Transcript ch16MentalHealthSocietyx

chapter sixteen
Law, Society, and the
Mental Health Profession
Law, Society, and the
Mental Health Profession
• It is influenced and sometimes
caused by societal and social
factors
• It affects the lives of relatives,
friends, and acquaintances
THE LAW
Psychological dysfunctioning
of an individual does not
occur in isolation
Clinical scientists and
practitioners do not
conduct their work in
isolation
• They are affecting and
affected by other societal
institutions
Law and Mental Health
LEGAL FIELD
• Legislative and
judicial systems; two
social institutions
that have a
particularly strong
impact on the
mental health
profession
This relationship has
two distinct aspects
FORENSIC
PSYCHOLOGY
• Mental health
professionals often
play a role in the
criminal justice
system
(“PSYCHOLOGY IN
LAW”)
• The legislative and
judicial systems act
upon the clinical
field, regulating
certain aspects of
mental health care
(“LAW IN
PSYCHOLOGY”)
• Intersection between
the mental health
field and the legal
and judicial systems
How Do Clinicians Influence the Criminal
Justice System?
 To arrive at just and appropriate
punishments, the courts need to know
whether defendants are responsible for
committing crimes and capable of defending
themselves in court
 These determinations are guided by the
opinions of mental health professionals
How Do Clinicians Influence the Criminal
Justice System?
• When people accused of crimes are
judged to be mentally unstable, they are
usually sent to a mental institution for
treatment (CRIMINAL COMMITMENT)
– Several forms
• NOT GUILTY BY REASON OF INSANITY (NGRI)
• COMMITTED UNTIL COMPETENT TO STAND
TRIAL
How Do Clinicians Influence the Criminal
Justice System?
• Judgments of mental instability have
provoked many arguments
– Loopholes
– Justice system requires look at extenuating
circumstances
• Criminal commitment differs from country
to country
Criminal Commitment and Insanity During
Commission of a Crime
1955:
American
Law Institute
test (ALI) test
Late
nineteenth
century:
Irresistible
impulse test
• Insanity based on
inability to control
one’s actions
1843:
M’Naghten test
or rule
• Defendant also had
to be unable to know
right from wrong
• Combined
aspects of
M’Naghten and
Durham
1954:
Durham test
• Not criminally
responsible if
unlawful act was
product of
mental disease
1983: APA
recommendation
• Call for return to
M’Naghten test
Crimes for Which Persons Are Found Not
Guilty by Reason of Insanity (NGRI)
• Reviews of NGRI
verdicts in a
number of states
show that most
people who are
acquitted on this
basis had been
charged with a
violent crime
What Concerns Are Raised by the Insanity
Defense?
• Despite changes in the insanity standard,
criticism of the defense continues
– Fundamental difference between the law and
the science of human behavior
– Uncertainty of scientific knowledge about
abnormal behavior
– Defense allows dangerous criminals to
escape punishment
What Concerns Are Raised by the Insanity
Defense?
• During most of U.S. history
– Successful insanity plea
amounted to a long-term
prison sentence
• Today, offenders are being
released earlier
– Increasing effectiveness of
drug therapy and other
treatments in institutions
– Growing reaction against
extended institutionalization
– Greater emphasis on patients’
rights
“Effectively misleading psychopath”
Do you remember Brian David Mitchell
and the Elizabeth Smart kidnapping?
PSYCH WATCH
FAMOUS INSANITY DEFENSE CASES
What was the verdict? You be
the judge and then check your
text to see what happened.
• 1977 In Michigan, Francine
Hughes poured gasoline on
and lit her abusive husband on
fire
– Verdict:
• 1978 David “Son of Sam”
Berkowitz was a serial killer in
New York City
– Verdict:
• 1979 Kenneth Bianchi, one of
the pair known as the Hillside
Strangler who sexually
assaulted and murdered
women
– Verdict:
• 1980 In December, Mark David
Chapman murdered John
Lennon
– Verdict
PSYCH WATCH
FAMOUS INSANITY DEFENSE CASES
• 1992 Jeffrey Dahmer, a 31year-old mass murderer in
Milwaukee, was tried for the
killings of 15 young men.
– Verdict:
• 1994 On June 23, 1993, 24year-old Lorena Bobbitt cut off
her husband’s penis with a 12inch kitchen knife while he
slept.
– Verdict:
• 2003 For three weeks in
October 2002, John Allen
Muhammad and Lee Boyd
Malvo went on a sniping spree
in the Washington, DC, area,
shooting 10 people dead and
wounding 3 others.
– Verdict:
• 2006 On June 20, 2001,
Andrea Yates, a 36-year-old
woman, drowned each of her
five children in the bathtub.
– Verdict:
What Other Verdicts Are Available?
• Over the past four decades, at least 20 states
have added another verdict option
– GUILTY BUT MENTALLY ILL
• Some states allow still another kind of defense
– GUILTY WITH DIMINISHED CAPACITY
What Are Sex Offender Statutes?
