Chapter 16 - Law, Society, and the Mental Health Profession Flashcards
does psychological dysfunction occur in isolation?
no, psychological dysfunction affects more than just the individual
what system defines and often regulates the professional responsibilities of clinicians?
a complex social system of societal institutions
3 major forces in society
the legislation/judicial system, the business/economic arena, and technology
collective term for the legislative and judicial systems
the “legal field”
what is the legal field responsible for
protecting both the public good and the rights of individuals
two distinct aspects of the relationship between mental health field and legal field
mental health professionals play a role in the criminal justice system (“psychology in law”) and legal systems act upon the clinical field (“law in psychology”)
forensic psychology
the collective term for the intersections between the mental health field and the legal and judicial systems
the varied activities of forensic psychologists
testifying in trials, researching the reliability of eyewitness testimony, or helping police profile the personality of a serial killer on the loose
what do courts need to know before they can arrive at just and appropriate punishments?
they need to know if the defendant is responsible for the crimes they commit and capable of defending themselves in court
criminal commitment
the process where someone accused of crimes is sent to a mental institution for treatment because they are judged to be mentally unstable
two forms of criminal commitment
person was mentally unstable at time of the crime and person is mentally unstable at time of the trial
plea for people who were mentally unstable at the time of the crime(s) and are innocent of wrongdoing
not guilty by reason of insanity
someone who was mentally unstable at the time of the crime are released from treatment when
they improve enough to be mentally stable
someone who is mentally unstable at the time of the trial is released from treatment when
they are competent enough to understand the trial procedures and to defend themselves in court
criticism of judgments of mental instability
judgments are loopholes that allow criminals to escape punishment
what kind of term is the term “insanity”
a legal term
who can the M’Naghten test be traced back to?
to the murder case of Daniel M’Naghten in England in 1843
the M’Naghten test
the defendant had to be unable to know right from wrong at the time of the crime
when was the irresistible impulse test first used?
in Ohio in 1834
the irresistible impulse test
a person who committed a crime during an uncontrollable “fit of passion” was considered insane and not guilty
when was the Durham test made?
in 1954 as a result of the case of Durham v. United States
the Durham test
people are not criminally responsible if their “unlawful acts was the product of mental disease or mental defect”
issue with the Durham test
anyone who fits the criteria of any disorder in the DSM-I would be considered “insane”
when was the American Law Institute test made?
in 1955
the American Law Institute test (in class called the American Legal Institute Rule)
people are not criminally responsible if, at the time of a crime, they had a mental disorder or defect that prevented them from knowing right from wrong or from being able to control themselves and to follow the law
American Psychiatric Association’s 1983 statement on legal insanity
people should be found not guilty by reason of insanity only if they did not know right from wrong at the time of the crime
states that got rid of the insanity plea altogther
Idaho, Kansas, Montana, and Utah
percent of people who are found not guilty by reason of insanity who have schizophrenia or another form of psychosis
80%
percent of people who successfully plead insanity that are white
50%
percent of people who successfully plead insanity that are male
86%
mean age of people who successfully plead insanity
32 years old
fraction of crimes for which defendants are found not guilty by reason of insanity that are violent crimes
2/3
percent of those found not guilty by reason of insanity that are accused of murder
15-30%
concerns raised by the insanity defense
the fundamental difference between the law and the science of human behavior; the uncertainty of scientific knowledge about abnormal behavior
problem which clinicians face when evaluating state of mind of defendant during the crime
the event took place weeks, months, or years earlier
percent of defendants who plead insanity
less than 1%
percent of defendants who plead insanity and are actually found not guilty for reason of insanity
25%
amount of people who are found not guilty by reason of insanity of every 400 defendants
1 of every 400 defendants
percentage of insanity pleas that are agreed to by the prosecution
75%
causes behind the trend of defendants being released earlier and earlier from mental institutions
increasing effectiveness of therapy in institutions, the growing reaction against extended institutionalization, and more emphasis on patients’ rights
Foucha v. Louisiana 1992, what did the supreme court clarify?
that the only acceptable basis for determining the release of hospitalized offenders is whether or not they are still “insane”
outpatient commitment
the states may insist on community treatment, monitor the patients closely, and rehospitalize them if neccessary
what other verdicts besides not guilty by reason of insanity are available?
