment procedures, be confined in a psychiatric hospital (or psychiatric unit of a general hospital).
how well do mental health professionals do in predicting the occurrence of dangerous acts?
). Violent acts are particularly difficult to predict because they often are determined not only by an individual’s personality traits or violent predispositions, but also by situational circumstances (for example, whether a person is under the influence of alcohol). One obvious and significantly predictive risk factor is a past history of violence (Burke, 2010; Megargee, 2009), but clinicians are not always able to unearth this type of background information.
Mental health professionals typically over-predict violence and consider felons to be more dangerous than they actually are, and usually predict a greater percentage of clients to be dangerous than actually become involved in violent acts (Megargee, 2009). Such a tendency is, of course, understandable from the perspective of the practitioner, considering the potentially serious consequences of releasing a violent individual. It is likely, however, that many innocent patients thereby experience a violation of their civil rights. Given a certain irreducible level of uncertainty in the prediction of violence, it is not obvious how this dilemma can be completely resolved.
The duty-to-warn legal doctrine / e Tarasoff decision
says that the court ruled that difficulty in determining dangerousness does not exempt a psychotherapist from attempting to protect others when a determination of dangerousness exists. The court acknowledged that confidentiality was important to the therapy relationship but stated that the protection privilege ends where public peril begins.
right to less restrictive treatment
patients also have a right to less restrictive treatment. In 1975 a U.S. district court issued a landmark decision in the case of Dixon v. Weinberger. The ruling established the right of individuals to receive treatment in less restrictive facilities than mental institutions.
e limitations on patients’ rights to refuse psychotropic medication.
Finally, we note that there are limitations on patients’ rights to refuse psychotropic medication. In 1990 the U.S. Supreme Court ruled, in Washington v. Harper, that a Washington State prison could override a disturbed prisoner’s refusal of psychotropic medications. This decision was based on a finding that the prison’s review process adequately protected the patient’s rights. We see in this instance that changes in the national political climate can reverse prior trends that favored patients’ rights.
patients have a right to freedom from custodial confinement/ right to live in a community
In other words, if they are not dangerous to themselves or others and if they can safely survive outside of custody, patients cannot be confined in a hospital against their will. Also, the need for confinement must be shown by clear, convincing evidence. In 1979 the U.S. Supreme Court ruled, in the case of Addington v. Texas, that a person’s need to be kept in an institution must be based on demonstrable evidence. It was also established, in the case of Stoner v. Miller, that patients released from state mental hospitals have a right to live in a community.
right to compensation for work
patient in a nonfederal mental institution who performed work must be paid according to the Fair Labor Standards Act. Although a 1978 Supreme Court ruling nullified the part of the lower court’s decision dealing with state hospitals, the ruling still applies to people with mental illness and patients with intellectual disabilities in private facilities.
insanity defense. actus rea vs mens rea
Within our legal system there is a fundamental principle that people who cannot comprehend or control their criminal behavior should not be punished. This is why we do not incarcerate young children who accidently get hold of the family gun and shoot a sibling as part of a game. This idea is also at the heart of the insanity defense. In technical legal terms, an act (actus reus)—even if it is a criminal act, may lack moral blameworthiness if there was a lack of intentionality because the defendant did not possess their full mental faculties at the time of the crime
guilty the person has to know what they were doing and have some awareness (mens rea) that what they are doing is wrong.
Jeffrey Dahmer.
Dahmer was on trial for the murder and dismemberment of 15 men in Milwaukee. He tricked his victims into being handcuffed (they thought it was part of a sexual game) and then dripped acid into their flesh and skulls, in an effort to turn them into zombie-companions. Then he would engage them sexually. Occasionally he also engaged in cannibalism. Dahmer never heard voices or broke with reality. In his case, the planned insanity defense proved unsuccessfu
Michael McDermott.
McDermott testified that Michael the Archangel had sent him on a mission to prevent the Holocaust when he gunned down seven coworkers in Massachusetts on December 26, 2000. McDermott also stated that he believed he was soulless and that by killing he would earn a soul. McDermott claimed to have been raped by a neighbor when he was a young boy and had a history of paranoia and suicide attempts. Despite this claim of insanity, a jury found McDermott guilty in the shooting deaths of his seven coworkers. The prosecution argued that McDermott was motivated to kill because his employer was about to deduct from his wages back taxes owed to the IRS. Evidence seized from his computer showed that McDermott had researched how to fake being mentally ill.
successful NGRI defense outcomes
ut. In most states, an NGRI verdict means that the person is automatically committed to a psychiatric institution. And in most states (such as New York), there is no limit to how long the person can be confined. What this means is that NGRI patients can end up being incarcerated for much longer periods of time than would be the case if they had been found guilty and sent to prison. There is also no monitoring of such people. No organization or central registry tracks these confined NGRI patients or notes how long they have been incarcerated. They can automatically be confined and locked up for an indefinite period. Although periodic reviews do occur, extensions to the period of commitment can be granted and then extended if there is a continued need to protect the public. If NGRI patients never fully recover, they can remain in a state forensic facility until they die.
“knowing right from wrong” rule
people are assumed to be sane unless it can be proved that at the time of committing the act they were laboring under such a defect of reason (from a disease of the mind) that they did not know the nature and quality of the act they were doing—or, if they did know they were committing the act, they did not know that what they were doing was wrong.
