week 11 mental health services;legal, ethical and professional issues Flashcards
discuss the development of the legal conception of ‘insanity’, and the multitudinous forces that have contributed to its evolution;
1843 M’NAGHTEN RULE ;must be proven that at time of committing act, accused was under defect of reason and so did not know the act he was doing or did not know it was wrong.
1954 DURHAM RULE;accused is not criminally responsible if the act was a product of mental illness.
1962 AMERICAN LAW INSTITUTE;person not responsible for criminal conduct if result of mental dz or due to mental dz lackscapacity to appreciate its criminality.
1978 DIMINISHED CAPACITY; abnormal mental condition affects degree of crime, ie such offenses requiring intent/knowledge, may be reduced to lesser offences such as reckless or criminal neglect.
1984 INSANITY DEFENCE REFORM ACT; person charged with criminal offence is not guilty by reason of insanity if shown due to mental illness/retardation, could not appreciate the wrongfulness of his conduct at the time of offending.
Textbook (=US).
describe the terms civil and criminal commitment and outline the conditions that must be met before such processes can be enacted;
CIVIL COMMITMENT-person is in hospital because have mental illness and may be there voluntarily or involuntrily.
CRIMINAL COMMITMENT;are held in a mental facility because accused of a crime and yet to be determined if fit to stand trial, or because have been found not guilty of a crime due to insanity.
describe the process required for a person to become an involuntary patient in Victoria;
Person may be subject to an ASSESSMENT ORDER which is given by a court, medical doctor, social worker working for a court, or psychologist. Criteria for meeting an asessment order includes;
a)person appears to have mental illness
b)person appears to require immediate treatment of said mental disorder to prevent serious deterioration of mental fn or physical health, or to prevent serious harm to self or others.
assessment order lasts 72 hours or 24 hours once at mental facility.
Least restrictive option should always be used but police, ambulance or psychiatric services have right to transport person to mental facility against their will. (The facility must be public as cannot transport against will to a private facility).
Must be assessed by a psychiatrist within 24 hours of reaching facility and this must not be same person as who made admission order or initial doctor’s assessment.
May then be placed under TEMPORARY TREATMENT ORDER if;
a) has mental illness
b) due to mental illness requires immediate tx to prevent serious deterioration of mental/physical health or to prevent serious harm to self or others
c) and th tx will be available if admitted
and d) no less restrictive means possible.
temporary treatment order may remain for up to 28 days. Must develop a tx and recovery plan by 15 days.After 28 days reviewed by mental health tribunal (consists of a lawyer, medical practioner and a member of general community). They may overturn the temporary treatment order or they may make it a permanent TREATMENT ORDER.
A COMMUNITY TREATMENT ORDER is very similar to a temporary treatment order but person is not in mental institute but must attend treatments etc and if fails to comply, are put back in mental institute/hospital.
outline the relationship between the psycho-legal constructs of ‘competence to stand trial’ and ‘insanity’
competance to stand trial is an assessment of ability to understand court proceedings at trial. Insanity as it relates to a verdict of Not Guilty by Reason of Insanity, pertains to an inability to understand the wrongness of actions when committed. They are not the same. A person may for example be ïnsane”whilst committing a crime, yet later be deemed to have regained function and be competent to stand trial.
In addition, to make a claim of incompetent to stand trial, the burden of proof is on the accussed ie accused (or their team) must convince court they are incompetent to stand trial.
outline how Australian legal systems have conceptualised insanity;
In Australia, no legal verdict of guilty by mental illness is available. There is only whether or not fit to stand trial. In Victoria, McNaughton rule applies.
discuss the existent tensions between mental health professionals’ ability to predict dangerousness/ risk, and the court’s requirements from such
Courts seek absolute answers where non exist. A person with mental illness may be at greater risk than general population of exhibiting violence, but also too are those with previous violent record or those who are angry or stressed.
Ability to predict patient’s potential for violence is not a certainty, and the more time passes since having seen patient eg years etc, the far less reliable the prediction is. HAVING MENTAL ILLNESS IS NOT BY ITSELF A RELIABLE PREDICTOR OF VIOLENCE.
outline the essential facts of the Tarasoff case and the ruling of the court with regard to a therapist’s duty to warn/ protect;
A student killed Tarasoff, another student. Tarasoff had prior rejected the killer’s advances. At the time of the murder, perpetrator had been seeing 2 therapists and been diagnosed with paranoid schizophrenia. Powder (the murderer) had at his last session indicated intent to kill Tarsaroff? Therapist informed campus police who investigated and received assurances from Poddar that he would leave Tarsaroff alone. 2 weeks later, Poddar tried to contact Tarsaroff, and shot and stabbed her.
Later, Tarsaroff’s family successfully sued, that the therapists should have warned Tarsaroff.
discuss recent trends in deinstitutionalisation and transinstitutionalisation and their consequences for those with mental illness;
Deinstituitionalisation occurred in the 1980’s. Moved people out of mental institutions.Due to reforms making civil commitment harder and with having the goal of increasing community level support. Whilst this occurred during increased unemployment and a shortage of public housing, it was the deinstitutionalisation that was blamed for an increase in homelessness in some quarters.
Transinstitutionalization occurred with a movement out of psychiatric hospitals but into other institutions such as prisons or aged care.
describe the rights of patients (and those of research participants) within an informed consent framework;
People have a right to tx, and a right to choose. Tx should always aim to improve functioning in the community and always be the least restrictive possible. People have a right to refuse to especially if it has known significant side effects. Whether or not a patient can be forced to take medication in order to become competent to stand trial, is not clear cut.
People in research have the right to be informed, the right to decline, and the right to withdraw, without reprisal, the right to privacy, to being treated with respect, and the right to be protected from harm, and have their records safeguarded and anonymous.
discuss the trend towards clinical practice guidelines, and the two axes commonly adopted by regulatory bodies when evaluating interventions.
Trend towards evidence based practices. From these, psychological treatment guidelines have been generated. These guidelines then need to be considered on two axes:
a) how clinically effective it is and
b) clinical utility ie how feasible, generalisable, cost effective, available etc is it.
