1. Abnormal Psychology, Twelfth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale & John M. Neale 1 © 2012 John Wiley & Sons, Inc. All rights reserved.

2.  Chapter 16: Legal and Ethical Issues I. Criminal Commitment II. Toward Greater Protection of the Rights of People with Mental Illness People with Mental Illness III. Ethical Dilemmas in Therapy and Research 2 Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.

3.  People with mental illness who are alleged to have broken the law are subject to criminal commitment A procedure that confines a person to a mental hospital either for: A procedure that confines a person to a mental hospital either for:  Determination of competency  After acquittal by reason of insanity  mens rea Guilty mind Guilty mind  “No crime without an evil intent”  Concept of insanity A disordered mind can’t be a guilty mind A disordered mind can’t be a guilty mind 3 © 2012 John Wiley & Sons, Inc. All rights reserved.

4.  Insanity a legal term Not a psychiatric or psychological concept Not a psychiatric or psychological concept  Based on mental state of the accused at the time the crime was committed  Insanity defense Defendant not responsible for an illegal act if it is attributable to mental illness or not knowing right from wrong Defendant not responsible for an illegal act if it is attributable to mental illness or not knowing right from wrong Pleaded in fewer than 1% of cases Pleaded in fewer than 1% of cases Rarely successful Rarely successful  Requires judgments by lawyers, judges, jurors, and clinicians 4 © 2012 John Wiley & Sons, Inc. All rights reserved.

5.  Irresistible impulse (1834)  The M’Naghten rule (1843)  American Law Institute Guidelines (1962)  Insanity Defense Reform Act (mid-1980s)  Guilty but mentally ill 5 © 2012 John Wiley & Sons, Inc. All rights reserved.

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7.  Not guilty by reason of insanity (NGRI) No dispute over guilt No dispute over guilt Accused not responsible for the crime because of mental illness Accused not responsible for the crime because of mental illness Indefinite commitment to a forensic hospital Indefinite commitment to a forensic hospital  Only released when no longer mentally ill John Hinckley John Hinckley  Guilty but mentally ill (GBMI) Found guilty and responsible for the crime Found guilty and responsible for the crime Mental illness plays a role in sentencing Mental illness plays a role in sentencing  Can be committed for treatment until no longer mentally ill  Then sent to prison to serve remainder of sentence  Most are incarcerated and may or may not receive any psychiatric care Jeffrey Dahmer Jeffrey Dahmer 7 © 2012 John Wiley & Sons, Inc. All rights reserved.

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9.  Accused must be able to participate in his or her defense 1960 US Supreme Court decision 1960 US Supreme Court decision  “…ability to consult with his lawyer with reasonable degree of rational understanding…”  “…has a rational as well as a factual understanding of the proceedings against him” Courts do not want a person to be brought to trial in absentia Courts do not want a person to be brought to trial in absentia  Determination of competency made before individual is tried Prosecutor, judge, or defense attorney can raise issue Prosecutor, judge, or defense attorney can raise issue 9 © 2012 John Wiley & Sons, Inc. All rights reserved.

10.  Synthetic sanity If medication can produce rationality, trial can be held If medication can produce rationality, trial can be held  Even if discontinuation of the drug would again render the defendant incompetent  Forced medication to restore competency can be used only in very limited circumstances 10 © 2012 John Wiley & Sons, Inc. All rights reserved.

11.  US Supreme Court Unconstitutional to execute individuals who are insane or have an intellectual developmental disorder Unconstitutional to execute individuals who are insane or have an intellectual developmental disorder  Execution would constitute cruel and unusual punishment However, definition of mental retardation varies from state to state However, definition of mental retardation varies from state to state 11 © 2012 John Wiley & Sons, Inc. All rights reserved.