“irresistible impulse.” T
A second precedent in the NGRI defense is the doctrine of the “irresistible impulse.” This view holds that accused persons might not be responsible for their acts—even when they knew that what they were doing was wrong (according to the M’Naghten rule)—if they had lost the power to control their actions. That is, they could not avoid doing the act in question because they were compelled beyond their will to commit the act.
The Durham rule. I
often referred to as the “product test,” the accused is not criminally responsible if her or his unlawful act was the product of mental disease or mental defect. As you might imagine this was a very flexible definition and difficult to apply in practice/ abandoned later
The American Law Institute (ALI) standard (1962). “substantial capacity test”
Often referred to as the “substantial capacity test” for insanity, this test combines the cognitive aspect of M’Naghten with the volitional focus of irresistible impulse in holding that the perpetrator is not legally responsible if at the time of the act he or she, owing to mental disease or defect, lacked “substantial capacity” either to appreciate the act’s criminal character or to conform his or her behavior to the law’s requirements.
“unable to appreciate,” rule
The federal Insanity Defense Reform ACT (IDRA). Adopted by Congress in 1984 as the standard for the insanity defense to be applied in all federal jurisdictions, this act abolished the volitional element of the ALI standard and modified the cognitive standard to read “unable to appreciate,” thus bringing the definition quite close to M’Naghten. IDRA also specified that the mental disorder involved must be a severe one and shifted the burden of proof from the prosecution to the defense. That is, the defense must clearly and convincingly establish the defendant’s insanity. This is in contrast to the prior requirement that the prosecution clearly and convincingly demonstrate the defendant to have been sane when the prohibited act was committed.
guilty but mentally ill (GBMI)
a defendant may be sentenced but placed in a treatment facility rather than in a prison. This two-part judgment serves to prevent the type of situation in which a person commits a murder, is found not guilty by reason of insanity, is turned over to a mental health facility, is found to be rational and in no further need of treatment by the hospital staff, and is unconditionally released to the community after only a minimal period of confinement. Under the two-part decision, such a person would remain in the custody of the correctional department until the full sentence has been served.
competent to stand trial
f someone is charged with a crime and is considered to be unable to understand the trial proceedings as a result of intellectual deficits or mental health problems, that person can be hospitalized until her or his mental state is judged to be improved sufficiently for the person to be considered competent to stand trial.
who is most likely to be incompetent to stand trial
concluded that defendants who had been diagnosed as having a psychotic disorder were approximately eight times more likely to be found incompetent than defendants without a psychotic disorder diagnosis. In addition, they found that defendants who had a previous psychiatric hospitalization, as compared with those never hospitalized, or had been unemployed, as compared to employed defendants, were more likely to be determined as incompetent to stand trial. Warren and colleagues (2013) found that about half of defen
recividism and mental health problems
More specifically, 23 percent of their sample of inmates with significant mental health problems returned to prison sooner than those without mental health problems. This highlights the importance of providing better treatment for mentally ill prisoners during their period of incarceration. Failure to do so may cost society more in the longer term than is saved by not providing such services.
e National Institute of Mental Health (NIMH)
(1) conducts and supports research on the biological, psychosocial, and sociocultural aspects of mental disorders; (2) supports the training of professional and paraprofessional personnel in the mental health field; (3) helps communities plan, establish, and maintain more effective mental health programs; and (4) provides information on mental health to the public and the scientific community. Two companion institutes—the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA)—perform comparable functions in these more specialized fields.
key functions of . Professional mental health organization
(1) establishing and reviewing training qualifications for professional and paraprofessional personnel; (2) setting standards and procedures for the accreditation of undergraduate and graduate training programs; (3) setting standards for the accreditation of clinics, hospitals, or other service operations and carrying out inspections to see that the standards are followed; and (4) investigating reported cases of unethical or unprofessional conduct and taking disciplinary action when necessary.
The Arc,
the largest national community-based organization advocating for people with intellectual and developmental disabilities, works to find community and residential treatment centers and services for people with intellectual and developmental disabilities, and to carry on a program of education aimed at better public understanding of people with intellectual and developmental disabilities and greater support for legislation. The Arc also fosters scientific research into intellectual and developmental disabilities, recruitment and training of volunteer workers, and programs of community action.
Psychological difficulties and outcomes
may result in numerous problems such as absenteeism, accident proneness, poor productivity, and high job turnover. Research has shown, however, that even those with severe mental health problems can be integrated into the workplace if a supportive employment model is used to assist their involvement
The World Federation for Mental Health
The WFMH was established in 1948 as an international congress of nongovernmental organizations and individuals concerned with mental health. Its purpose is to promote international cooperation among governmental and nongovernmental mental health agencies, and its membership now extends to more than 94 countries (Brody, 2004). The federation has been granted consultative status by WHO, and it assists UN agencies by collecting information on mental health conditions all over the world
The World Health Organization
Formed after World War II as part of the United Nations (UN) system, WHO’s earliest focus was on physical diseases; it has helped make dramatic progress toward the conquest of such ancient scourges as smallpox and malaria. Over the years, mental health, too, has become an increasing concern among the member countries. WHO’s goals are to integrate mental health resources to deal with the broad problems of overall health and socioeconomic development that many of the more than 150 member countries face (WHO, 2018).
Another important contribution of WHO has been its International Classification of Diseases (ICD), which enables clinicians and researchers in different countries to use a uniform set of diagnostic categories
Goldwater rule
prohibits psychiatrists from offering diagnostic opinions on people they have never examined in a professional context.