• Since 1937, when Michigan passed the first
“sex psychopath” law, many states have
placed sex offenders in a special category
– MENTALLY DISORDERED SEX OFFENDERS
• People categorized this way are found guilty of a crime
and judged to be responsible but are committed to a
mental health facility instead of prison
• Over the past two decades, most states have
changed or abolished these laws
– Difficulty for placement judgment
– Racial bias
Criminal Commitment and Incompetence to
Stand Trial
• Regardless of their state of mind at the
time of a crime, defendants may be judged
to be MENTALLY INCOMPETENT to
stand trial
– Ensures that defendants understand the
charges they are facing and can work with
their lawyers to present an adequate defense
– This standard of competence was specified
by the U.S. Supreme Court in 1960
Multicultural Issues: Race and Forensic
Psychology
• Psychologically disturbed people from racial minority groups
are more likely than disturbed white Americans to be sent to
prison, as opposed to mental health facilities.
• Among defendants evaluated for competence to stand trial,
those from racial minority groups are more likely than white
American defendants to be referred for inpatient evaluations.
• When nonwhite and white defendants are evaluated for
competence to stand trial, the defendants from racial minority
groups are more likely to be found incompetent to stand trial.
• In New York State, 42 percent of all people ordered into
involuntary outpatient commitment are African American, 34
percent are white American, and 21 percent are Hispanic
American. In contrast, these three groups comprise,
respectively, 17 percent, 61 percent, and 16 percent of New
York’s general population.
Criminal Commitment and Incompetence to
Stand Trial
 When the issue of incompetence is raised, the
judge orders a psychological evaluation
 Many more cases of CRIMINAL COMMITMENT result
from decisions of mental incompetence than from
verdicts of NGRI
 Majority of criminals currently institutionalized for
psychological treatment are convicted inmates
 Their psychological problems have led prison officials
to decide they need treatment
How Do the Legislative and Judicial Systems
Influence Mental Health Care?
• Just as clinical science and practice have
influenced the legal system AND the legal
system has influenced clinical practice
– Process of CIVIL COMMITMENT, which allows
certain people to be forced into mental health
treatment
– Involuntary commitment of individuals who are
considered to be in need of treatment and
dangerous to themselves or others
• May include suicidal or reckless patients
• May include patients who put others at risk intentionally
or unintentionally
Prison and Mental Health
•
According to studies
conducted in several
Western countries,
psychological disorders are
much more prevalent in
prison populations than in
the general population.
•
For example, schizophrenia
is four times more common
and personality disorders
(particularly antisocial
personality disorder) are five
times more common among
prisoners than among nonprisoners. (Information from:
Andreoli et al., 2014; Butler
et al., 2006; Fazel &
Danesh, 2002.)
What Are the Procedures
for Civil Commitment?
• Civil commitment laws vary from state to
state
– Family members often begin the proceedings
• Few guidelines have been offered by the
Supreme Court
– 1979: Minimum standard of proof required:
• Must be “clear and convincing” proof of illness and
of meeting the state’s criteria for commitment
Emergency Commitment
• Many states give clinicians the right to
certify certain patients as needing
temporary commitment and medication
– Requires the agreement of two physicians
and/or mental health professionals
• By tradition, these certifications often are referred
to as “2PCs” (TWO-PHYSICIAN CERTIFICATES)
• The length of stay is often limited to 3 days
Who Is Dangerous?
• A judgment of “DANGEROUSNESS” is
often required for involuntary civil
commitment
– Research suggests mental health
professionals are very often wrong in making
long-term predictions of violence
– Short-term predictions of imminent violence
can be accurate
What Are the Problems
with Civil Commitment?
• Civil commitment has been criticized on
several grounds
– It is difficult to assess dangerousness
– The legal definitions of “mental illness” and
“dangerousness” are vague
– Civil commitment has questionable therapeutic
value
• On the basis of these and other arguments,
some clinicians argue that involuntary
commitment should be abolished
Trends in Civil Commitment
• The flexibility of involuntary commitment laws
peaked in 1962
– The Supreme Court ruled that imprisoning people
who suffered from drug addictions might violate
the Constitution’s ban on cruel and unusual
punishment
– As the public became aware of these issues,
states passed stricter standards for commitment
• Today, fewer people are institutionalized
through civil commitment proceedings than in
the past
Protecting Patients’ Rights
• Over the past two decades, court
decisions and state and federal laws have
greatly expanded the rights of patients
with mental disorders
– RIGHT TO TREATMENT
– RIGHT TO REFUSE TREATMENT
How Is the Right to Treatment Protected?
• Several court rulings addressed this issue
– 1972: A federal court ruled that the state was
constitutionally obligated to provide “adequate
treatment” to all people who had been committed
involuntarily
– 1975: The Supreme Court ruled that institutions
must review case files periodically and that the
state cannot continue to institutionalize against
their will people who are not dangerous and are
capable of surviving on their own or with willing
help of responsible family members or friends
How Is the Right to Refuse Treatment
Protected?
