L13: legal issues

Question 1

cjs + mental health system overlap

Answer 1

legal system excercises influence over mental health.

- impacts disciplines, ethical principles and laws.

Question 2

what is civil commitment?

Answer 2

person can be declared to have mental illness + forcefully placed in hospital.
– once in hospital, each province has diff way to handle.

Question 3

three conditions met to have civil commitment

Answer 3

1. mental illness as defined by mental health act
2. deemed dangerous to self or others.
3. in need of treatment.

Question 4

3 criteria that physicians looks at when civilly committing someone?

Answer 4

1. suffering a mental disorder
2. likely to cause harm to self/others OR suffering mental/physical deterioration OR serious physical impairment
3. unsuitable for admission as formal patient (unwilling)

Question 5

2 types of authority that the govt has justified its right to act against the wishes of the individual

Answer 5

1. police power authority: police take against will to protect public health, welfare + safety.
2. under parens patriae: state applies power when citizen is unlikely to act in best interst. act as surrogate parent.

Question 6

when does civil commitment begin?

Answer 6

when voluntary help isnt sought, but others feel treatment is necessary.

Question 7

what happens once civil commitment begins

Answer 7

Psych assessment of mental illness (defined legally =/= psych disorder): agreement by a few.

Question 8

two components of criminal commitment?

Answer 8

criminal act = actus reus

guilty mind = mens rea

Question 9

2 reasons why ppl are detained in psych facility when accused of committing crime?

Answer 9

1. detained until assessed to be “fit to stand trial”

2. if found ncrmd (insanity).

Question 10

M’Naghten case?

Answer 10

psychotic episode led him to kill secretary.

• courts declared insanity bc defect reason, disease of mind = didnt understand the nature of the act.

Question 11

not guilty by reason of insanity

Answer 11

old criminal term.

• in psych hospital due to mental disorder improved sufficiently.
• one guy said “ not fair to have indeterminate detention” = won + changed rule

Question 12

difference btw ncr and not guilty

Answer 12

ncr = deed was done, person did deed. lacked mens rea

not guilty = lack proof of actus reus. not legally liable

Question 13

burden of proof in ncr?

Answer 13

on defendant.

Question 14

how is mental disorder defined in ccc?

Answer 14

disease of mind.

- but not all “disease of mind” => ncrmd.

Question 15

to be ncrmd need?

Answer 15

mental disorder
incapable of appreciating quality/nature
*exceptions : self-induced intoxication

Question 16

three dispositions (“sentences”) avail for ncrmd.

Answer 16

1. absolute discharge: free + clear.
2. conditional discharge: release into community with conditions
3. detention: in custody

Question 17

prevalence of ncr

• adult?
• youth?
• quebec?

Answer 17

A: 7.5-9/10,000
Y: 1.4-4/10,000
quebec has 3% more than other provinces

Question 18

what is alberta ncr project?

Answer 18

prof reserach on ncr data in province

Question 19

of those ncr in alberta, what is most common psych diagnosis?

Answer 19

psychotic.

- many co-morbid disorders

Question 20

average age of ppl ncr in alberta?

Answer 20

35 yoa

Question 21

how many youth were ncr?

Answer 21

14/551 = 2.5%

Question 22

what offence is most likely considered ncr?

Answer 22

direct violenct (no homicide, sex assault)

Question 23

% of prior criminal experience in those that are ncr?

Answer 23

54% had none
44% had one
18% had 5+
7.1% had 10+

Question 24

most common level of education in ncr cases?

Answer 24

below grade 12

Question 25

most common race for ncr?

Answer 25

white. but statistics look vvv similar to demographic of province. - no over-representation

Question 26

marital status for ncr?

Answer 26

mostly single, none are actually connected with someone | - rare to have healthy marriage

Question 27

time to absolute discharge IF they receive it?

Answer 27

- more time in custody than if were to plead guilty = not easier. - doesn't have to be absolute discharge ever.

Question 28

define recidivism?

