Ch 16 (lesson 19): legal and ethical issues

Question 1

Criminal commitment

Answer 1

• people w psych disorder who are alleged to have broken the law subject to criminal commitment
  
  • confines person to mental or forensic hospital for:
    
    • determination of competency (are they able to assist in their own defence?)
    • after acquittal by reason of insanity - committed to treatment facility

Question 2

concept of insanity

Answer 2

• insanity is a legal concept, not psychological
• mens rea
  
  • guilty mind (to be guilty, must understand what they did was wrong)
• “no crime w/out evil intent
• concept of insanity
  
  • disordered mind can’t be guilty mind

Question 3

insanity defense

Answer 3

• legal argument that defendent shouldn’t be held responsible for illegal act if it is attributable to psych disorder or intellectual disability that intereferes w/ rationality (knowing right from wrong)
• pleaded rarely, and is rarely successful
• based on mental condition at time of the crime
• retrospective, often speculative judgement on part of attorneys, judges, jurors, and psychologists required
• psych disorders and crime don’t go hand in hand

Question 4

lardmark cases regarding insanity defense-irresistable impuse

Answer 4

• Irressistible impulse:
  
  • pathological impulsive or drive that person couldn’t control compelled them to commit criminal act

Question 5

M’Naghten rule

Answer 5

• M’Naghten rule:
  
  • person didnt know nature/quality of criminal act they engaged in/ didn’t know it was wrong

Question 6

Durham Test

Answer 6

• Durham test:
  
  • persons criminal act product of mental disease/defect
    
    • new hampshire currently uses

Question 7

American Law Insistute Guides

Answer 7

• American Law Institute Guides:
  
  • 1. criminal act result of mental disease or defect that results in them not appreciating wrongfulness of act/ persons inability to behave according to law
  • 2. term “mental disease or defect” do not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct

Question 8

Insanity defense reform act

Answer 8

• Insanity defense reform act:
  
  • 1. criminal act result of severe mental illness or defect that prevents understanding nature of crime
  • 2. burden of proof shifted from prosecution to defense (defense must prove insanity)
  • 3. person released from forensic/prison hospital after being judged no longer dangerous+ recovered (can be longer than imprisonment)

Question 9

Guilty but mentally ill

Answer 9

• Guilty but Mentally ill:
  
  • person can be found legally guilty of crime- maximizing chances of incarceration- and mental illness plays role in how they are dealt with. a seriously ill person can be held legally responsible, but committed instead of imprisoned

Question 10

Current Insanity pleas- 2 types

Answer 10

• Not Guilty by reason of insanity (NGRI)
  
  • no dispute over whether person did crime
  • accused not responsible for the crime because of mental illness
  • indefinitely committed to forensic hospital (secured hospital)
  • released when no longer mentally ill
• Guilty but mentally ill (GBMI)
  
  • found guilty and responsible for crime
  • mental illness plays role in sentencing
    
    • can be committed for treatment, then sent to prison
    • can be sentenced to prison, then put in mental hospital after
  • most incarcerated and may or may not receive any psychiatric care

Question 11

NGRI vs GBMI

Answer 11

not responsible — responsible
forensic hospital — prison
not sentenced— sentenced
released when no longer mentally ill — released at end of sentence, but could be committed
treatment given— treatment possibly given

Question 12

criticisms of GBMI

Answer 12

• doesn’t benefit criminal defendents w psychological disorders
• doesn’t result in appropriate treatment for those convicted
• the mental health evaluations before imprisonment don’t lead to better treatment
• jurors believe verdict isn’t as tough as guilty verdict, those getting GBMI verdict often spend more time in prison than if they received guilty verdict

Question 13

Competency to stand trial

Answer 13

• accused must be able to participate in their defense
  
  • “ability to consult w lawyer w reasonable degree of rational understanding”
  • ” has a rational as well as a factual understanding of the proceedings against them”
• courts do not want person to be brought to trial in absentia (physically or mentally not there)
• determination of competency made before individual is tried
  
  • prosecutor, judge, or defense attorney can raise issue
• having a psychological disorder doesn’t necessarily men incompetent to stand trial

Question 14

what happens if someone is incompetent to stand trial?

