chapter 15 Flashcards
Voluntary Hospitalization
Patient seeks out treatment of their own volition and can, and with notice, leave whenever they want
Note* - if staff believes patient isi a threat to themselves or others, then they can petition the court to change their status to involuntary
Civil Commitment
placing an individual, regardless of their will, in a psychiatric institution
Requires a relative or professional file a petition with the court
Criminal Commitment
placing an individual, regardless of their will, in a psychiatric institution, after they have been acquitted of a crime by reason of insanity
What Gets Someone Admitted?
- danger to self or others
- grave disability
- need for immediate care
Grave disability
a. A person who, due to mental or emotional impairment, is in danger of serious harm because they have failed or is unable to provide for their basic needs:
i. Essential food, clothing, shelter, or safety
b. The persian needs hospital treatment, which available, but their psychiatric disabilities make them incapable of determining whether to accept it
Need for Immediate Care
a. Combined psychiatric and medical emergency
i. Neurocognitive disorder
ii. Consequences of substance use
b. Actively suicidal, homicidal, significant aggression
i. Active attempts or completed behaviors
New York State Mental Hygiene Law
- Two physicians agree and present certifications that the person has a mental illness for which care and treatment in a mental hospital is essential to his or her welfare;
- Person’s judgment is too impaired for him or her to understand the need for such care and treatment, or;
- As a result of his or her mental illness, the person poses a substantial threat of harm to self or others.
- Substantial threat of harm” may encompass (i) the person’s refusal or inability to meet his or her essential need for food, shelter, clothing or health care, or (ii) the person’s history of dangerous conduct associated with noncompliance with mental health treatment programs.
Predicting Dangerousness
Mental health professionals have not demonstrated any special ability to predict dangerousness
Not always accurate - “general tendencies”
Base-rate problem
Lack of agreement over what types of behavior are violent or dangerous
Clinician predictions are generally less accurate than predictions based on evidence of past violent behavior
False negative and false positives
More objective screening methods and violence rating scales help improve ability of clinicians to predict the likelihood of violent behavior - short term predictions
Risk of violent behavior is greater in those with psychotic disorders who are untreated
Factors that may account for the failure to predict dangerousness include:
- Recognizing violent tendencies post hoc is easier than predicting them
- Generalized perceptions of violent tendencies may not predict specific acts of violence
- There is a lack of agreement in defining violence or dangerousness
- It is difficult to make predictions about infrequent or rare events (the
base-rate problem) - A dangerous person is unlikely to disclose direct threats of violence
- Predictions based on hospital behavior may not generalize to community settings.
Base-rate problem
The relative difficulty of making predictions about infrequent or rare events
The Duty to Warn
Although there is an increased risk of violence in people with severe mental disorders as compared to the general population, fewer than 10% of violent crimes are linked to psychological disorders
Tarasoff v. Regents of the University of California:
Duty to warn: a legal obligation to warn the intended targets of threats made by patients against others
Issues with the duty to warn
Difficulty predicting
Clients may be less willing to confide
Potentially violent people will be less likely to enter therapy
Therapists may be less likely to probe, or may ‘overreact’ to protect themselves
patients’ rights cases
- Wyatt v. Stickney
- O’Connor v. Donaldson
- Youngberg v. Romeo
- Rogers v. Okin
Wyatt v. Stickney context
1972 - Class action suit against Stonewall Stickney (commissioner of mental health for the state of Alabama) brough by Ricky Wyatt (an intellectually disabled young man
Federal district court in Alabama held both at the hospital had failed to provide treatment to Wyatt and others and that living conditions at the hospital were inadequate and dehumanizing
Wyatt v. Stickney held that
a court in Alabama imposed a minimum standard of care
- Human psychology and physical treatment
- Qualified staff in numbers sufficient to administer adequate treatment
- Individualized treatment plans
O’Connor v. Donaldson
context
1975 - Donaldson, former patient at a state hospital in Florida, sued two hospital doctors on the grounds that he had been involuntarily confined without receiving treatment for 14 years, although he posed no serious threat to himself or others
O’Connor v. Donaldson
held that
SCOTUS rules that non dangerous mentally ill people could not be held psychiatric facilities against their will if such people could be maintained safely in the community
Youngberg v. Romeo
context
1982 - Nicholas Romeo, with profound intellectual disability, had been institutionalized. He was often kept in restraints
Youngberg v. Romeo
held that
SCOTUS rules that involuntarily confined patients have a right to less restrictive types of treatment and to receive training to help them function
Rogers v. Okin
context
1979 - Massachusetts federal district court
Rogers v. Okin
held that
Established that patients have a right to refuse medication, except in case of emergency
Legal Bases of the Insanity Defense
The insanity defense is a legal defense in which a defendant in a criminal case pleads not guilty on the basis of insanity
Three court cases established legal precedents for the insanity defense
(1) In 1834, a court in Ohio applied a principle of irresistible impulse as the basis of an insanity defense (example: State vs. Bobbitt, 1994)
ruled that people could not be held responsible if they are compelled to commit criminal actions because of impulses they are unable to resist
(2) The M’Naghten rule, based on a case in England in 1843, treated the failure to appreciate the wrongfulness of one’s action as the basis of legal insanity.
holds that people do not bear criminal responsibility if they either have no knowledge of their actions or are unable to tell right from wrong
(3) The Durham rule was based on a case in the United States in 1954 in which it was held that persons did not bear criminal responsibility if their criminal behavior was the product of “mental disease or defect.”
“accused [person] is not criminally responsible if his unlawful act was the product of mental disease or mental defect”
Another set of standards developed by the American Law Institute that combines the M’Naghten rule and the irresistible impulse principle has been adopted in some states
People who are criminally committed may be hospitalized for an indented period of time, with their eventual release dependent on a determination of their mental status
Determinate vs Indeterminate Commitment
Determinate → typical court case
Indeterminate → insanity plea
Jones v. United States
context
1975 - Jones was arrested and charged with petty larceny for attempting to steal a jacket at a store
Was first committed to St. Elizabeth’s Hospital - diagnosed with suffering from paranoid schizophrenia and was kept hospitalized until he was judged competent to stand trial (6 months later)
Jones v. United States
held that
Established a principle that individuals who are acquired by reason of insanity “constitute a special class that should be treated differently” from civilly committed individuals
Provided that usual and customary sentences that the law provides for particular crimes have no bearing on criminal commitment
Individuals who are acquitted by reason of insanity may be committed for an indefinite period under criteria that require a less stringent level of proof of dangerousness than is ordinarily applied in cases of civil commitment.
Competency to stand trial
The ability of criminal defendants to understand the charges and proceedings brought against them and to participate in their own defense
Defendant can be held competent to stand trial but still be judged not guilty of a crime by reason of insanity
On the other hand, a person may be incapable of standing trial at a particular point in time by the tried at a later time when competency is restored
People who incapable of understanding the charges against them or of assisting in their own defense can be found incompetent to stand trial
Then sent to a psychiatric facility
Jackson v. Indiana
SCOTUS placed restriction on the length of time a person judged incompetent to stand trial can be held in a psychiatric facility
