CHAPTER 17 SOCIETY’S RESPONSE TO MALADAPTIVE BEHAVIOR

TYPES OF PREVENTION Levels Primary Reduce new cases Secondary Reduce impact of existing condition Tertiary Reduce impairment that has already resulted Situation-focused Reduce or eliminate environmental causes Competency-focused Enhance abilities to cope with conditions that lead to maladaptive behavior

SITES OF PREVENTION The family Intervene to remediate parenting practices that lead to child aggressive behaviors Intervene during parental conflict or divorce Prevent child abuse and spouse abuse The school Prevent behavioral disorders Strengthen social and cognitive skills The community Help develop skills Provide role models and caring adults

DIVERSE PATHS TO PREVENTION Paraprofessionals Consist of people of same social, economic, and ethic groups as population served No special mental health training but make important prevention contributions Self-help groups People with common problems come together Provide support Community psychology Utilize social systems and community resources to aid in prevention

COMMUNNITY TREATMENT Integrated network of services can prevent hospitalization Few programs are integrated Lack of continuity and uniformity in services Day treatment, halfway houses, adequate case management are necessary to prevent rehospitalization Deinstitutionalization has resulted in increased admission of people for short- term stays

LEGAL ASPECTS OF TREATMENT AND PREVENTION Institutionalization commitment Voluntary – Patient agrees to admission Involuntary – Admitted pursuant to court proceeding (civil commitment) Criminal commitment Institutionalized by court order when crime deemed due to insanity, and Necessary to protect public safety

THE INSANITY DEFENSE Insanity Legal term that refers to state of mind when criminal act committed Competency Person’s state of mind at any stage in judicial proceeding Competence means ability to understand proceedings and assist defense attorney Rule of insanity Varies by state, but generally the crime was the result of a mental disease or defect Acquittal usually requires that person have severe disorder such as psychosis

INSANITY DEFENSE MYTHS Criminals use the defense to escape punishment. Fact: Most people found not guilty by reason of insanity spend more time confined than if they had been found guilty and sent to prison. The defense is widely abused. Fact: The insanity defense is seldom used and rarely successful. The defense allows criminals to “get away with murder.” Fact: Only a small number using the defense have committed violent crimes, especially murder. Most have been involved in minor felonies.

OTHER LEGAL ISSUES IN TREATMENT Patient’s rights Informed consent Right to terminate consent Least restrictive alternative Confidentiality General duty of therapist to keep confidential patient communications but there are exception Duty to Warn Duty to warn third persons if patient threatens imminent harm or death to others (Tarasoff decision)