Transcript Chapter 16

Abnormal Psychology, Twelfth Edition
by
Ann M. Kring,
Sheri L. Johnson,
Gerald C. Davison,
& John M. Neale
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Chapter
16: Legal and Ethical Issues
I. Criminal Commitment
II. Toward Greater Protection of the Rights of
People with Mental Illness
III. Ethical Dilemmas in Therapy and Research
Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.
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 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:
 Determination of competency
 After acquittal by reason of insanity
 mens rea
• Guilty mind
 “No crime without an evil intent”
 Concept of insanity
• A disordered mind can’t be a guilty mind
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 Insanity a legal term
• Not a psychiatric or psychological concept
 Based on mental state of the accused
time the crime was committed
 Insanity defense
at the
• 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
• Rarely successful
 Requires
judgments by lawyers, judges,
jurors, and clinicians
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Irresistible
impulse (1834)
 The M’Naghten rule (1843)
 American Law Institute Guidelines (1962)
 Insanity Defense Reform Act (mid-1980s)
 Guilty but mentally ill
© 2012 John Wiley & Sons, Inc. All rights reserved.
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
Not guilty by reason of insanity (NGRI)
• No dispute over guilt
• Accused not responsible for the crime because of mental illness
• Indefinite commitment to a forensic hospital
 Only released when no longer mentally ill
• John Hinckley

Guilty but mentally ill (GBMI)
• Found guilty and responsible for the crime
• 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
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 Accused
must be able to participate in his or
her defense
• 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
 Determination
of competency made before
individual is tried
• Prosecutor, judge, or defense attorney can raise issue
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Synthetic
sanity
• 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
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 US
Supreme Court
• 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
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Parens Patriae: “Power of the state”
• 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
• Danger to self or others
 Commitment should end when person is no longer dangerous
 Formal
commitment
• Requires a court order
 Informal
emergency commitment
• Initially no court involvement is needed
 2PC: Two physician certificate
 Further detainment requires formal judicial commitment
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 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
• If violent, target is usually family or friends, not
strangers
• Stranger homicide by people with mental illness is
extremely rare
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Factors
that influence accuracy of violence
prediction:
• 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
• Person is on the brink of committing a violent act
• Medication noncompliance
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 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
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 Least restrictive alternative
• Required to be provided when treating mentally ill
 Right to treatment
• State required to provide treatment after civil
commitment
 Right to refuse treatment
• Unless person is a danger to self or others
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Deinstitutionalization
• In the 1960s, many states released patients from state
psychiatric hospitals; community treatment preferred
• Many cities lack sufficient community mental health
facilities
 Transinstitutionalization
• 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
 New laws provide funding for special training
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 Research
• Ethical restraints to avoid unnecessary harm, risk,
humiliation, and invasion of privacy to participants
• Institutional Review Board (IRB) approval necessary
• Researchers must receive training in research ethics
 Researchers
must ensure that mentally ill
participants understand risks of research before
participating
• 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
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 Therapy
• Confidentiality
• Privileged communication
 Patient “holds the privilege”
 Both
can be broken if:
• Patient has filed a malpractice suit against a therapist
• 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 a danger to self or others
 Tarasoff decision
© 2012 John Wiley & Sons, Inc. All rights reserved.
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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
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© 2012 John Wiley & Sons, Inc. All rights reserved.
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