Chapter 16: Mental Health and Services

Question 1

civil commitment laws

Answer 1

When a person can be legally declared to have a mental illness and be placed in a hospital for treatment
* Involves legal definition of mental illness
* Civil commitment laws in the United States date back to the late 19th century
* Laws vary by state

Question 2

Criteria for Civil commitment

Answer 2

One of the above…
*person has a mental illness and needs treatment
*person is dangerous to themselves or others (acute suicidality, mania, psychosis)
*person is gravely disabled
Inability to care for self
(They have not committed a crime.)

Question 3

voluntary vs involuntary admission

Answer 3

Voluntary: the person wants to be hospitalized
Involuntary: the person is forced to be hospitalized

Question 4

The civil commitment process initial stages

Answer 4

• Person fails to seek help
• Others feel that help is needed
• Petition is made to a judge on behalf of the person (only 24-48 hours)
• Individuals must be notified of the commitment process

Question 5

the civil commitment process subsequent stages

Answer 5

*Involve normal legal proceedings in most cases
*Determination is made by a judge
*Decision informed by expert opinions

Question 6

mental illness definition as a legal concept

Answer 6

Typically defined as severe emotional or thought disturbances that impact health and safety. Definitions can vary by state
Often include: Cognitive disability and substance-related disorders

Question 7

Is mental illness as a legal concept synonymous with having a psychological diagnosis?

Answer 7

Definition is not synonymous with having a psychological diagnosis
* Benefit: Flexibility for provider
* Disadvantage: Vulnerable to bias

Question 8

Can professionals predict the likelihood of someone being or becoming violent?

Answer 8

*Assessment tools are best at identifying persons at low risk of being violent, not good at long-term prediction
*Professionals cannot predict whether any given individual
will become violent

(good at predicting who will not be violent, bad at predicting who will be violent)

Question 9

Are people with mental illness more likely to be dangerous?

Answer 9

NO its a misconception that people with mental illness are much more likely to be dangerous—perpetuated by media
* Substance use disorder and recent victimization increase likelihood of violence
* People with mental illness are more likely to be victims of violent crimes than those without

Question 10

governmental authority and civil commitment

Answer 10

police can escort someone to the hospital or the person receives help from the state because they cant care for themselves (parens patrice)

Question 11

What is the new restriction the Supreme Court has placed on involuntary commitment?

Answer 11

A non-dangerous person cannot be involuntarily committed

Question 12

deinstitutionalization definition, and what is the problem that comes with it?

Answer 12

Movement of people with mental illness out of institutions
* Problem: Led large numbers of ill people to become homeless (severe mental illness cant have a job so it leaves to homelessness)

Question 13

transinstitutionalization definition

Answer 13

People with mental illness have been moved out of large mental hospitals to other institutions, including prisons and nursing homes (because of being homeless, crime for the mentally ill has gone up)

Question 14

Is mental illness common in prisons? Do they get the mental help they need?

Answer 14

Yes and no

Question 15

criminal commitment

Answer 15

Accused of committing a crime
* Detained in mental health facility
* Evaluation determines fitness to stand trial
* Can be found guilty, not guilty, or not guilty by reason of insanity

Question 16

Insanity defense plea

Answer 16

*Accused not guilty because of insanity at time of crime
*Diagnosis of a disorder is not the same as insanity

Question 17

Definitions of insanity

Answer 17

*M’Naghten rule: Inability to distinguish right from wrong at the time of the crime
*Durham rule: Crime was the product of a mental illness
*American Law Institute standard: Knowledge of right vs. wrong; self-
control; diminished capacity (reduced ability to understand their behavior)

Question 18

Is pleading insanity common?

Answer 18

No despite it being seen a lot in the media, it is extraordinarily rare; it is used in 1% of criminal cases

Question 19

What caused public outrage about the insanity defense?

Answer 19

After John Hinckley Jr. (guy who tried to assassinate president Reagan) found not guilty by reason of insanity, 75% of states moved to abolish or change the insanity defense because it is seen as a legal loophole (like a get out of jail free card)

Question 20

Downsides to insanity plea

Answer 20

It is not a get-out-of-jail-free card; it is arguably worse. person is not going free; they have to spend a lot of their time in mental institutions

Question 21

Changes that have been made regarding the insanity defense

Answer 21

*Insanity defense reform act
*Guilty but mentally ill (GBMI)
*Allows for treatment and punishment (even with this, they dont get adequate treatment)

Question 22

Therapeutic Jurisprudence

Answer 22

Using knowledge of behavior change to help those in trouble with the law
* “Problem solving” courts
* Address unique needs of people with specific problems
* Examples include drug treatment courts, domestic violence courts, and mental health courts
(If you do these things, you can stay out of jail and give the person resources.)

Question 23

Requirements for competence to stand trial

Answer 23

• Understanding of legal charges
• Ability to assist in one’s own defense
• Essential for trial or legal processes
• Burden of proof is on the defense (not competent to stand trial)

Question 24

Consequences of a determination of incompetence

Answer 24

• Loss of decision-making authority
• Results in commitment (psych hospitalization), but with limitations. Sometimes they hold the person in a psych hospital until they are ok enough to stand trial

Question 25

Tarasoff V Regents of the University of California (duty to warn)

Answer 25

When someone says they want to harm in general. Must warn individual in danger (wanna harm yourself, others, or are being hurt; the practitioner has to tell authorities and break confidentiality, other than that, everything is confidential)

Question 26

Thompson v County of Alameda

Answer 26

Like Tarasoff but threats must be specific, like for example, school shooting threat or “I wanna shoot Billy”

Question 27

is the level of duty to warn the same across states

Answer 27

No it can be very different from state to state, so if you are certified in multiple states, you have to know the rules for all the states

Question 28

Mental health professionals as an expert witness

Answer 28

• Person with specialized knowledge and expertise
• Assist in competency determinations
• Assist in making reliable DSM diagnoses
• Advise the court regarding psychological assessment and diagnosis.
• Assess malingering (i.e., faking symptoms)

Question 29

Patients rights

Answer 29

*The right to treatment
- Cannot be involuntarily
committed without treatment
- Treatment: reduce symptoms
and humane care
*The right to the least restrictive alternative
- Treatment within the least
confining and limiting setting
*The right to refuse treatment
- Often in cases involving
medical or drug treatment
- Persons cannot be forced to
become competent for trial
(e.g., by taking medications)

Question 30

Research Participant Rights

Answer 30

• Right to be informed about the research (Involves informed consent, not simply consent alone)
• The right to privacy
• Right to be treated with respect
  and dignity
• Right to be protected from
  physical and mental harm
• Right to choose or to refuse to
  participate in research
• Right to anonymity in report of
  study findings
• Right to safeguarding of records

Question 31

Clinical efficacy axis

Answer 31

involves thorough consideration of scientific evidence to determine whether intervention is effective compared to alternative treatment

Question 32

Clinical Utility Axis

Answer 32

is concerned with the effectiveness of the intervention in the practice setting

Question 33

Evidence-based care

Answer 33

before providing treatment, it must be ensured there is evidence behind the care you are giving the patient and in the real world, is this treatment helping people

Question 34

NICE guidelines

Answer 34

treatment parameters for depression (in England)