guilty but mentally ill, guilty with diminished capacity
guilty but mentally ill
defendants who receive this verdict are found to have had a mental illness at the time of their crime, but the illness was not fully related to or responsible for the crime
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 the person is guilty
why do many legal experts have argued against the diminished capacity defense
because of possible miscarriages of justice
when did Michigan passed the first sexual psychopath law
1937
purpose of sexual psychopath laws
some of those who are repeatedly found guilty of sex crimes have a mental disorder, so the state categorizes them as “mentally disordered sex offenders”
where are mentally disordered sex offenders sent to?
a mental health facility
“sexually violent predator” or “sexually dangerous person” laws
sex offenders removed from prison before their release and committed involuntarily to a mental hospital for treatment if a court judges them likely to engage in further “predatory acts of sexual violence” as a result of “mental abnormality” or “personality disorder”
supreme court case that upheld the constitutionality of the sexually violent predator laws
1997 case of Kansas v. Hendricks
why can a person be judged mentally incompetent to stand trial?
to ensure that the defendant understands the charges they are facing and can work with their lawyers to prepare and conduct an adequate defense
Supreme Court upholds the minimum of the defendant being competent in this case
Dusky v. United States in 1960
number of competency evaluations conducted in the United States every year
50,000-60,000
percent of defendants who are evaluated for competency that are found incompetent to stand trial
20-25%
supreme court ruling that addressed indefinite commitment
Johnson v. Indiana in 1972
until the early 1970s, most states required that mentally incompetent defendants be committed to what kind of place
maximum security institution for the “criminally insane”
jail diversion
the disturbed person is “diverted” from jail to the community for mental health care
civil commitment
certain people are forced into mental health treatment
people who are subjected to civil commitment
people who are unaware of their psychological problems or those who are not interested in going through therapy
where are people who are committed involuntarily sent to?
mental facilities
in what circumstance would the US legal system permit involuntary (civil) commitment?
when the individual being committed is in need of treatment and dangerous to themselves or others
in what ways might someone be dangerous to themselves?
if they are suicidal or if they act recklessly
in what ways might someone be dangerous to others?
if the individual seeks to harm others or if they unintentionally place others at risk
is a hearing necessary when committing a minor?
no, a hearing is not necessary as long as a qualified mental health professional considers commitment necessary
process of being involuntarily committed as an adult
the court orders a mental examination and allow the person to contest the commitment in court, often represented by a lawyer
before an individual is involuntarily committed, what does the supreme court say there must be?
“clear and convincing” proof that the person is mentally ill and has met the state’s criteria for involuntary commitment
what makes proof “clear and convincing” in the context of civil commitment?
if the proof provides 75% certainty that the criteria of commitment has been met
in the past, what was necessary before initiating emergency commitment?
certification by two physicians
what must clinicians declare to initiate emergency commitment?
that the state of mind of the patient makes them dangerous to themselves or others
what are the certifications from physicians for emergency commitment referred to as?
two-physician certificates, or 2 PCs
limit of emergency commitment stay
3 days
percent of people with mental disorders that are not dangerous or violent
90%
percent of violent acts that are committed by people with mental disorders
5%
what makes someone with a mental disorder somewhat more likely to perform violent behaviors
if their mental disorder is untreated
disorders with the strongest relationship to violence
severe substance use disorder, impulse control disorder, antisocial personality disorder, and psychotic disorders
what is often required before involuntary civil commitment is carried through?
the determination of dangerousness of the individual
are long-term predictions of violence or short-term predictions of violence more accurate?
short-term predictions of violence are more accurate than long-term predictions of violence
in long-term predictions of violence, is the likelihood that the individual will be violent overerstimated or underestimated?
overestimated
what are the problems with civil commitment?
