1. Society’s Response to Maladaptive Behavior

2. Community Treatment
Community mental health views problems as originating (at least partly) within the social setting & social system
Services should be located within the community
Emphasis is on prevention & early detection
Mental health professionals should act as consultants, rather than treatment providers
Paraprofessionals often are used as providers or facilitators of services
Competence & empowerment are emphasized rather than deficits, illness or pathology
Political & social change are needed to change some of the causes of mental health problems
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

3. Community Treatment
Integrated network of services can prevent hospitalization
Unfortunately, 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
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

4. One person’s experience with hospitalization
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

5. Levels of Prevention Tertiary Prevention Secondary Prevention
Primary Prevention
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

6. Community Locations for Prevention
The family
Intervene to change parenting practices that lead to child problems
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
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

7. Diverse Pathways 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 social support and normalization
Community psychology
Utilize social systems and community resources to aid in prevention
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

8. Legal Issues in Treatment
Commitment to Institutions
Voluntary – Patient agrees to admission
Involuntary – Admitted pursuant to court proceeding (civil commitment)
Involuntary admission possible under Mental Health Act (2 conditions required)
Criminal commitment
Institutionalized by court order when crime deemed due to insanity, and
Necessary to protect public safety
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

9. The Not Guilty by Reason of Insanity (NGRI) Legal Defense
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
Legal rules vary in different states
Acquittal usually requires that person have severe disorder such as psychosis
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

10. NGRI 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.
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005

11. Other Legal Issues in Mental Health
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 exceptions (dangerousness, child abuse)
Duty to Protect
Duty to warn specific third persons if patient threatens imminent harm or death to specific others (Tarasoff decision)
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005