Chapter 16 - Professor Name: Brian Schmitt PDF

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Professor Name: Brian Schmitt...

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Chapter 16: Legal and Ethical Issues Criminal Commitment  People with mental illness who are alleged to have broken the law are subject to criminal commitment o A procedure that confines a person to a mental hospital either for …  Determination of competency  After acquittal by reason of insanity  Concept of insanity: A legal concept o A disordered mind can’t be a guilty mind o Unable to formulate and carry out a criminal purpose o Only a guilty mind can engender culpable actions o A defendant can’t be guilty if they have a psychological issue Insanity Defense  Insanity a legal term o Not a psychiatric or psychological concept  Based on mental state of the accused at the time the crime was committed  Insanity defense o Defendant not responsible for an illegal act if it is attributable to mental illness or not knowing right from wrong o Pleaded in fewer than 1% of cases o Rarely successful  Requires judgments by lawyers, judges, jurors, and clinicians Landmark Laws and Cases

Two Kinds of Insanity Pleas  Not guilty by reason of insanity (NGRI) o No dispute over guilt o Accused not responsible for the crime because of mental illness o Indefinite commitment to a forensic hospital  Only release when no longer mentally ill  Example: John Hinckley – shot president, was released from asylum  Guilty but mentally ill (GBMI) o Found guilty and responsible for the crime o Mental illness plays a role in sentencing  Can be committed for treatment until no longer mentally ill  Then sent to prison to serve remainder of sentence  Most are incarcerated and may or may not receive any psychiatric care  Example: Jeffery Dahmer – killed and ate victims, released from asylum and sent to prison to finish sentence Competency to Stand Trial  Accused must be able to participate in his or her defense o 1960 U.S Supreme Court decision  Ability to consult with his lawyer with reasonable degree of rational understanding  Has a rational as well as a factual understanding of the proceedings against him o Courts do not want a person to be brought to trial in absentia

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Determination of competency made before individual is tried o Prosecutor, judge, or defense attorney can raise issue Synthetic sanity o If medication can produce rationality, trial can be held  Even if discontinuation of the drug would again render the defendant incompetent Forced medication to restore competency can be used only in very limited circumstances: no guarantee it will allow for the defendant to be competent to stand trial

Insanity, Intellectual Disability, and Capital Punishment  US Supreme Court o Unconstitutional to execute individuals who are insane or have an intellectual developmental disorder  Execution would constitute cruel and unusual punishment o However, definition of mental retardation varies from state to state

Civil Commitment  Parents Patriae: “Power of the state” o Duty of government to limit freedoms for people’s protection o Protect someone who is unable to protect themselves  An individual can be committed to a psychiatric hospital against his wishes if o Person is mentally ill, and o Danger to self or others  Commitment should end when person is no longer dangerous  Formal commitment o Requires a court order  Informal emergency commitment o Initially no court involvement is needed  2PC: Two physician certificate (Psychologist, Psychiatrist, MD)  Further detainment requires formal judicial commitment Preventive Detention and Problems in the Prediction of Dangerousness  When substance abuse is not a factor, mentally ill are no more likely to commit violent crimes than the average person o Only 3% of violent crimes linked to mentally ill o If violent, target is usually family or friends, not strangers o Stranger homicide by people with mental illness is extremely rare  Factors that influence accuracy of violence prediction: o Repeated violent acts in the past o Individual returns to same environment in which past violent acts were committed and individual’s personality has not changed

o Person is on the brink of committing a violent act o Medication noncompliance Protection of Patient Rights  Courts try to balance patient rights and the right of the public to be protected  Supreme Court ruled that evidence for commitment must be clear and convincing  Danger must be imminent  Least restrictive alternative o Required to be provided when treating mentally ill  Right to treatment o State required to provide treatment after civil commitment  Right to refuse treatment o Unless person is a danger to self or others Deinstitutionalization, Civil Liberties, and Mental Health  Deinstitutionalization o In the 1960s, many states released patients from state psychiatric hospitals; community treatment preferred o Many cities lack sufficient community mental health facilities  Transinstitutionalization o Many mentally ill end up in nursing homes, hospitals and prisons  Justice department survey found that between 17 - 30% of prison population is mentally ill o Police officers increasingly called on to work with mentally ill  New laws provide funding for special training Ethical Dilemmas in Therapy and Research  Research o Ethical restraints to avoid unnecessary harm, risk, humiliation, and invasion of privacy to participants o Institutional Review Board (IRB) approval necessary o Researchers must receive training in research ethics  Researchers must ensure that mentally ill participants understand risks of research before participating o Informed consent  Sufficient information must be provided to allow an individual to make an informed decision to participate o Freedom to withdraw at any time for any reason  Therapy o Confidentiality o Privileged communication: what the client/patient allows counselor to disclose outside of a session to others  Patient “holds the privilege”

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Both can be broken if… o Patient has filed a malpractice suit against a therapist o Patient is under age 16 and a crime or abuse victims o Patient is trying to avoid arrest for a crime committed or planned o Patient is a danger to self or others  Tarasoff decision  Case where Tarasoff was a student in the state of Cali, and dated a guy twice, the guy went to counseling center and he told the counseling he was going to kill Tarasoff  Counselor broke confidentiality and called police, police pulled guy over and he denied thoughts of killing he  Cops let him go and he ended up killing Tarasoff  Result of this case came the Duty to Warn...