Answer 28

return to target behaviour

Question 29

sexual recidivism of ncr?

Answer 29

4/528 | - at least 4 yeaers after.

Question 30

major violent recidivism of ncr?

Answer 30

2 years = 0.8% | 20 years = 4%

Question 31

violent recidivism of ncr?

Answer 31

5 years = 2% 35 years = 11.4% in gen pop, takes 3-6 months to have 10% recidivism rate.

Question 32

ncr + public alarm

Answer 32

moral panic | - sensationalized. not as frequent as thought, but ncrmd spend more time in detection than non-ncr

Question 33

what is fitness to stand trial?

Answer 33

fitness to stand requires person understand charges against them + able to assist with their own defence

Question 34

3 issues addressed to determine fitness

Answer 34

1. accused assist in defence (communicate w counsel) 2. understand roles of various court room players 3. know what they are charged with

Question 35

what happens if person is deemed unfit?

Answer 35

- lose authority to make decision + faces commitment. | review board may conditionally discharge, retain in hospital, order treatment to restore fitness

Question 36

3 ways to assess dangerousness?

Answer 36

1. clinical opinion 2. actuarial approach 3. structured professional judgement

Question 37

clinical opinion in assessing dangerousness

Answer 37

consider info in each case + make judgement to dangerousness - problem: useless in predicting dangerousness

Question 38

actuarial approach to assessing dangerousness

Answer 38

- take known risk factors from literature review + create equation to numerically predict likelihood of violence. - precise estimates (+) - dunno what to do about risk (-)

Question 39

structured professional judgement in assessing dangerousness

Answer 39

review literature + ID factors that predict violence. - have clinicians base opinions on these factors. (+): can predict dangerousness using crim record (-): not perfect

Question 40

why do mental health professionals tend to over-predict dangerousness

Answer 40

overpredict > underpredict that way no consequences to releasing dangerous ppl.

Question 41

societal impacts of over-prediction on society?

Answer 41

civil + economic impact. | - more ppl in custody, more tax money goes there.

Question 42

controversy of dangerousness from?

Answer 42

- patient in new york was civilly committed, said it was unjust - 900 ppl released = rate of violence in the popln was super low.

Question 43

what is post hoc problem

Answer 43

- recognizing pattern after-the-fact. - hindsight bias - - recognize violent tendencies after violence occurs.

Question 44

what is problem in leaping from general to specific?

Answer 44

generalized perceptions of violent tendencies do not predict specific acts.

Question 45

what are some problems in defining dangerousness?

Answer 45

lack agreement of what dangerous behaviours include | - drug dealing?

Question 46

what are base-rate problems?

Answer 46

hard time making predictions about events that occur infrequently.

Question 47

psychologists + treatment ethics?

Answer 47

when provide treatment to individuals with mental disorder, psychologists bound by canadian code of ethics for psychologists.

Question 48

what does ccep cover?

Answer 48

boundary issues patient rights professional issues + legal liability

Question 49

what are boundary issues?

Answer 49

minimize harm - practice within limits of competence - avoid dual-role

Question 50

what are patient rights

Answer 50

fundamental right of those in mental health facilities = right to treatment, right to say no to treatment

Question 51

wyatt v stickney case?

Answer 51

american. set standard for staff:patient ratio

Question 52

ccr+f protect rights of ppl with mental illness how?

Answer 52

- right to treatment in least restrictive enviro | - right to refuse treatment

Question 53

why is right to refuse treatment controversial?

Answer 53

concern of mental health/society + individual choice/freedom of will

Question 54

duty to warn vs duty to protect:

Answer 54

warn: warn id-ed person that danger could befall them protect: dont need to tell explicity, just act to protect them

Question 55

tarasoff case

Answer 55

- duty to warn came up. patient talked about killing T. psychologist went to police, + superior = they took patient in + released him. patient later killed T. ruled that psychologist had duty to warn T -- switched to duty to protect. - if roles reversed, complete confidentiality > duty to warn.