Mental Health and the Law Review

Question 1

Civil Commitment

Answer 1

Laws designed to protect both people displaying abnormal behaviour and society, can be tipped to favour either one.

Question 2

Mental Health Acts

Answer 2

Provinces/territories with laws when people are detained against will in legal manner. Must meet three conditions: have a mental disorder, danger to self/others, in need of treatment.

Question 3

Safety and Protection

Answer 3

Quebec requires a mental disorder be present before being detained, BC says they need hospitalization to prevent deterioration of mental/physical self. Ontario says if a person causes serious bodily harm or imminent and serious impairment to self or others.

Question 4

Action Autonomie

Answer 4

Collective in Quebec saying Mental Health Acts were too broad and compromised autonomy.

Question 5

Guaranteed Rights of Person

Answer 5

Refuse treatment, informed of detention in hospital, and legal counsel.

Question 6

Authorities

Answer 6

Permit government power to take actions against will: Police power protects public health, safety, and welfare with laws/regulations to ensure protection, held in custody if threat to society.

Parens patriae power or state as parent, allow people to be committed when potential due to inability to secure basic necessities like food and shelter, treatment not recognized.

Question 7

Compulsive Community Treatments (CCT)

Answer 7

No commitment to hospital, either voluntary or involuntary, prevent relapse and care in independent environment, first form of treatment in Australia, second in Canada until prior treatment, two criteria are risk of increasing mental deterioration or pose harm to self and/or others.

Question 8

Mental illness in the Eyes of the Law

Answer 8

Legal concept, severe emotional/thought disturbances negatively affecting individual’s health and safety. Saskatchewan looks at disorder of thought, perception, thoughts, feelings, or behaviours impairing judgement, capacity to realize reality, associate with others, or meet ordinary demands of life, in respect of advised treatments. Ontario simply sees it as a disease/disability of the mind. Allow for flexibility in making decision on individual cases with subjective impressions/biases influencing decision.

Question 9

Dangerousness

Answer 9

Controversial thanks to some stating those with illness are more dangerous compared to others thanks to media, views important in civil commitment if bias of danger and link to mental health illness. Some evidence points to small increased rate on violence in disorders, yet inmates with serious illness are less likely to commit new offense on release.

Question 10

Predicting Violence

Answer 10

Hard if not impossible, rating scale based on psychopathy, age of first arrest, failure on prior releases predicting violent recidivism in individuals. Much judgment needed to assess scores and importance thanks to risk assessment. Self-harm has assessment for suicidal behaviours, variables like physical aggression, history of self-harm, and engagement in suicidal behaviours. Suicide Risk Assessment Scale developed at correctional service of Canada validated in Quebec and performed better compared to other samples.

Question 11

Homelessness

Answer 11

22190 in shelters with 61% men, 245000 experience homelessness in a year, 18000 use emergency shelter, 500000 use provisional shelter, 5000 unsheltered. 1/3 had significant problems with mental health, 75% with issues of mental health, harder time due to victimization, stress, difficulty with food and work. No longer older male abusing alcohol now younger, women, families, Indigenous, refugees, and ethnic minorities being overrepresented.

Question 12

Deinstitutionalization

Answer 12

Closure of hospitals and reduced beds, two goals were to downsize and create a network of community mental health services to treat released. Continues today with more communal integrations, deterioration in care was considered failure with communal care being praised yet support is needed as it is deficient. Concern over continuity of care, some argue deinstitutionalization does not cause homelessness, found in 96 sample with no higher rates. Trans institutionalization refers to moving a patient to another care facility.

Question 13

Battered Woman Syndrome

Answer 13

Jane Hurshman shot husband after years of abuse, recognized as battered woman syndrome in Canada, not in DSM-5 but a state of helplessness or post traumatic stress from chronic abuse in relation where women can not leave. Acknowledged in cases where they are under apprehension of death, not in immediate harm at moment and use force to protect selves. 80% of women killed by intimate partners, defense against state it is the abuse excuse.

Question 14

Criminal Commitment

Answer 14

Held due to belief of committing crime, detained in mental health facility until fit participate in legal proceedings.

Question 15

M’Naghten Law

Answer 15

Schizophrenic killed secretary, law says people are not responsible if they do not comprehend what they are doing, no knowledge of actions being wrong, insanity defense today, compulsive disorders for instance know the action may be wrong but do it regardless.

Question 16

Not Criminally Responsible on Account of Mental Disorder

Answer 16

Wording changed so person is guilty for act committed but omitted from knowing if wrong, 84% male convicted with NCRMD, not dangerous group as mental disorder resulted in lower reconviction risk with only 1/5 convicted and 13% reconvicting crime .

Question 17

Public Outcry

Answer 17

NCRMD seen as excuse where people get off too easy, negatively perceived, 91% agree with statement of juries and judges having hard time telling whether defendants are insane, 90% saw it as a loophole, 90% saw it used too often, escaping responsibility. 1/3 disagreed with availability. Of course they were all wrong with only 100 cases in 1991, 29% of time used in BC, 53 cases in 2 years, no automatic detention in psychiatric hospitals.

