Mental Health and The Legal System

Question 1

Mental Health and the Law (3 things to consider)

Answer 1

• Managing care for people with serious mental illness requires balance between multiple things
  
  • Patient’s rights as individual
  • Patient’s safety
  • Society’s right to safety and security
• Can be difficult to determine
• Ethics and legal concepts shift with societal and political perspectives

Question 2

Courts and Mental health (determining state for consequences)

Answer 2

• Courts decide if someone w mental illness who’s committed a crime can be held accountable or stand trial
• Informed by evaluations done by mental health professionals who
  
  • Make diagnosis
  • assess malingering
  • assist in determining competency
  • Use knowledge of behavior change to help those in trouble with law

Question 3

Mental Illness Legal concept

Answer 3

• Definitions vary by state
• Typically ‘severe emotional or thought disturbances that impact health and safety’
• exclude cognitive disability and substance-related disorder
• Not the same as having a diagnosis
  
  • e.g. Connecticut state law defines mentally ill as having a mental condition with substantial effects on the ability to function and requires care or treatment
  • Ambiguous in terms of ‘mental condition’ and ‘Adverse affects’

Question 4

The dangerousness of self to others (misconception and prediction)

Answer 4

• Important but highly controversial
• Misconception that those w mental illness are more dangerous
  
  • reality: mental illness only mildly increases dangerous behavior
  • Media sensationalizes occurances
• Predicting violence
  
  • Assessment tools (check lists) good at identifying those who are currently low risk, not good for long term
  • Recent stressors, substance use, hopelessness, psychopathy, delusions of persecution increase risk
  • Ultimately mental health professionals cannot predict

Question 5

Civil Commitment law originally established and results

Answer 5

• Determines when someone can be involuntarily hospitalized or sent to a treatment
• Civil Commitment laws established in the late 19th century
  
  • mentally ill previously cared for by family or community or left to care for themselves
  • Large public hospitals developed: increase in involuntary commitment for reasons unrelated to mental illness
    
    • e.g. ‘disobedient wives’
• Each state made own laws

Question 6

Supreme court ruling consequences (and deinstitutionalization)

Answer 6

• Tightened restrictions on involutary commitment >> more mentally ill living in the community
• some eventually run into legal system >> criminalization of mentally ill
• Deinstitutionalization had similar effects:
  
  • rather than being placed in community care, sent to jails or nursing homes
  • increase in homelessness

Question 7

Criteria for Civil Commitment

Answer 7

• Voluntary commitment is an option
• involuntary commitment requires
  
  • Person has mental illness and needs treatment
  • AND person is dangerous to self or others
  • OR person is gravely disabled (inability to care for self)

Question 8

Civil Commitment process initial stags

Answer 8

• Initial stages
  
  • Person fails to seek help but others feel help is needed
  • Begins with 72-hour holding period where mental health professional contacts police
  • Basically arrest- the person can be held without consent in a hospital up to 72-hours
  • At same time petition is made by relative or mental health professional requesting individual is civilly committed
  • Individual must be notified of the commitment process

Question 9

Civil Commitment process later subsequent stages

Answer 9

• Normal legal proceedings in most cases
• The determination made by judge
• Individual in question has the right to challenge a judges determination

Question 10

Criminal Commitment

Answer 10

• Accused of committing a crime
• Detention in mental health facility for evaluation
• Two main points;
  
  • The insanity defense: was person mentally unstable at the time of the crime
  • Competence to stand trial: can person understand and participate in their defense

Question 11

Definition of Insanity (three laws in making)

Answer 11

• Originated from M-Naughten rule (1843)
  
  • Individual did not know what they were doing
  • Did not know what they were doing was wrong
• Durham rule (1954)
  
  • Took into account cognitive and emtional functioning
  • Not a crime if it was mental illness result
  • (not used anymore)
• American law institute standard
  
  • Not responsible for the criminal if it’s due to mental illness, inability to distinguish right from wrong, or incapacity for self-control
    
    • Diminished capacity: the ability to understand nature of behavior (i.e. criminal intent) can be diminished by mental illness

Question 12

Consequences of insanity defense

Answer 12

• Public misperceptions and outrage
  
  • John Nickley Jr. (Reagan assassination) found not guilty by insanity
  • 75% of states moved to abolish or change insanity defense to make more difficult to use
  • Insanity defense reform act
    
    • Only found not guilty if at time of the crime, individaul was unable to understand it was wrong
    • more strict
  • Guilty but mentally ill defense
    
    • Individual knew what she was doing but needs psychological help
    • Recommendation for treatment ¡ prison sentence (usually don’t recieve)

Question 13

Competence to stand trial

Answer 13

• Those who don’t understand the nature of criminal proceedings against them unfit for trial
  
  • Usually serious mental illness (e.g. schizophrenia)
  • intellectual disability another cause
  • 20-25% defendents attempt to malinger
• Consequences of determination of incompetence
  
  • Loss of decision-making authority
  • Results in commitment but with limitations

Question 14

Legal/ethical obligations of Mental Health Professionals

Answer 14

• Mental health professionals = mandated reporters
  
  • If become aware of abuse to child, elderly person or one with disabilities must inform appropriate authorities
• What to do if client threatens bodily harm to another person
  
  • Tarasoff v Regents
    
    • The therapist was made aware that the patient wanted to harm a woman, told authorities, not her she ended up being killed
    • Must warn individual in danger
  • 1980 Thompson V County
    
    • Threats must be specific
  • When in doubt, consult colleague and document when you did (records could be used on trial)

Question 15

Patients rights: an overview

Answer 15

• Right to treatment
  
  • Cannot be involuntarily commited without treatment
  • Must target symptom reduction and be humane
• Right to least restrictive alternative for case
  
  • Treatment with least confining setting
• Right to refuse treatment
  
  • Person can’t be forced to take medication
  • In the case of minors, sometimes can w consent from parents

Question 16

Research Participant Rights

Answer 16

• Informed consent
• No psychological or physical harm
• Debriefed on deception
• Treated with respect
• Right to withdrawal
• Right to anonymity