L13: legal issues Flashcards
cjs + mental health system overlap
legal system excercises influence over mental health.
- impacts disciplines, ethical principles and laws.
what is civil commitment?
person can be declared to have mental illness + forcefully placed in hospital.
– once in hospital, each province has diff way to handle.
three conditions met to have civil commitment
- mental illness as defined by mental health act
- deemed dangerous to self or others.
- in need of treatment.
3 criteria that physicians looks at when civilly committing someone?
- suffering a mental disorder
- likely to cause harm to self/others OR suffering mental/physical deterioration OR serious physical impairment
- unsuitable for admission as formal patient (unwilling)
2 types of authority that the govt has justified its right to act against the wishes of the individual
- police power authority: police take against will to protect public health, welfare + safety.
- under parens patriae: state applies power when citizen is unlikely to act in best interst. act as surrogate parent.
when does civil commitment begin?
when voluntary help isnt sought, but others feel treatment is necessary.
what happens once civil commitment begins
Psych assessment of mental illness (defined legally =/= psych disorder): agreement by a few.
two components of criminal commitment?
criminal act = actus reus
guilty mind = mens rea
2 reasons why ppl are detained in psych facility when accused of committing crime?
- detained until assessed to be “fit to stand trial”
2. if found ncrmd (insanity).
M’Naghten case?
psychotic episode led him to kill secretary.
- courts declared insanity bc defect reason, disease of mind = didnt understand the nature of the act.
not guilty by reason of insanity
old criminal term.
- in psych hospital due to mental disorder improved sufficiently.
- one guy said “ not fair to have indeterminate detention” = won + changed rule
difference btw ncr and not guilty
ncr = deed was done, person did deed. lacked mens rea
not guilty = lack proof of actus reus. not legally liable
burden of proof in ncr?
on defendant.
how is mental disorder defined in ccc?
disease of mind.
- but not all “disease of mind” => ncrmd.
to be ncrmd need?
mental disorder
incapable of appreciating quality/nature
*exceptions : self-induced intoxication
three dispositions (“sentences”) avail for ncrmd.
- absolute discharge: free + clear.
- conditional discharge: release into community with conditions
- detention: in custody
prevalence of ncr
- adult?
- youth?
- quebec?
A: 7.5-9/10,000
Y: 1.4-4/10,000
quebec has 3% more than other provinces
what is alberta ncr project?
prof reserach on ncr data in province
of those ncr in alberta, what is most common psych diagnosis?
psychotic.
- many co-morbid disorders
average age of ppl ncr in alberta?
35 yoa
how many youth were ncr?
14/551 = 2.5%
what offence is most likely considered ncr?
direct violenct (no homicide, sex assault)
% of prior criminal experience in those that are ncr?
54% had none
44% had one
18% had 5+
7.1% had 10+
most common level of education in ncr cases?
below grade 12
most common race for ncr?
white. but statistics look vvv similar to demographic of province.
- no over-representation
marital status for ncr?
mostly single, none are actually connected with someone
- rare to have healthy marriage
time to absolute discharge IF they receive it?
- more time in custody than if were to plead guilty = not easier.
- doesn’t have to be absolute discharge ever.
define recidivism?
return to target behaviour
sexual recidivism of ncr?
4/528
- at least 4 yeaers after.
major violent recidivism of ncr?
2 years = 0.8%
20 years = 4%
violent recidivism of ncr?
5 years = 2%
35 years = 11.4%
in gen pop, takes 3-6 months to have 10% recidivism rate.
ncr + public alarm
moral panic
- sensationalized. not as frequent as thought, but ncrmd spend more time in detection than non-ncr
what is fitness to stand trial?
fitness to stand requires person understand charges against them + able to assist with their own defence
3 issues addressed to determine fitness
- accused assist in defence (communicate w counsel)
- understand roles of various court room players
- know what they are charged with
what happens if person is deemed unfit?
- lose authority to make decision + faces commitment.
review board may conditionally discharge, retain in hospital, order treatment to restore fitness
3 ways to assess dangerousness?
- clinical opinion
- actuarial approach
- structured professional judgement
clinical opinion in assessing dangerousness
consider info in each case + make judgement to dangerousness
- problem: useless in predicting dangerousness
actuarial approach to assessing dangerousness
- take known risk factors from literature review + create equation to numerically predict likelihood of violence.
- precise estimates (+)
- dunno what to do about risk (-)
structured professional judgement in assessing dangerousness
review literature + ID factors that predict violence.
- have clinicians base opinions on these factors.
(+): can predict dangerousness using crim record
(-): not perfect
why do mental health professionals tend to over-predict dangerousness
overpredict > underpredict that way no consequences to releasing dangerous ppl.
societal impacts of over-prediction on society?
civil + economic impact.
- more ppl in custody, more tax money goes there.
controversy of dangerousness from?
- patient in new york was civilly committed, said it was unjust
- 900 ppl released = rate of violence in the popln was super low.
what is post hoc problem
- recognizing pattern after-the-fact.
- hindsight bias
- recognize violent tendencies after violence occurs.
what is problem in leaping from general to specific?
generalized perceptions of violent tendencies do not predict specific acts.
what are some problems in defining dangerousness?
lack agreement of what dangerous behaviours include
- drug dealing?
what are base-rate problems?
hard time making predictions about events that occur infrequently.
psychologists + treatment ethics?
when provide treatment to individuals with mental disorder, psychologists bound by canadian code of ethics for psychologists.
what does ccep cover?
boundary issues
patient rights
professional issues + legal liability
what are boundary issues?
minimize harm
- practice within limits of competence
- avoid dual-role
what are patient rights
fundamental right of those in mental health facilities = right to treatment, right to say no to treatment
wyatt v stickney case?
american. set standard for staff:patient ratio
ccr+f protect rights of ppl with mental illness how?
- right to treatment in least restrictive enviro
- right to refuse treatment
why is right to refuse treatment controversial?
concern of mental health/society + individual choice/freedom of will
duty to warn vs duty to protect:
warn: warn id-ed person that danger could befall them
protect: dont need to tell explicity, just act to protect them
tarasoff case
- duty to warn came up.
patient talked about killing T. psychologist went to police, + superior = they took patient in + released him. patient later killed T. ruled that psychologist had duty to warn T – switched to duty to protect. - if roles reversed, complete confidentiality > duty to warn.