Question 18

Misconceptions about NCRMD

Answer 18

While public believe they get off too easy the truth is they may be in institutions longer than if convicted, public perception unaltered so NCRMD was changed with specifier of high-risk accused, more restrictions, secured setting, no community transition., Amended law did not improve public safety, community program one of best tools for helping those with NCRMD, awareness, education, assessment of psychopathic traits and risk assessment tools. Becomes much more difficult when we take into consideration the desire to assist individuals while protecting society from them.

Question 19

State of Mind Assessment

Answer 19

Must be able to assist in own defence, understand role in proceedings, and nature of proceedings. Unfit to stand trial refers to inability to comprehend proceedings, consequences, or communicate with counsel.

Question 20

Tarasoff act/Duty to Warn

Answer 20

Tarasoff was killed when stalker was rejected, mentioned intentions to therapist who told security but were assured by perpetrator. Code of ethics point to therapist being responsible for warning third party of danger, everything in reason is done to stop harmful consequences of actions, can be done even in confidential relations, limit occurs when breaking confidentiality allows for the protection of third parties who may be harmed.

Question 21

Expert Witness

Answer 21

People with specialized knowledge assisting in making decisions with judge, ambivalent due to persuasiveness in education or hired by whoever pays their bills so reliability is questioned. Determine malingering (falsifying disease)and assess competence. detected by MMPI with 90% success rate, Carleton University found expert witness in prosecutions pocket rated offenders as more psychopathic compared to defendant’s.

Question 22

Ethics and Treatment

Answer 22

CPA code of ethics for psychologists in 2017, with boundary issues, do no harm, and practise in realm of competence.

Question 23

Boundary issues

Answer 23

Breached in 1980s with David Garner sexually engaging with eating disorder patients, license revoked, resigned as clinical psychologist, Ohio board approved him in 1994. Should be clear in boundaries so as to avoid conflicts of interest, avoid dual relations, or act as therapist to someone in other context so no exploitation may arise.

Question 24

Do no Harm

Answer 24

Minimize harm to clients, broad principle to record keeping must be clear or risk misinterpretation and misuses. No sexual intimacy between parties aware of power relation in therapy, no encouragement of sexual intimacy with clients. Goes for therapy and any period following therapy where power relation may influence decision making.

Question 25

Practise in Realm of Competence

Answer 25

Neuropsychologist should not treat substance abuse disorder unless they possess proper training in coursework, research, individual study, applied training, supervision in areas to provide clinical services. Clients have right to receive treatment from competent and well-trained professionals.

Question 26

Rights of the patient

Answer 26

Right to treatment has received explicit recognition with lawsuits against facilities unable to acquire funding for treatments, should make attempts to attain treatment for patients. Points to every attempt being made to move patients from more to less structured living.

Question 27

Refuse Treatment

Answer 27

Controversial in Manitoba and Ontario it is explicitly recognized, competent patients, BC does not recognize this and puts the right in hand of physician. 1/10 happens when right is used, so refused medication but detained in hospital, so clinician provides treatment despite protests but then advocates for patients point to fundamental right being violated.

Question 28

Research Participants

Answer 28

Respect of persons, concern for welfare, and justive on part of Tri-council policy statement. Fully informed on risks, benefits, informed consent with ongoing information being disclosed.

Question 29

Improving systems for mental health services

Answer 29

Hope to reduce costs by eliminating unnecessary/ineffective treatments while facilitating dissemination of interventions based on latest evidence, alleviating pain is ultimate goal to reduce costs since treatments are no longer needed. APA task force is aimed to help both physician and patient make decision on proper treatment for psychological disorder of physical disorders (psychosocial included).

Question 30

The Two Axes of the APA Task Force

Answer 30

Clinical efficacy, thorough consideration of evidence to determine whether intervention was effective, passage of time or natural healing process is a thing and sees nonspecific effects of treatments like empathetic professional is enough to help.

Other axis is clinical utility, effectiveness in setting applied, interventions improve in research setting yet not the real-world setting. Most are done with homogenous groups, not comorbid, common phenomenon to know whether results are generalized to complicated patient types.

Question 31

Feasibility

Answer 31

Accepting intervention in addition to complying with requirements and administration protocols, ECT was effective but frightening to patients, man refused it. Generalizable to other people of different background is the next consideration, guidelines in best evidence-based psychological care for those suffering from disorders, guidelines document specific disorders being available now, bring opportunities to scientist-practitioners with information pertaining to clinical/external validity collected in course of practice.

Question 32

Principle I of the CPA

Answer 32

Respect for the dignity of persons and peoples: Includes equal inherent-worth, non-discrimination, moral rights, and distributive, social, and natural justice.

Question 33

Principle II of the CPA

Answer 33

Responsible Caring: Recognizes rights and respects abilities of individuals and groups to make decisions for self, and others they care for.

Question 34

Principle III of the CPA

Answer 34

Integrity in relationship: Relationship forms implicit and explicit expectations vital to the continuation of scientific research.

Expectations include truthfulness, accuracy and honesty, straightforwardness, and openness, maximizing objectivity and minimizing bias, and avoiding conflicts of interest.

Question 35

Principle IV of the CPA

Answer 35

Responsibility to Society: Two expectations are to increase knowledge and conduct affairs in such ways promoting the welfare of all humans.

The Foundation of psychological foundation, science, and practice are freedom of enquiry, innovation, and debate.