Answer 14

• bail automatically denied
• usually kept in hospital for pretrial examination
  
  • during this time supposed to receive treatment to render them competent
  • may lose employment and be separated from friends/family/ familiar surroundings, making it harder to show competency
• in Jackson v Indiana forced states to speedier determination of incompetency
  
  • pretrial confinement limited to time it takes to determine whether treatment during detainment can render them competent
• cannot be committed for determination of competency for period longer than the maximum sentence they face

Question 15

synthetic sanity

Answer 15

• if medication can produce rationality, trial can be held
  
  • even if discontinuation of drug would render defendent incompetent
• forced medication to restore competency can only be used in very limited circumstances
  
  • only if alt treatments failed,
  • meds likely to be effective,
  • meds wont interfere w right to defend themselves at trial
  • and important govt interest in trying defendent for serious crime
• meds are oft the most effective means of restoring competency
• even if found competent, that person cannot serve as their own attorney

Question 16

US supreme court- capital punishment

Answer 16

US Supreme court ruled

• unconstitutional to execute those who are insane or have intellectual developmental disorder
  
  • considered cruel and unusual punishment
• however, definition of intellectual disability varies from state to state
  
  • in 2014, based on Atkins ruling, changed that it cant be based solely on IQ score- must also include assessments of adaptive func over lifetime

Question 17

Civil Commitment

Answer 17

• Parens Patriae: “power of the state”
  
  • Duty of govt to limit freedoms for peoples protection
• a person can be committed to a psych hospital against their will if:
  
  • mentally ill, and
  • a danger to self or others
    
    • commitment should end when no longer dangerous

Question 18

two types of civil commitment

Answer 18

• formal
  
  • any responsible citizen can request it
  • requires a court order - mental health examination, if person objects a court hearing can be scheduled
• informal
  
  • emergency commitment
  • initially now court involvement
    
    • 2PC: two physician certificate
    • further detainment requires formal judicial commitment

Question 19

mental illness and violence

Answer 19

• when substance abuse isnt a factor, mentally ill are no more likely to commit violent crimes
  
  • 3% violence linked to mentally ill
  • correlation btwn particular delusions and violence, however (others out to get them)
  • 90% not violent
  • more likely to be victims than perpetrators
  • if violent, target is usually family or friends

Question 20

factors that influence accuracy of violence prediction

Answer 20

• repeated violent acts in the past
• individual returns to same enviro where violent acts were committed and their personality has not changed
• person is on the brink of committing a violent act
• medication noncompliance

Question 21

protection of patient rights

Answer 21

• courts try to balance patient rights + right of public to be protected
• supreme court ruled that evidence for commitment must be clear and convincing
• danger must be imminent

Question 22

aspects of protection of patient rights

Answer 22

• least restrictive alternative
• right to treatment
• right to refuse treatment

Question 23

least restrictive alternitive

Answer 23

• have to provide treatment that restricts a person’s liberty as little as possible
  
  • only those who cannot be adequately looked after in less restrictive settings be placed in hospital
• unconstitutional to confine person who is nondangerous and capable of living on their own or with help of friends/family
• this only works if society provides suitable residences and treatment- it does not

Question 24

right to treatment

Answer 24

• state required to provide treatment after civil commitment
• cannot put them away w/out meeting minimal standards of care
• also specific requirements for mental hospitals- certain size, privacy, limited physical restraints, how many people working there

Question 25

right to refuse treatment

Answer 25

• able to refuse treatment unless a danger to self/others

Question 26

Deinstitutionalization

Answer 26

• in 1960’s many states released patients from psychiatric hospitals; community treatment preferred
• many cities lack sufficient community mental health facilities
• transinstituionalization
  • mentally ill now end up in nursing homes, hospitals, prisons
    
    • 17-30% prison population mentally ill
  • police officers increasingly called on to work w mentally ill
    
    • new laws provide funding for special training - Mentally Ill Offender Treatment and Crime Reduction Act, the Consensus Project

Question 27

Ethical issues in Research

Answer 27

• Ethical restraints to avoid unnecessary harm, risk, humiliation, invasion of privacy
• Institutional Review Board (IRB) approval necessary (contains citizens)
• researchers must receive training in research ethics
• Belmont Report
• Researchers must ensure that mentally ill participants understand risks of research before participating
  
  • informed consent: sufficient info must be provided to allow person to make informed decision to participate
  • freedom to withdraw any time for any reason

Question 28

ethical dilemmas- therapy

Answer 28

• confidentiality: nothing revealed to 3rd party except for other professionals/those intimately involved in treatment
• privileged communication: confidential relationship protected by law
• individual doesn’t have to reveal info in court/ disclose as a witness
• applies to relationships such as: husband/wife, physician/patient. pastor/pentinent, attorney/client
  
  • patient “holds the privelege”- they have to release other person to disclose confidential info in legal proceeding

Question 29

when can confidentiality and privileged communication be broken?

Answer 29

• patient filed malpractice suit against therapist- therapist can divulge info to defend themselves
• patient under 16 and victim of crime/abuse (required to report to police or child welfare agency w/in 36 hrs)
• patient is trying to avoid arrest for crime committed or planed
• patient is danger to self/others (tarasoff decision- have to call to warn someone if patient is a danger to them)