• During the past 25 years, the courts have
also decided that patients, particularly those
in institutions, have the right to refuse
treatment
– Most rulings center on biological treatments,
including psychosurgery
– In addition, some states have acknowledged a
patient’s right to refuse ECT and/or psychotropic
medications
Executing the Mentally Ill
Where Do You Stand?
•
Charles Singleton, a man who
killed a store clerk in Arkansas,
was sentenced to death in 1979,
and then developed schizophrenia
at some point after the trial.
Inasmuch as the United States
does not allow executions if a
person cannot understand why he
or she is being executed, state
officials wanted Singleton to take
medications to clear up his
psychosis.
•
After years of legal appeals, the
U.S. Supreme Court ruled in 2003
that Singleton was by then taking
medications voluntarily, and he
was executed by lethal injection in
2004.
What Other Rights Do Patients Have?
 Court decisions have protected other
patient rights
 Guaranteed at least a minimum wage
 Right to aftercare and appropriate community
residence after release
 Right to receive treatment in the least
restrictive facility available
The “Rights” Debate
• While people with psychological disorders have
civil rights that must be protected at all times,
many clinicians express concern that patients’
rights rulings may unintentionally deprive these
patients of opportunities for recovery
What do you think?
In What Other Ways Do the Clinical and
Legal Fields Interact?
• During the past 25 years, their paths have
crossed in four key areas
–
–
–
–
Malpractice suits
Professional boundaries
Jury selection
Psychological research of legal topics
• EYEWITNESS TESTIMONY
Psychological Research of Legal Topics
• Eyewitness testimony
– In criminal cases testimony by eyewitnesses
is extremely influential
– Research indicates that eyewitness testimony
can be highly unreliable
– Accuracy is heavily influenced by the method
used in identification
Psychological Research of Legal Topics
• Patterns of criminality
– The study of criminal behavior patterns and
the practice of “profiling” has increased in
recent years and has been the topic of an
increasing number of media programs
– However, it is not as revealing or influential as
the media and the arts convey
PSYCH WATCH
Serial Murders: Madness or Badness?
• Likely, but not always present, serial killer
characteristics
– Males: between 25 and 34 years of age;
average to high intelligence, clean-cut,
articulate, and manipulative
– Severe personality disorders
• Antisocial personality disorder; narcissistic thinking;
sexual dysfunction and fantasy; general feelings of
powerlessness; abusive background
So what do you think: Madness or badness?
What Ethical Principles Guide Mental Health
Professionals?
The code of the American Psychological
Association (APA)
• Psychologists are permitted to offer advice
• Psychologists may not conduct fraudulent research,
plagiarize the work of others, or publish false data
• Psychologists must acknowledge their limitations
• Psychologists who make evaluations and testify in legal
cases must base their assessments on sufficient
information and substantiate their findings appropriately
• Psychologists may not take advantage of clients and
students, sexually or otherwise
• Psychologists must follow the principle of confidentiality
Mental Health, Business, and Economics
• Collectively, psychological disorders are
among the 10 leading categories of workrelated disorders and injuries in the United
States
• The business world often turns to clinical
professionals to help prevent and correct
such problems
– EMPLOYEE ASSISTANCE PROGRAMS
– STRESS-REDUCTION OR PROBLEM-SOLVING
SEMINARS
The Economics of Mental Health
 Governmental
economic decisions
may influence the
clinical care of people
with psychological
disorders
• Private insurance
companies have
significant effect on the
way clinicians work
– Managed care programs
– Peer review systems
Caught in an economic spiral Group
home residents and mental health
advocates rally at the legislative office
building in Raleigh, NC, to protest a
Medicaid payment law change.
Technology and Mental Health
• Today’s dynamic technology influences the
focus, tools, and research direction of the
mental health field
– New triggers and vehicles for the expression of
abnormal behavior
– Violent video games’ contribution to the
development of antisocial behavior, and perhaps
to the onset of conduct disorder (MMOGs)
– Social networking’s impact on psychological
dysfunctioning in certain cases
New Forms of Psychopathology
• Research also indicates that today’s
technology also is helping to produce new
psychological disorders
– INTERNET USE DISORDER is marked by
excessive and dysfunctional levels of texting,
tweeting, networking, Internet browsing
– Similarly, the Internet has brought a new
exhibitionistic feature to certain kinds of
abnormal behavior, for example, posting
videos of self-cutting
Cybertherapy
• CYBERTHERAPY is growing as a treatment
option by leaps and bounds
– Examples include: Long-distance therapy using
Skype, therapy offered by computer programs,
treatment enhanced by video gamelike avatars,
and Internet-based support groups
• Unfortunately, this movement is not without
its problems, including a wealth of
misinformation and a lack of quality control
The Person Within the Profession
• The actions of clinical researchers and
practitioners
– Influence and are influenced by other
institutions
– Are closely tied to their personal needs and
goals
The Person Within the Profession
 Surveys have found that as many as 84
percent of therapists have reported being in
therapy themselves at least once
 Same reasons as those of other clients, with
emotional problems, depression, and anxiety
topping the list
 It is not clear why so many therapists report
having psychological problems
 Possible theories include: job stress, increased
awareness of negative feelings, biased entry into
the field itself