Legal and Ethical Issues

Legal Issues

 civil commitment
 criminal commitment
– competency to stand trial
– insanity defense
 right to treatment
 right to refuse treatment
 mandated reporting
Civil Commitment

 set of procedures for hospitalizing a

mentally ill person against his or her will
Criteria

 person has a mental illness and is

– dangerous to himself or others
– unable to take care of himself (“grave
disability”)
 how these conditions are interpreted
has varied over the years, and has
always been controversial
Criteria (continued)
 “Mental illness” is a legal concept
 Typically means severe emotional or thought
disturbance that negatively affects an
individual’s health and safety
 It is not synonymous with a DSM-IV diagnosis
or “psychological disorder.”
 Each state has it’s own definition. Many
states exclude MR and substance-related
disorders.
Criteria (continued)

 Dangerousness
– public perception is that people who are
mentally ill are more dangerous than
people who are not
– research shows
• having a mental illness in general does not
increase risk for violence
• specific symptoms (hallucinations, delusions)
do increase risk for violence
Government’s Authority

 government justifies its right to act

against the wishes of an individual
under 2 types of authority
– police power: protect public health, safety,
and welfare
– parens patriae: state acts as surrogate
parent, applies in circumstances when
person is unlikely to act in his/her own best
interest
Process
 relative or mental health professional petitions judge
 court may request an examination
– psychological status, ability to care for self, need
for treatment, potential for harm
 person must be present, must be represented by an
attorney, can examine witnesses, can request an
independent evaluation
 judge considers this info and decides whether
commitment is appropriate
 in most states, person can request that a jury hear
evidence and make determination
Emergency Situations

 person is admitted to hospital for time-

limited period (e.g., 72 hours)
 takes court order to hold person longer
Voluntary Admission

 person can voluntarily request

admission to a mental health facility
 will be evaluated by a mental health
professional and, if needed, admitted
Criminal Commitment

 procedure that confines a person to a

mental institution either for
determination of competency to stand
trial or after acquittal by reason of
insanity
Competency to Stand Trial

 person must be able to understand

charges against them and assist in their
own defense
Insanity Defense: Historical
Developments
 M’Naghten Rule: Britain, 1843
– person should not be held responsible if he was
unaware of the “nature and quality of the act”
(didn’t know what he was doing) or that the
criminal act was morally wrong
– emphasized cognitive factors: ability to tell
difference between right and wrong
– problem: perhaps too limited, ignores role of
emotional and motivational factors
 Durham Rule: DC, 1954
– person should not be held responsible if
his criminal act was the “product of a
mental disease or defect”
– problem: too broad, produced over-
reliance on expert witness testimony
 American Law Institutes Guidelines: 1962
– person should not be held responsible if, as the
result of a mental disease or defect, he lacked
substantial capacity to either appreciate the
criminality (wrongfulness) of his conduct or to
conform his conduct to the requirements of the law
– allows for diminished capacity
– Hinckley verdict: resulted in public backlash
against the insanity defense
 Insanity Defense Reform Act: enacted
by Congress in 1984
– person should not be held responsible if
criminal act was the result of a severe
mental illness or defect that prevents
person from understanding the nature of
his crime
Important Elements
 emphasizes cognitive factors (knowing difference
between right and wrong); eliminates volitional (ability
to conform behavior to law) component of ALI rule
 changed “lacked substantial capacity to appreciate”
to “unable to appreciate”
– more stringent criterion
 stipulates that mental disease or defect must be
“severe”
– excludes nonpsychotic disorders (e.g., antisocial personality
disorder)
– excludes defenses based on mitigating circumstances such
as extreme passion or “temporary insanity”
 shifts burden of proof from prosecution to defense
 Guilty but Mentally Ill: Michigan, 1975
– person is found guilty of crime, but mental
illness plays a role in how he is dealt with
– person may be imprisoned and receive
treatment there
– person may be confined to mental hospital;
sent to prison for rest of term if he recovers
Insanity and Mental Illness

 term “insanity” is a legal concept

 has to do with person’s ability to
distinguish between right and wrong
 not synonymous with mental disorder or
any DSM-IV dx
 person can be diagnosed with a
psychological disorder (e.g., pedophilia)
and still be held responsible for a crime
Right to Treatment

 in least restrictive setting

Right to Refuse Treatment

 even if hospitalized against will, can

refuse certain treatments
– antipsychotic medications
Mandated Reporting

 child abuse
 abuse of elderly person or other
dependent adult
 spouse abuse
Ethical Issues

 APA has formal ethics code

 can report ethical violations to APA,
state psychological associations, state
licensing boards
Confidentiality

 can’t disclose info obtained during

therapy without patient’s permission
 there are exceptions
– mandated reporting of abuse
– harm to self or others
– duty to warn: must notify intended victim
and police where patient lives and where
victim lives
Other Ethical Standards
 must practice within boundaries of
competence
 must get informed consent to treatment
 must avoid dual relationships
 assessments/opinions must be based on
adequate examination of patient
 don’t have sex with current clients; don’t
accept as clients people with whom you have
had sex
 don’t abandon clients