12.  Parens Patriae: “Power of the state” Duty of government to limit freedoms for people’s protection Duty of government to limit freedoms for people’s protection  An individual can be committed to a psychiatric hospital against his wishes if Person is mentally ill, and Person is mentally ill, and Danger to self or others Danger to self or others  Commitment should end when person is no longer dangerous  Formal commitment Requires a court order Requires a court order  Informal emergency commitment Initially no court involvement is needed Initially no court involvement is needed  2PC: Two physician certificate  Further detainment requires formal judicial commitment 12 © 2012 John Wiley & Sons, Inc. All rights reserved.

13.  When substance abuse is not a factor, mentally ill are no more likely to commit violent crimes than the average person Only 3% of violent crimes linked to mentally ill Only 3% of violent crimes linked to mentally ill If violent, target is usually family or friends, not strangers If violent, target is usually family or friends, not strangers Stranger homicide by people with mental illness is extremely rare Stranger homicide by people with mental illness is extremely rare 13 © 2012 John Wiley & Sons, Inc. All rights reserved.

14.  Factors that influence accuracy of violence prediction: Repeated violent acts in the past Repeated violent acts in the past Individual returns to same environment in which past violent acts were committed and individual’s personality has not changed Individual returns to same environment in which past violent acts were committed and individual’s personality has not changed Person is on the brink of committing a violent act Person is on the brink of committing a violent act Medication noncompliance Medication noncompliance 14 © 2012 John Wiley & Sons, Inc. All rights reserved.

15.  Courts try to balance patient rights and the right of the public to be protected  Supreme Court ruled that evidence for commitment must be clear and convincing  Danger must be imminent 15 © 2012 John Wiley & Sons, Inc. All rights reserved.

16.  Least restrictive alternative Required to be provided when treating mentally ill Required to be provided when treating mentally ill  Right to treatment State required to provide treatment after civil commitment State required to provide treatment after civil commitment  Right to refuse treatment Unless person is a danger to self or others Unless person is a danger to self or others 16 © 2012 John Wiley & Sons, Inc. All rights reserved.

17.  Deinstitutionalization In the 1960s, many states released patients from state psychiatric hospitals; community treatment preferred In the 1960s, many states released patients from state psychiatric hospitals; community treatment preferred Many cities lack sufficient community mental health facilities Many cities lack sufficient community mental health facilities  Transinstitutionalization Many mentally ill end up in nursing homes, hospitals and prisons Many mentally ill end up in nursing homes, hospitals and prisons  Justice department survey found that 16.2% of prison population is mentally ill Police officers increasingly called on to work with mentally ill Police officers increasingly called on to work with mentally ill  New laws provide funding for special training 17 © 2012 John Wiley & Sons, Inc. All rights reserved.

18.  Research Ethical restraints to avoid unnecessary harm, risk, humiliation, and invasion of privacy to participants Ethical restraints to avoid unnecessary harm, risk, humiliation, and invasion of privacy to participants Institutional Review Board (IRB) approval necessary Institutional Review Board (IRB) approval necessary Researchers must receive training in research ethics Researchers must receive training in research ethics  Researchers must ensure that mentally ill participants understand risks of research before participating Informed consent Informed consent  Sufficient information must be provided to allow an individual to make an informed decision to participate Freedom to withdraw at any time for any reason Freedom to withdraw at any time for any reason 18 © 2012 John Wiley & Sons, Inc. All rights reserved.

19.  Therapy Confidentiality Confidentiality Privileged communication Privileged communication  Patient “holds the privilege”  Both can be broken if: Patient has filed a malpractice suit against a therapist Patient has filed a malpractice suit against a therapist Patient is under age 16 and a crime or abuse victim Patient is under age 16 and a crime or abuse victim Patient is trying to avoid arrest for a crime committed or planned Patient is trying to avoid arrest for a crime committed or planned Patient is a danger to self or others Patient is a danger to self or others  Tarasoff decision 19 © 2012 John Wiley & Sons, Inc. All rights reserved.

20. Copyright 2012 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. 20 © 2012 John Wiley & Sons, Inc. All rights reserved.