Transcript Legal and Ethical Issues - California State University

Legal Concerns
 Defining “Mental Illness”
 Mental Illness is a Legal Concept
 Varies by State
 Not the Same as Psychological Disorder
 Responsible for Actions?
 How do you determine this?
Legal Concerns
 Insanity Defense
 Less than 1% of all cases
 Even
fewer succeed
 Often spend more time locked in hospital than would
be in prison
 Not
same as having a disorder
 Knowledge of right vs. wrong, Self-control, &
Diminished capacity
 “Twinkie Defense”
 Guilty But Mentally Ill
Legal Concerns
 Competent to Stand Trial
 Understand Charges
 Assist in Own Defense
Civil Commitment
 Should People Be Committed to a Psychiatric
Institution Against Their Will?

Criteria for Civil Commitment
Person has a Mental Illness
 Needs Treatment
 Is Dangerous (self or others)
 Is Unable to Care for Self (gravely disabled)
 Known as “5150” in California


Problems with determining risk and disability
 Right to Refuse Treatment?
Clients’ Rights
 To Refuse Treatment
 To Obtain Treatment
 To Confidentiality
 Therapeutic Effect
 Limits

Imminent Harm to Self or Others


Duty to Warn (Tarasoff)
Suspicion of Child Abuse
 “Least Restrictive Environment”
Deinstitutionalization
 Made Possible Largely Due to Medications for Severe
Disorders
 Intended Shift of Treatment to Community Mental
Health Centers
 Largely a Failure
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Least restrictive environment gone awry?
Criminalization of the mentally ill
“Greyhound Therapy”
Homelessness
Other care facilities

Nursing and group homes
Antipsychotic Drugs and Inpatient Treatment
Current Trends
Managed Mental Health Care
Fewer Hospitalizations
Briefer Treatments
Fewer psychiatrists, and now psychologists,
providing psychotherapy
 Greater use of medications
 Movement Toward Practice Guidelines

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Manualized treatments
 EVTs, ESTs, and narrowing treatments

 Treatment is in many cases very good, but some
areas not very good
Social Aspects of Mental Illness
 Social Stigma
 Choice of wording
 The Myth of Mental Illness
 Szasz
 Mental illness is an invention not a discovery
 Power of Mental Health Professions
 Abuse of power, even if unintentional
 “On Being Sane in Insane Places” - Rosenhan
 Be Aware and Willing to NOT Pathologize People
Summary, Reflections, & the Big Picture
 So, what does all this mean?
 Not just this chapter, but the whole set of chapters?
 What are some of the central themes of this
semester?
 What are some of the most valuable principles
and/or ideas you’ve learned?
 What about this semester do you think will help you
the most in your career/profession?
 How will you continue your learning and growth in
this area?