it is difficult to assess a person’s dangerousness; the legal definitions of “mental illness” and “dangerousness” are vague; the actual therapeutic value of civil commitment is questionable
ruling of Robinson v. California 1962
imprisoning people who suffered from substance use disorders might violate the constitution’s ban on cruel and unusual punishment, and involuntary civil commitment was recommended as a more reasonable action
the two rights of patients that the legal system aims to protect
the right to treatment and the right to refuse treatment
ruling of Wyatt v. Stickney
the state was constitutionally obligated to provide “adequate treatment” to all people who had been committed involuntarily
the “adequate treatment” that Wyatt v. Stickney ruled ought to be provided to those who were committed involuntarily
more therapists, more social interactions and physical exercise, better living conditions, more privacy, and a more proper use of physical restraint and medication
Supreme Court ruling for the O’Connor v. Donaldson 1975
mental institutions had to review patient cases periodically; state cannot continue to institutionalize people involuntarily if they aren’t dangerous and are capable of surviving on their own or with help from family or friends
Protection and Advocacy for Mentally Ill Individuals Act in 1986
set up protection and advocacy systems in all states and U.S. territories; gave to public advocates who worked for patients the power to investigate possible abuse and neglect and to correct those problems legally
what do most of the right-to-refuse-treatment rulings center on?
biological treatments
what do some states also acknowledge in their right-to-refuse-treatment laws?
the right to refuse electroconvulsive therapy (ECT) and psychotropic medications
in what case could a patient’s refusal to take medications be overturned?
if the patient’s refusal is considered incompetent, dangerous, or irrational
three other rights that patients have
patients who work in mental institutions get a minimum wage; patients 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 four other ways the legal field and the mental health field interact with each other
malpractice suits, professional boundaries, jury consultation, and psychological research of legal topics
malpractice suits
claims made against clinicians in response to inappropriate, irresponsible, or negligent behavior of the clinician
examples of malpracitce
sexual activity with a patient, failure to obtain full consent for a treatment, negligent drug therapy, omission of drug therapy that would speed improvement, improper termination of treatment, and wrongful commitment
professional boundaries
the legal field has helped change the boundaries that distinguish one clinical profession from another
1991, the Department of Defense makes this change to the difference between the practices of psychiatrists and of psychologists
they gave the authority to psychologists to prescribe drugs, something previously denied to psychologists
American Psychological Association’s recommendation regarding giving psychologists the power to prescribe medications
extensive educational and training programs in prescription services in order to receive certification to prescribe medications
jury consultation
clinicians advise lawyers about which potential jurors are likely to favor their side and which strategies are likely to win juror’s support during trials
clinicians involved in jury consultation
jury specialists
on what do jury specialists make their suggestions?
on surveys, interviews, analyses of juror’s backgrounds and attitudes, and laboratory simulations of upcoming trials
the focus of the psychological research of legal topics
eyewitness testimony and patterns of criminality
eyewitness testimony
not very reliable and can be made less accurate by misinformation; the confidence of witnesses is not indicative of the accuracy of their testimony
patterns of criminality
the study of criminal behavior patterns in order to make profiles of criminals that help identify a criminal
positives of criminal profiling
researches have indeed found that perpetrators of particular kinds of crimes (serial murder or serial rape) frequently share a number of traits and background features
the issue with psychological profiling
while particular traits are often present in criminals, they are not always present in criminals; applying profile information can be wrong and misleading
the best way to use psychological profiling
to keep in mind the limitations of profiling
how do clinicians regulate themselves?
by continually developing and revising ethical guidelines for their work and behavior
how many guidelines are in the American Psychological Association code of ethics?
7 guidelines
are psychologists allowed to give advice wherever they want?
yes, as long as they do so responsibly, professionally, and base their advice on appropriate psychological literature and practices
what kind of advice has been difficult to regulate?
internet-based professional advice
APA guideline regarding proper research practice
psychologists may not conduct fraudulent research, plagiarize the work of others, or publish false data
with whom should psychologists acknowledge their limitations
with patients who are disables or whose gender, gender identity, ethnicity, language, socioeconomic status, or sexual orientation differs from that of the therapist
what must psychologists who make evaluations and testify in court do?
base their assessments on sufficient information and substantiate their findings appropriately
what must clinicians never participate or assist in?
acts of torture
until how long after treatment ends is it allowed that a therapist and a former client be in an intimate relationship?
2 years after the end of treatment
can psychologists accept as clients people they once had a sexual relationship with?
no, a psychologist cannot take in a former sexual partner as a client
percent of therapists today that have a sexual relationship with a client
4-5%
percent of therapists that report having been sexually attracted to a client
more than 80%
what principle must psychologists follow?
the principle of confidentiality
why is confidentiality important in therapy?
so that the client may have peace of mind and to make sure that therapy is as effective as possible
two situations in which confidentially can be broken
if therapist reports to a supervisor or if someone is in danger
case that lead to the rule that confidentially can be broken if someone is in danger
1976 case of Tarasoff v. Regents of the University of California
phrase that explains the limits of confidentiality
“the protective privilege ends where the public peril begins”
percent of workers who find their jobs very stressful and a cause of mental health issues
40% of workers
percentage of stressed-out workers that report excessive workload causes their stress
46% of stressed-out workers
percentage of stressed-out workers that report people and personnel issues cause their stress
28% of stressed-out workers
percentage of stressed-out workers that report difficulties balancing work with home life cause their stress
20% of stressed-out workers
percentage of stressed-out workers that report lack of job security as the cause of their stress
6% of stressed-out workers
percent of work absences that can be tied to stress of related mental health issues
60% of absences
stress in work can contribute to these problems at work
poor productivity, more accidents, employee mistakes, employee departures, insurance costs, and worker compensation expenses
two common approaches that employers use to address employee stress
employee assistance programs and stress reduction programs
employee assistance programs
mental health services made available by a place of business, and are run either by mental health professionals who work directly for a company of by outside mental health agencies
stress reduction and problem-solving programs
workshops or group sessions in which mental health professionals teach employees techniques for coping, solving problems, and handling and reducing stress
what technique of stress reduction is provided by 1/4 of all employers?
mindfulness training
how many workers agree that they need help learning how to manage stress?
nearly half of workers
acuts reus
guilty act; that the defendant committed the crime
mens rea
guilty mind; that the defendant did the crime intentionally
implication of an insanity defense
the defendant did not have mens rea when they committed the crime
Insanity Defense Reform Act (1984)
at the time of the crime, as a result of a “mental disease” or intellectual disability, the person did not know their behavior was wrong
who has the burden of proof under the Insanity Defense Reform Act?
the defense
who has the burden of proof under the Irresistible Impulse Rule?
the defense
who has the burden of proof under the M’Naughten Rule?
the prosecution
who has the burden of proof under the Durham Rule?
the prosecution
who has the burden of proof under the American Legal Institute Rule?
the prosecution
percentage of cases where defense attorneys suspect their clients have impaired competence
10% of cases
three possible outcomes after competence evaluation
competent to stand trial; incompetent and restorable; incompetent and not restorable
4 philosophies of incarceration
rehabilitation, deterrence, incapacitation, and retribution
rehabilitation
teach people not to do crime again and to be more prosocial
deterrence
punish criminal to show why civilians shouldn’t commit crimes
incapacitation
society is made safer by locking up criminals
retribution
an eye for an eye; the criminal hurt us, so we will hurt the criminal
example of how a broad economic decision by the government may influence the clinical treatment of people with mental disorders
deinstitutionalization was motivated by the government’s desire to reduce to costs
government funding for mental health services in 1963 compared to today
1 billion USD in 1963 compared to 179 billion USD today
percent of mental health services covered by government funding
64% of mental health services
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
peer review systems
clinicians who work for the insurance company periodically review a client’s treatment program and recommend that insurance benefits be either continued or stopped
what do insurance companies require from clinicians in peer review systems
reports or session notes from the therapist, often including intimate personal information about the patient
one of the issues with managed care programs
the priorities of managed care programs lead to therapy being cut off prematurely, and they may promote short-term treatments over long-term improvement
issue with insurance coverage of mental disorders in general
reimbursements for mental disorders are, on average, lower than those for physical disorders
2014 act that expanded the reach of the 2008 parity law
The Affordable Care Act (“Obamacare”)
what provides new triggers for abnormal behavior?
the digital world
what has brought a new exhibitionistic feature to certain kinds of abnormal behavior?
the Internet
clinicians’ fear regarding social media
it will lead shy or socially anxious people to withdraw from valuable face-to-face relationships
telemental health
the use of remote technologies such as long-distance videoconferencing to provide real-time therapy sessions without the therapist being physically present
percentage of therapists who have reported going to therapy at least once
84%
the issues most often credited as the reason a therapist goes to therapy
relationship problems, depression, and anxiety
how many therapists have said that anxiety, depression, and/or relationship problems have affected the quality of their work?
more than half of therapists
